Introduction
Chronic staff shortages hinder access to mental health services in New Zealand (NZ) (Te Hiringa Mahara—Mental Health and Wellbeing Commission, 2024). In 2023/2024, approximately 10.7% of adults reported an unmet need for professional help for their emotions, stress, mental health or substance use, compared with 4.9% in 2016/2017. Unmet need for professional help was highest among adults aged 25–34 years (16.2%), and 6.5% of children had an unmet need for professional help (up from 4.8% in 2016/2017) (Ministry of Health, 2024a). Among the professional roles affected, psychologists were identified as a key area of shortage, with estimates suggesting there were approximately 1,000 fewer psychologists practising in NZ than needed to meet demand (NZ Psychological Society, 2023). In response to these persistent gaps, government initiatives aimed to increase the acceptance rates for clinical psychology programmes across NZ (Hon Little, 2022), and introduce assistant psychologist roles (Hon Doocey, 2024). However, workforce development efforts involve more than increasing practitioner numbers, and must also include understanding and better using existing capacity (Ministry of Social Development, 2021). Achieving this requires detailed workforce audits to identify untapped skills, roles and opportunities for task-shifting (Stokker & Hallam, 2009). Although such audits have been conducted in public mental health services (Whāraurau, 2023), no comparable assessment has been performed in the private sector. Data from Health New Zealand (personal communication; August 13, 2024) indicated that nearly one-third of registered psychologists (1,042 of 3,731) primarily worked in private practice. Although demographic and scope-of-practice data are available, key information about the services they provide and client demographics remains lacking (Te Hiringa Mahara—Mental Health and Wellbeing Commission, 2024). Without such data, efforts to accurately assess and optimise the capacity and skills of the private workforce are limited. This risks inadequacies in service provision for those who do not meet criteria for public services.
A detailed understanding of the private sector’s current contributions is essential for workforce development. It will facilitate identification of service gaps and highlight areas for evaluating whether practitioners possess the necessary knowledge, skills and confidence to deliver these services. Profiling this sector will also provide critical insights into capacity, distribution and case mix, enabling policymakers and healthcare providers to make informed decisions regarding resource allocation, workforce development and service expansion—ultimately improving access for all population groups.
Aim
This study aimed to profile NZ’s private practice psychologists, and examine the services they offered and client populations they served.
Method
This study received ethical approval from the Victoria University of Wellington’s Human Ethics Committee (HEC Application ID 0000031034). A survey designed by the first author and reviewed by Health NZ’s Manager of Analytics and Intelligence underwent pilot testing with three practising psychologists to enhance clarity. The survey (see Table S1) comprised nine sections. Sections 1–3 collected demographics for all private practice respondents, and Sections 4–9 focused specifically on those providing services to adolescents aged 12–19 years. The survey focused on providing a snapshot of overall private psychological services available in NZ. This paper reports only on the first three sections.
The survey primarily used close-ended questions, supplemented by open-ended questions to capture additional data, such as sources of service funding outside of the provided options. It was designed to be completed in approximately 15 minutes. Recruitment targeted the 1,042 registered psychologists in NZ practising (at least part-time) privately. The survey was promoted through the newsletters of New Zealand Psychological Society (NZPsS) and New Zealand College of Clinical Psychologists (NZCCP). This was supplemented by personalised emails to NZCCP members using publicly available contact information.
Data were collected using Qualtrics software. Descriptive statistics were used to characterise the overall composition of the private psychology workforce and types of services provided. It is important to note that because of the possibility of respondents skipping questions, reported results reflect the responses received for each individual item. This study explored potential service gaps related to different categories of psychologists, considering characteristics such as age, gender and scope of practice. The relationships between these categorical variables were examined using chi-square tests. This non-parametric test was selected because it evaluates associations between categorical data without assuming a normal distribution, making it suitable for analysing frequency data across groups (McHugh, 2013). The analysis was conducted using Qualtrics, with the significance level set at p<0.05.
Results
Representativeness of the Sample
In total, 313 responses were received from the surveyed private psychologists in NZ, representing approximately 30% of the private psychologist workforce (N=1,042). There were significant differences between the respondent group and the total private psychologist population (Health New Zealand, personal communication; August 13, 2024). For example, NZ European or Asian psychologists, those aged 40–59 years, males and those registered as generalists were underrepresented (p<0.05) in our sample. Conversely, females, clinical psychologists and Māori were overrepresented (p<0.05). Despite these differences, the relatively large sample size may have reduced the margin of error.
Respondents’ Profile
The majority of respondents were female (81%; n=253) and identified as NZ European/Other (81%; n=272), 57% (n=180) were aged over 50 years, and 69% (n=211/311) were registered under the clinical scope of practice. Experience among respondents ranged from 1 to 55 years, with a mean of 19 years. Almost one-fifth (19%, n=15/55) of the respondents with 6–10 years of experience had been in private practice for 6–10 years, and more than 50% (n=52/139) with 11–25 years of experience had been in private practice for 11–25 years. Only 20% (n=16/84) of those with more than 26 years of experience had been in private practice for less than 10 years (p<0.05). These characteristics are presented in Table 1.
Most respondents worked in sole practice (83%; n=254/308) and 58% (n=179/310) were in one of NZ’s three largest cities (Auckland, Wellington or Christchurch). Notably, 94% (n=192/211) offered telepsychology services, enhancing the accessibility of services across NZ, and 93% (n=195/210) provided onsite services. Those in the clinical scope of practice were more likely to offer telepsychology, whereas generalists were less so (p<0.05). There were no significant differences in the provision of telepsychology by respondents’ age or gender (p<0.05).
Clinical Services Offered by Respondents
In total, 92% of respondents (n=275/298) provided psychological therapy, with individual therapy being the most common service provided (n=275; 92%). Family therapy was provided by 15% (n=45), couple therapy by 23% (n=67) and group therapy by 7% (n=22). Respondents aged 60–69 years (39%), those aged ≥70 years (47%) and those with ≥26 years of experience (35%) were more likely to offer couple therapy, whereas males (40%), individuals aged 30–49 years (11%) and those with 6–10 years of experience (11%) were less likely to do so (p<0.05). Respondents ≥70 years (41%), those practising for 11–25 years (20%) and those located in the Hawkes Bay region (43%) were more likely to provide family therapy, whereas those with 6–10 years of experience (6%) were less likely to do so (p<0.05). There were no statistically significant differences in the provision of family therapy based on gender or scope (p<0.05).
Most respondents (92%; n=275) worked therapeutically with adults, particularly clinical psychologists (95%) and those ≥26 years of experience (94%) (p<0.05). Conversely, only 28% (n=83) worked with children, with generalist psychologists (41%) and females (31%) more likely to so than clinical psychologists (23%), males (12%) and those with ≥26 years of experience (35%) (p<0.05). Furthermore, 46% of respondents (n=137) worked with adolescents, with the proportion lower among clinical psychologists (42%) but greater among those practicing for 6–10 years (59%) (p<0.05). Generalist psychologists (85%) were more likely to work with young adults, whereas those aged ≥70 years (53%) were less likely to do so (p<0.05).
In terms of assessments, 53% (n=165/313) conducted Accident Compensation Corporation (ACC) assessments and 51% (n=158) provided diagnostic assessments. Organisational assessments (5%; n=17) and neuropsychological assessments (6%; n=19) were the least frequently performed. Respondents aged ≥70 years (38%) or with ≥26 years of experience (46%) were less likely to provide ACC reports; however, those with 11–25 years of experience (68%) were more likely to do so (p<0.05). Respondents with ≥26 years of experience were more likely to provide family court (18%) and organisational (14%) assessments, whereas no respondents with <5 years of experience offered family court assessments (p<0.05). Notably, respondents aged 30–39 years (69%) and clinical psychologists (65%) were more likely to conduct diagnostic assessments, whereas those aged 60–69 years (41%), generalists (35%), counselling psychologists (14%) and those with ≥26 years of experience (42%), were less likely to do so (p<0.05).
Discussion
This study aimed to address gaps in the understanding of the private psychologist workforce in NZ, with a focus on services provided and client bases served.
Contribution of the Private Psychologist Workforce
The results indicated the private psychologist workforce offers a diverse range of services, including assessments and talking therapy, often servicing individuals who did not meet criteria for public services (Accident Compensation Corporation, 2018) or providing services not available in the public system, such as couple counselling (New Zealand Government, 2020).
Identifying Service Gaps and Informing Workforce Development
Although this workforce plays a crucial role, our findings identified gaps in both the client populations served and types of services offered. Mapping these gaps is essential to inform targeted workforce development strategies, such as expanding capacity for working with underrepresented groups and diversifying service offerings. A comprehensive profile of private psychologists’ current contributions can identify specific areas where capacity-building and professional development are needed to better meet NZ’s evolving mental health needs.
Expanding Age Demographics of Potential Clients
Private psychologists have the autonomy to select their client base. The findings indicate a clear preference among respondents for working with
adult clients, with fewer than half expressing willingness to treat
children and adolescents. This is concerning given that reported emotional
symptoms among 10-14-year-olds have increased by approximately 150%—from 10% in 2016/17 to 15% in 2021/23 (Ministry of Health, 2024b). However, it is challenging to obtain precise statistics for the 15-19-year age group, as individuals over fifteen are categorised and reported within the adult population. Furthermore, this age group also experiences the longest wait times for accessing specialist care services compared to other age groups (Te Hiringa Mahaha, 2024). Addressing mental health problems early in life is crucial, as childhood and adolescence are critical periods for development (Hudson et al., 2023), and untreated problems can have lasting effects on individual life outcomes and broader societal costs (Allouche et al., 2021; McGorry, 2022; Office of the Auditor General, 2024).
Understanding whether private psychologists have the necessary knowledge, skills and confidence to serve these younger populations will help determine training priorities and capacity-building efforts. Currently, the limited availability of postgraduate qualifications focused on child and family psychology (University of Auckland, 2021; University of Canterbury, 2023) may constrain private psychologists’ ability to serve these groups, which is concerning given the long-term implications. Profiling this sector can therefore inform the development of education and training programmes to improve service access for children and adolescents, ultimately benefitting both individuals and society.
Expanding the Range of Services Offered
Family and couple therapy are vital components of a comprehensive treatment approach, addressing relational dynamics that significantly influence individual mental health outcomes (Jabbari et al., 2025). Family therapy is particularly important in managing conditions such as substance use disorders (Hogue et al., 2022), depression (Diamond et al., 2021) and eating disorders (Baudinet et al., 2021), especially when working with children and adolescents (Berry et al., 2023). Similarly, couple therapy plays an important role in addressing relationship distress, which has a moderate to strong association with common mental health problems, notably, depression, anxiety disorders and substance abuse (Snyder & Halford, 2012). Despite its importance, only a small number of private psychologists currently offer these modalities.
Importantly, our findings revealed an age disparity, where psychologists aged 60 years and above were significantly more likely to offer family and couple therapy than their younger counterparts. This suggested a future gap in service provision as experienced practitioners retire or reduce their practice, which could further restrict access to these vital modalities for many clients. Addressing this impending gap requires an understanding of the barriers that hinder younger psychologists from offering family and couple therapy. Such barriers may include limited access to specialised training, lack of confidence or gaps in formal education—particularly as these services are not routinely included in NZ psychology curricula (Nelson, 2024). Exploring and addressing these barriers is essential. Targeted professional development and education initiatives could build the necessary skills and confidence among emerging psychologists, helping to ensure the sustainability and expansion of these services in the future.
Potential Trade-Offs in Developing the Private Psychology Workforce
Until the barriers faced by psychologists in expanding private practice are thoroughly understood it remains challenging to accurately assess the impact on the public sector. Key questions include whether private sector development occurs within the same financial resources or ‘pot of money’ as public services, and whether expanding private practice may come at the expense of public sector capacity. Without a clear understanding of these dynamics, policy development risks unintended consequences, such as workforce depletion in public services or increased inequalities in access. Addressing these uncertainties is essential for balancing the growth of the private sector with the sustainability and equity of publicly funded mental health care.
Implications for Further Research
Although this study was not exhaustive, it provided an important snapshot of the current mental health services delivered and the client bases served by the private psychology sector. This knowledge helps identify the future developmental needs of the private psychologist workforce to better meet the diverse mental health needs of the NZ population seeking services in this sector. The results have several important implications.
-
Extending service offerings to children and adolescents: The findings indicate a strong preference among private psychologists for working with adults with fewer willing to serve children and adolescents. Further research is needed to identify the barriers preventing private psychologists from engaging with these younger clients. Addressing these barriers could inform strategies to expand service access for these vulnerable populations, helping to reduce the treatment gap and improve long-term outcomes.
-
Expanding service offerings: The findings highlight gaps in service provision, particularly in couple and family therapy, which may widen in the future. It is important to explore barriers faced by early career psychologists in offering these services. Understanding these challenges can inform targeted strategies to support workforce development and expand service capacity, ensuring that clients can access vital relational therapies.
Study Limitations
At 30%, the response rate for this study was below the reported average of 44% for all types of online surveys (Wu et al., 2022), which may impact the reliability of the data. Although higher response rates are generally desirable (Carpenter, n.d.; Shih & Fan, 2008), perspectives on optimal rates vary. For example, Fosnacht et al. (2017) suggested response rates of 20%–25% may be sufficient for studies with a sampling frame of fewer than 500 participants. This lower threshold is particularly relevant when the sample group represents the target population (Sauro & Lewis, 2016), as was the case in this study.
Another key limitation was the voluntary nature of participation, which might have introduced non-response bias (Daikeler et al., 2022), potentially affecting the representativeness of the sample. However, the demographic characteristics and professional scopes of practice of the sample aligned with the data on the private psychologist workforce held by Health NZ, suggesting the findings were representative and generalisable.
Conclusion
Approximately one in three psychologists in NZ work in private practice, yet their contribution to addressing the nation’s mental health needs has not been thoroughly evaluated. This study addressed this gap by examining the services offered by private psychologists and the client groups they serve. The findings identify opportunities to expand service capacity, particularly in couple and family therapy, and broaden access for different age groups, specifically, children and adolescents. Recognising and leveraging the potential of the private sector is essential in developing an equitable, sustainable mental health system capable of meeting the current and future needs of all New Zealanders.