Taking the first step towards getting help with your mental health can be a huge milestone.

For many men, the hardest part isn’t necessarily the therapy itself. It can be the uncertainty beforehand.

Who do I speak to? What will they ask me? Will they judge me? Do I have to talk about everything? What happens if I tell them I’m struggling? Will I be offered medication? How long will I have to wait?

If you’ve never accessed mental health support before, not knowing what happens next can make the whole process feel more difficult than it needs to be.

NHS Talking Therapies, formerly known as IAPT (Improving Access to Psychological Therapies), is an NHS service designed to provide psychological support for people experiencing common mental health difficulties such as anxiety and depression.

The exact process varies slightly between different parts of England, but this guide gives you a general idea of what you can expect.

First: You Don’t Necessarily Need to See Your GP

One of the most important things to know is that you don’t necessarily have to start with your GP. Depending on where you live in Reading, you may be able to self-refer directly to your local NHS Talking Therapies service.

This can be particularly useful for men who might find the idea of sitting in front of their GP and saying, “I’m struggling with my mental health” difficult.

You don’t have to wait until things become unbearable. You can seek support because you’re:

• Constantly worrying
• Feeling low or emotionally flat
• Struggling to sleep
• Finding work increasingly difficult
• Experiencing panic attacks
• Feeling overwhelmed by stress
• Struggling after a relationship breakdown
• Finding it difficult to cope with a bereavement or major life change
• Avoiding things you used to do
• Feeling increasingly isolated
• Experiencing anxiety that is interfering with everyday life

Asking for help isn’t an admission that you have failed. It is a decision to do something about what is happening.

Step 1: Making Initial Contact

What happens?

You can either speak to your GP or, where available, self-refer directly to your local NHS Talking Therapies service. There are so many GPs in Reading. Just google them if you have not registered with one.

If you see your GP, they may ask you questions about your mental health and how it is affecting your everyday life. They might ask about:

• Your mood
• Anxiety or worrying
• Sleep
• Appetite
• Energy levels
• Concentration
• Work
• Relationships
• Physical symptoms
• How long you’ve been experiencing difficulties
• Whether anything has recently happened that has made things worse

They may also consider whether there could be an underlying physical health problem contributing to how you feel.

What might you be thinking?

For some men, this can be the first uncomfortable moment. You may find yourself thinking: “I don’t even know what to say.” That’s okay. You don’t need to arrive with a psychological diagnosis or a perfectly explained account of your life. You can simply say: “I’m not feeling like myself at the moment and I’m struggling to cope.”

That is enough to start the conversation. Your GP may discuss different options, which could include lifestyle changes, medication, further assessment or psychological therapy. If appropriate, you may be referred to NHS Talking Therapies.

Step 2: Referral and Registration

Once you have been referred, or if you have self-referred, the local Talking Therapies service will process your referral. The exact process and waiting time vary between services. You may receive contact by:

• Telephone
• Text message
• Email
• Letter

You may then be asked to arrange an initial assessment. You will often also be asked to complete some questionnaires.

Two commonly used questionnaires are the: PHQ-9 – which looks at symptoms associated with depression. GAD-7 – which looks at symptoms associated with anxiety.

Don’t worry if you see a questionnaire and think: “What is the right answer?” There isn’t one. The purpose isn’t to pass or fail. The questionnaires help the practitioner understand what you’re experiencing and provide a way of tracking whether things change during treatment.

Step 3: Your Initial Assessment

This is usually your first proper conversation with a practitioner from the service. Depending on the service, this might take place by:

• Telephone
• Video
• Face-to-face

The length varies, but you should expect a reasonably detailed conversation. This isn’t an exam. You aren’t expected to know what type of therapy you need. The practitioner is trying to understand what is happening and what kind of support might be appropriate.

What will they ask you?

They may ask about:

Your current difficulties

What has brought you to the service? What are you struggling with at the moment? How is it affecting your life?

Your history

They may ask whether you’ve experienced similar difficulties before and whether you’ve previously received mental health support.

Your everyday life

They may ask about things such as:

• Work
• Relationships
• Family
• Sleep
• Exercise
• Social life
• Alcohol or substance use
• Physical health
• Things you have stopped doing

Your goals

This is an important part of the assessment. The practitioner may ask: “What would you like to be different?” You don’t need to have a sophisticated answer. It could be:

“I want to stop constantly worrying.”

“I want to sleep properly.”

“I want to be able to go back to work without feeling overwhelmed.”

“I want to stop losing my temper.”

“I want to feel like myself again.”

These are all legitimate reasons for seeking therapy.

The Part Many Men Worry About: Questions About Risk

You may also be asked questions about your safety. This can include questions about whether you’ve experienced thoughts of harming yourself, suicide or harming somebody else. For some men, this can feel quite direct. It is important to understand why these questions are asked. The practitioner isn’t trying to catch you out.

They are trying to understand how safe you currently are and what level of support you need. You don’t need to be embarrassed by these questions. Mental health professionals ask them because they are part of responsible assessment and care.

If you are experiencing thoughts of suicide or self-harm, being honest about this allows the practitioner to understand what is happening and consider what support is appropriate.

Step 4: Deciding What Kind of Treatment You Need

Following the assessment, the practitioner will consider what type of support is most appropriate. NHS Talking Therapies generally works within a stepped-care model. This means that treatment is matched to the person’s needs rather than everyone automatically receiving the same type of therapy.

Step 2: Low-Intensity Support

For some people experiencing mild-to-moderate difficulties, treatment may begin with what is called low-intensity psychological intervention. This does not mean your problem isn’t important. It means that research suggests you may be able to make meaningful improvements using a less intensive form of treatment.

This might include:

Guided self-help

You may work through structured CBT-based materials with support from a Psychological Wellbeing Practitioner. This could involve learning about:

• Anxiety
• Depression
• Worry
• Avoidance
• Sleep
• Behaviour patterns
• Managing difficult thoughts

Online therapy programmes

Some services use digital platforms to support treatment.

Group courses and workshops

You may be offered a group programme focusing on areas such as:

• Managing anxiety
• Managing stress
• Understanding depression
• Improving sleep
• Managing worry

Employment support

Some Talking Therapies services also provide access to employment advisers where work is contributing to someone’s difficulties or mental health is affecting their ability to work.

Step 5: Higher-Intensity Psychological Therapy

If your difficulties are more persistent, severe or complex, you may be offered higher-intensity psychological therapy. This might include individual CBT, depending on your needs and what your local service provides.

Sessions may explore the relationship between:

Thoughts → Feelings → Physical sensations → Behaviour

For example, imagine a man who has started struggling at work. He might think: “I’m falling behind. Everyone can see I’m struggling.”

That thought may increase anxiety. The anxiety might lead to physical symptoms such as tension, racing thoughts or poor sleep. He may then start avoiding difficult tasks or withdrawing from colleagues. Avoidance might provide temporary relief. But over time, it can reinforce the belief that he can’t cope. Therapy can help identify these cycles and experiment with different ways of responding.

What About Other Types of Therapy?

Depending on your circumstances and the service available in your area, you may be offered other psychological approaches. These can include approaches such as:

• Counselling for depression
• Interpersonal therapy (IPT)
• Behavioural therapies
• Couples or relationship-focused interventions where available
• Trauma-focused therapies for appropriate presentations
• EMDR for certain trauma-related difficulties

Not every Talking Therapies service offers every type of therapy. Your treatment will depend on your symptoms, circumstances, assessment and what is available locally.

Step 6: Starting Your Therapy

Once you and the practitioner have agreed on a treatment plan, you will begin working towards your goals. Sessions may be weekly or at another agreed frequency, depending on the intervention. The number of sessions varies. Some people receive a relatively short course of treatment, while others require a longer period of support.

Therapy isn’t simply about sitting in a room and talking about your childhood for an hour. Depending on the approach, you may spend a significant amount of time learning and practising specific psychological skills.

You might work on:

• Understanding your anxiety
• Challenging unhelpful thinking patterns
• Behavioural activation
• Gradually facing situations you have been avoiding
• Problem-solving
• Managing worry
• Improving sleep
• Managing stress
• Developing healthier routines
• Understanding triggers
• Changing patterns of behaviour

What About the Questionnaires Before Each Session?

One thing that sometimes surprises people is how much measurement is involved. You may be asked to complete brief questionnaires regularly throughout treatment. This might feel repetitive.

You might even think: “Why am I filling this thing in again?” The reason is that the service wants to monitor your progress. Therapy isn’t supposed to be a mysterious process where nobody knows whether anything is changing. Your scores can provide another way of looking at whether your symptoms are improving, remaining the same or becoming worse.

But remember: a questionnaire doesn’t tell the whole story. Your lived experience matters too. You may have a particular week where your score changes because something significant happened in your life. That is something you can discuss with your practitioner.

Step 7: The Work Between Sessions

This is an important part of psychological therapy. You may be given exercises or tasks to try between appointments. Some men hear the word “homework” and immediately think: “I’m not doing homework.”

But these exercises aren’t designed to give you more work for the sake of it. The purpose is to take what you have discussed in the session and test it in real life.

For example, if you have learned about avoidance, you might gradually start doing something you’ve been putting off.

If you’ve been learning about negative thinking, you might record and examine some of the thoughts that appear during difficult situations.

If sleep is the problem, you may experiment with changes to your routine.

The therapy session is the training ground. Your everyday life is where the changes have to happen.

Step 8: Reviewing Your Progress

Throughout treatment, you should have opportunities to review how things are going. The practitioner may ask:

“Is this helping?”

“What has changed?”

“What still isn’t working?”

“Are we working on the right things?”

This is important because therapy isn’t supposed to be something that simply happens to you.

You should be involved in decisions about your treatment. If something doesn’t make sense, ask. If you don’t understand why you’re being asked to do something, say so. If you feel that your goals have changed, discuss them. Being involved in therapy doesn’t mean you have to know everything. It means your experience matters.

Step 9: Finishing Therapy

Eventually, you and your practitioner may decide that it is time to bring treatment to an end. This doesn’t necessarily mean: “Everything in my life is now perfect.” That isn’t the goal.

The goal is usually to help you develop the understanding, skills and confidence to manage difficulties more effectively. You may review:

• What brought you into therapy
• What has changed
• What strategies helped
• What you have learned about yourself
• What warning signs to look out for
• What you can do if difficulties return

You may also create a relapse prevention or staying-well plan. This can help you recognise the early signs that you are beginning to struggle again.

What Happens After You Finish?

Finishing therapy doesn’t mean you are expected to become completely independent from that point onwards. Life will continue to happen. You may experience another bereavement. A relationship may end. You may lose your job. You may become a parent. You may experience financial pressure. You may simply go through a difficult period.

Depending on the circumstances and local service arrangements, you may be able to access NHS Talking Therapies again in the future if you experience further difficulties.

Your GP may also receive an update about your treatment, depending on the service and your circumstances.

What If You’re a Man Who Doesn’t Like Talking About Feelings?

This is worth addressing directly. You might be thinking: “I’m not really a therapy person.” Or: “I don’t want someone analysing me.” Or: “I don’t want to sit there talking about my feelings for an hour.”

You don’t have to arrive at therapy already comfortable talking about yourself. That is something you can develop. You can even tell the practitioner: “I’ve never done anything like this before and I’m not very good at talking about how I feel.”

That is useful information. A good practitioner doesn’t need you to perform being emotionally open. You can start with what you do know. What is happening? What has changed? What are you struggling with? What do you want to be different?

Sometimes talking about your mental health doesn’t begin with:

“I feel...”

It begins with:

“I can’t sleep.”

“I’m constantly angry.”

“I don’t want to see anyone.”

“I can’t concentrate at work.”

“I’ve stopped enjoying things.”

“My relationship is suffering.”

Those statements can be the beginning of a much bigger conversation.

The Most Important Thing to Remember

You don’t need to wait until your mental health reaches crisis point before asking for help. You don’t need to know exactly what is wrong. You don’t need to understand psychological terminology. You don’t need to have the perfect explanation. And you certainly don’t need to prove that you are struggling badly enough to deserve support.

You can simply start with: “I’m struggling, and I don’t know what to do about it.” That is a perfectly reasonable place to begin. For many men, asking for help can feel like losing control. In reality, it can be the first step towards getting some of that control back.

Looking for Counselling Specifically for Men in Reading?

If you are a man or young man living in Reading or the surrounding Berkshire area and you would prefer to explore private counselling rather than NHS Talking Therapies, Male Minds Counselling provides counselling specifically focused on the experiences and challenges faced by boys and men.

You can learn more about the support available at Male Minds Counselling or get in touch to discuss whether counselling might be appropriate for you.

This article is intended as general information and is not a substitute for professional medical or psychological advice. NHS Talking Therapies processes, waiting times, eligibility criteria and available treatments vary between local services. If you are concerned about your mental health, contact your GP or your local NHS Talking Therapies service for advice.