The ‘Push and Pull’ of NHS Talking Therapies: A Qualitative Study of Adaptations and Accommodations in a UK Mental Health Workforce Pilot

Objectives The United Kingdom's NHS Talking Therapies programme currently provides talking therapy free at the point of use, namely by high‐intensity cognitive behavioural therapy practitioners. However, the programme suffers from chronic workforce shortages and limited treatment options. This study explores the experiences of participants in a pilot programme designed to address these issues by introducing psychotherapeutic counsellors from alternate underrepresented therapeutic modalities into the NHS Talking Therapies programme. The research aimed to understand the positive and negative aspects of working within the Talking Therapies programme and fit with similar research on therapeutic practice in the NHS. Methods Two focus groups were conducted with participants of the pilot programme. The data were analysed via template analysis. Results The results touched on a number of themes, revealing both the positives of working within the talking therapies programme (wide client base, collegiality, job stability and opportunity) as well as pressures from service delivery standards, long waiting lists and the reality of working in a structure that was designed for a different therapy. Participants navigated these pressures by adapting their therapeutic practice, sometimes in ways that they found unethical. Conclusion The ongoing ethical concerns suggest that accommodations on the part of the NHS would be fruitful alongside adaptations on the part of practitioners.