Many people assume that getting psychological support means first persuading a GP that things are bad enough. For a large group of common difficulties, that is not the case: the NHS lets you refer yourself directly to a talking therapies service. This guide explains who can use it, what is on offer and what to expect.
What are NHS Talking Therapies?
NHS Talking Therapies is the name for local NHS services that provide psychological treatment for common mental health problems. According to the NHS, self-referral covers anxiety, depression, phobias, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), body dysmorphic disorder, and help with coping with long-term health conditions.
The NHS is explicit that “you do not need to have a diagnosed mental health condition” to use the service. That matters for people who feel persistently low, tense or overwhelmed but are unsure whether what they are experiencing “counts”. The service exists precisely so that nobody has to settle that question alone before asking for help.
Treatment can be delivered in person, by video or phone call, or as an online course, and you may be offered a choice between group sessions and one-to-one work.
Who can refer themselves, and who needs a GP?
Two practical conditions apply. First, the NHS says you need to be registered with a GP, even though you do not need an appointment with them. Second, the service is generally for adults aged 18 and over, or 16 and over in some areas.
Some difficulties are handled differently. The NHS says that for eating disorders, bipolar disorder, personality disorders, psychosis or substance problems, you will need a GP referral rather than a self-referral. If you are unsure which route applies, your GP surgery can point you in the right direction, and the NHS website has a tool for finding talking therapies services for anxiety and depression in your area.
Which therapies might you be offered?
The NHS describes a range of approaches. Which one is suggested usually depends on what you are struggling with.
| Therapy | What the NHS says it involves |
|---|---|
| Guided self-help | A workbook or online course, based on cognitive behavioural principles, completed with a therapist’s help |
| Cognitive behavioural therapy (CBT) | Working with a therapist to change how you think and act, with practice between sessions |
| Counselling | Talking through thoughts, feelings and experiences with a therapist who listens and helps you find your own solutions |
| Interpersonal therapy | Exploring difficult relationships and developing ways to manage them |
| Eye movement desensitisation and reprocessing (EMDR) | Discussing traumatic memories alongside specific eye movements, to make them less intense and easier to manage |
| Mindfulness-based cognitive therapy (MBCT) | Learning to notice thoughts and feelings as they happen, using meditation and breathing exercises |
The NHS also lists dynamic interpersonal therapy and couples therapy. You will not be offered all of these; a clinician will discuss what fits your situation.
Why guided self-help often comes first
It can come as a surprise to be offered a workbook or online course rather than weekly sessions with a therapist. The NHS notes that guided self-help is often offered first, and that if your symptoms do not improve, you may be offered another type of therapy.
This is sometimes described as stepped care: starting with the least intensive approach likely to help, and moving up if needed. It is not a judgement that your difficulties are minor. The “guided” part is important, because you are supported by a therapist rather than left to work through material alone. If a first step does not help, that is useful information rather than a failure on your part.
What does CBT actually involve, and how long does it take?
CBT is the approach people most often hear about. The NHS describes it as a talking therapy in which a therapist helps you change how you think and act. In practice that means discussing difficult situations and their emotional impact, questioning unhelpful thoughts and beliefs, considering other ways of looking at things, and gradually changing avoidant behaviour through practice between appointments.
The NHS says people typically have between 5 and 15 sessions of CBT, depending on what it is for. It can be delivered one-to-one, in a group, or as guided self-help, in person, online or by phone. If your symptoms have not improved after a first course, the NHS says you may be given more sessions, or a different approach may be considered.
CBT is used for a wide range of difficulties, including depression, anxiety disorders and PTSD, and the NHS also lists sleep problems such as insomnia. Readers interested in that last application can find more in our guide to CBT for insomnia and when to get help.
Counselling is a little different
Counselling tends to be less structured than CBT. According to the NHS, a counsellor listens without judgement and helps you explore your own thoughts and experiences, though they typically will not give direct advice. Individual sessions usually last 50 to 60 minutes, and NHS-provided counselling usually involves 8 to 16 sessions in total. Those figures are typical rather than guaranteed, and local services vary.
Is therapy right for everyone, and what does the evidence say?
Talking therapies are an established part of NHS care for anxiety and depression, and the NHS lists a wide range of conditions they are used for. But it would be a mistake to treat any single approach as a guaranteed fix. Not everyone responds to the first therapy they try, the fit with an individual therapist matters, and some people find that a different format, such as group work or an online course, suits them better.
It is also worth being realistic about what therapy is. It is a skills-based, collaborative process that usually asks for effort between sessions, rather than something done to you. Many people find that useful; others find the early weeks uncomfortable, because the work involves paying attention to things they would rather avoid. Raising this with your therapist is part of the process, not a sign you are doing it wrong.
Therapy also sits alongside, not instead of, other things that support mental wellbeing. The NHS-backed Five Ways to Wellbeing offers a gentle everyday framework, and if your difficulties are tied to work, our piece on burnout and what actually helps covers why workplace conditions matter as much as personal coping.
What about private counselling or help through work?
The NHS is not the only route. It points out that talking therapies are sometimes available for free through an employer, university or local charity, and private therapy is also an option.
If you choose a private counsellor, the NHS advises checking that they are registered with a body such as the British Association for Counselling and Psychotherapy (BACP), and more generally that they are on a register accredited by the Professional Standards Authority. This gives you some assurance of professional standards and a route for complaints if something goes wrong. Private fees vary widely, so it is sensible to ask about the cost per session and the cancellation policy before you start.
When to speak to a GP or NHS 111
Self-referral suits common difficulties that are affecting daily life, but it is not an emergency service. Speak to your GP if low mood, anxiety or exhaustion is persisting, getting worse or making it hard to work, sleep or look after yourself, particularly if you are not sure which service is right for you, or if your difficulties fall into a category that needs a GP referral.
For urgent help with your mental health, the NHS says you can use NHS 111 online or call 111 and select the mental health option. According to the NHS, 111 will tell you the right place to get help, and you may be able to speak to a trained mental health professional over the phone. If someone’s life is at risk, for example they have seriously injured themselves or taken an overdose, call 999 or go to A&E now. If you simply need someone to listen, Samaritans is free to call on 116 123.
Taking the first step, and keeping expectations realistic
Asking for help is often harder than the process that follows. The NHS route is deliberately low-barrier: no diagnosis needed, no GP appointment required for most common problems, and a choice of formats. The honest caveats are that waiting times and the exact therapies available vary by area, that the first step may be guided self-help rather than one-to-one sessions, and that it may take more than one attempt to find the approach that works for you. Starting the conversation is still the most useful move.
This article is general information, not a substitute for advice from a doctor or other qualified health professional. If you are worried about your mental health, speak to your GP or call NHS 111, and if you need someone to talk to, you can call the Samaritans free on 116 123.
Sources: NHS
