A lot of people sit with the thought "I think I need therapy" for a surprisingly long time before doing anything about it. Sometimes the delay is about cost. Sometimes it's uncertainty about whether their problems are "bad enough." Sometimes they assume they need to go through their GP first—and the idea of that conversation feels like yet another hurdle.

The reality is simpler than it seems. You can start therapy on your own terms, without a GP referral, without being in crisis, and without anyone else's permission.

Here's exactly how.

Do You Need a GP Referral for Therapy?

For private therapy: No. You can contact any private therapist or counsellor directly and arrange an appointment. There's no gatekeeping, no waiting list beyond the therapist's diary, and no requirement to justify why you want support.

For NHS Talking Therapies (the main NHS psychological therapy service in England): No. NHS Talking Therapies operates a self-referral system. You don't need to go through your GP—you can refer yourself directly online or by phone. Find your local service by searching "NHS Talking Therapies [your borough]."

For specialist NHS services (community mental health teams, secondary care psychiatry): These typically do require a GP referral. But for most presentations—anxiety, depression, relationship difficulties, stress, personal growth—you'll never need to reach this level.

Step 1: Work Out What You're Looking For

Before contacting anyone, it helps to have a rough sense of what you want. You don't need to have all the answers—in fact, "I'm not quite sure what's going on, but I know something isn't right" is a perfectly valid starting point for therapy.

Think about:

What's prompting the decision now? Even vaguely: "I've been feeling low for months and I'm tired of it" or "I keep having the same argument with my partner and I want to understand my part in it" or "I don't like the person I'm becoming at work."

What format suits you?

In-person vs video (Zoom) sessions
Weekly vs fortnightly sessions
Day and time preferences—morning, evening, weekends?

What's your budget? Private therapy in London ranges from around £40 per session (trainee/student therapist, NHS concession) to £150+ for senior specialists. Most established practitioners charge £70–£100. Some offer concessions for students, trainees, or those on lower incomes.

Any preferences about the therapist? Gender, age, cultural background, approach, lived experience—all can be relevant. Some people feel strongly; others don't mind. There's no right answer.

Step 2: Find Potential Therapists

Professional directories:

BACP (British Association for Counselling and Psychotherapy): bacp.co.uk/find-a-therapist — search by postcode, modality, and presenting issue. All listed therapists are BACP members.
Psychology Today UK: uk.psychologytoday.com/gb/therapists — extensive directory with detailed profiles, photos, and often fee information
Counselling Directory: counselling-directory.org.uk — comprehensive UK directory with therapist self-written profiles

What to look for in a profile:

Clear description of their approach and what they work with
Relevant professional registration (BACP, UKCP, BPS)
Qualifications that match their claimed approach (e.g., a therapist describing themselves as "person-centred" should have a relevant diploma or degree)
A profile that sounds human and genuine, not a list of conditions they claim to treat

Word of mouth: Personal recommendations carry genuine weight. A therapist who helped someone you trust is worth exploring—provided you understand that therapy is personal, and what worked for them may or may not suit you.

Step 3: Make Initial Contact

Most therapists offer an initial phone call or email exchange at no charge. This isn't a commitment to proceed—it's an opportunity for both of you to assess whether it's worth having a first session.

What to say: You don't need to have a speech prepared. Something like this works:

"Hi, I'm looking for a therapist and came across your profile. I'm dealing with [brief description—e.g., anxiety and some difficult relationship patterns]. I wondered if you'd be available for a brief call to discuss whether we'd be a good fit."

Keep it simple. You'll get a sense from the exchange—their warmth, how they listen, whether they ask sensible questions—of whether you want to go further.

What to ask:

What's their approach?
What does a first session typically involve?
What are their fees, and do they offer any concessions?
How do they handle cancellations?
What's their availability?

You're not being difficult by asking these questions. Good therapists expect them.

Step 4: Have the First Session

The first session—often called an assessment or introductory session—serves several purposes:

For you:

Getting a feel for the therapist and whether you feel comfortable with them
Beginning to articulate what brought you to therapy
Understanding how they work

For the therapist:

Understanding your situation
Assessing whether their approach is appropriate for what you're bringing
Starting to build a picture of relevant history

The first session rarely resolves anything. Its job is to start. You may leave feeling relieved, or uncertain, or both. You may feel you talked too much, or not enough, or said the wrong thing. All of this is normal.

One important note: Chemistry isn't always instant. A first session can feel uncomfortable or awkward without meaning the therapist is wrong for you. Give it two or three sessions before drawing firm conclusions.

Practical Things to Sort Beforehand

Confirm the fee and payment method (bank transfer, card, or cash—varies by therapist)
Know the cancellation policy (most require 24–48 hours' notice; short-notice cancellations are often charged at full or reduced rate)
Confirm the location or video link if online
Give yourself travel time or a few minutes before the session to settle

What If You Don't Know What to Say?

This is one of the most common fears people have about starting therapy. "What if I can't explain what's wrong?" or "What if I just go blank?"

You won't. And even if you do, that's fine. A therapist who can only work with people who arrive articulate and prepared isn't much of a therapist.

Say what's true. "I don't really know where to start" is a perfectly valid opening. "I feel stupid saying this but..." is also fine—it's a genuine expression of where you are.

The first session exists precisely to begin untangling things. You don't need to arrive already untangled.

What If It Doesn't Feel Right?

Sometimes the first therapist you try isn't the right one. This happens. It doesn't mean therapy isn't for you—it means this particular match wasn't right.

A few things that might signal poor fit:

You feel judged or criticised
The therapist seems distracted, bored, or reads from a script
You feel talked at rather than listened to
There's something that simply doesn't sit right—even if you can't name it

Trust this. Therapeutic fit is one of the strongest predictors of whether therapy will work for you. If it's not there, it's worth trying someone else rather than forcing it.

If the first session went well, book the next one. If you're uncertain, it's reasonable to have one more session before deciding. If something was clearly off, contact another therapist.

The NHS Route: Self-Referring to Talking Therapies

If you'd prefer to start with free NHS support:

Go to your NHS Talking Therapies local service website (search "[your London borough] NHS Talking Therapies")
Complete the online self-referral form—this usually takes 10–15 minutes
You'll typically receive a call within a week for an initial assessment
Based on that assessment, you'll be placed on a waiting list for an appropriate intervention (often online CBT or face-to-face sessions)

Be honest on the assessment form. The questions are designed to match you to the right level of support, not to exclude you.

Important: NHS Talking Therapies is primarily CBT-based and typically offers 6–20 sessions. If you want a relational, longer-term, or humanistic approach, private therapy will serve you better.

Frequently Asked Questions

Is it weird to start therapy when I'm not in crisis?

Absolutely not. Therapy is most effective when started before you're at breaking point. Many people do some of their best work in therapy when they're struggling in ordinary, everyday ways rather than in acute crisis.

Should I tell my GP I'm seeing a therapist?

You don't have to, but there's no harm in mentioning it—particularly if you're also receiving other treatment. Your GP can't share that information without your consent.

How quickly can I get a first session?

With a private therapist, often within a few days. With NHS Talking Therapies, waiting times vary by borough—typically a few weeks for an initial assessment, possibly longer for an ongoing treatment slot.

What if I'm not sure therapy is what I need?

Try an initial session and see. Most therapists are happy to have an exploratory conversation, and you're under no obligation to continue. The worst outcome is that you spend an hour having a thoughtful conversation with someone trained to listen—which is rarely a waste of time.

How to Start Therapy Without a GP Referral