As the cost of living rises and disposable incomes fall for many, what will the impact be on therapists in private practice? What decisions will we make about whether to pass increasing costs on to our clients, in the form of fee increases. And what if doing so would result in a decline in new referrals?

Or in existing clients finding the cost of therapy one they can no longer afford? Will the freedom to choose to see a therapist in private practice become even more rarefied? The privilege of the wealthy elite?

To a large extent, this is already the case, and – I will tie my colours to my mast here – I’m not among those who argue that therapy should be free at the point of use. I’m in the camp that holds that a monetary exchange should take place and that this should hurt a little, so the client is acknowledging that the therapy has value to them and is choosing to make an affordable sacrifice in exchange for it.

That’s not to forget, however, that there will always be those for whom even a nominal fee will not be affordable, and it's right that therapy should be available to them at no cost. But properly funded within the statutory sector and not provided by unpaid, inexperienced trainees on placement.

Those most in need of therapeutic support but least able to pay often present with the kinds of complex traumas that only experienced clinicians can best provide. This is not to dismiss the good work that trainees do, but we shouldn't be in a position where the least experienced among us are providing therapy to the most complex of clients, while the most experienced work in private practice because of the dearth of permanent jobs in the statutory sector.

There is a vast army of qualified, experienced therapists, many of whom have the capacity for more work, but are underused because the funds are simply not available to pay them. In this issue, two of our members, Turiya Martyn Gough, in Hitting the nail on the head, and Anthony Prendergast, in Sharing the video, write about innovations in thinking and practice in their work. While consultant psychotherapist at the Tavistock Clinic and expert on trauma, neuroscience and developmental psychology, Graham Music, talks to Sarah Van Gogh about the way that trauma and neglect take root in the body, in Reigniting the spark

Views expressed in this article are the views of the writer and not necessarily the views of BACP. Publication does not imply endorsement of the writer’s views. Reasonable care has been taken to avoid errors but no liability will be accepted for any errors that may occur.