When to See a Therapist, Signs You Need Help
Most people who need therapy never book, and the reason is rarely money or time. It is a quiet feeling that their problem is not bad enough to count. This page gives you a simple check you can run tonight: how long it has lasted, what it is costing you, and whether what you tried yourself worked.
Short answer: how do I know if I need therapy?
Book a therapist if two of these three are true: it has lasted more than two weeks, it is affecting your sleep, work, appetite or relationships, and what you have tried yourself has not worked. You do not need a crisis or a diagnosis to book a first session.
- Punjab Healthcare Commission licence R-05172
- 4.7 average rating, 500+ patient reviews
- Online since 2016, all of Pakistan
You are not waiting for permission. You are waiting for it to get bad enough.
Almost nobody delays therapy because they think it will not work. They delay because of one sentence sitting at the back of the mind: this is not bad enough to bother a professional with. That thought is kind, and it is expensive. It sets a bar that ordinary suffering can never clear, so you wait, and the waiting becomes part of the problem.
Therapy is not a last resort. The World Health Organization defines a mental health condition by distress or by trouble functioning in the areas of life that matter to you, not by how dramatic it looks from outside.4 People book for a marriage that has gone quiet, a fear of driving, exam panic, a grief that will not settle, a boss who has moved into their head. None of that is dramatic. All of it is treatable.
So stop asking whether you deserve help. That is a question about worth, and you will always answer it badly. Ask three factual questions instead.
The two week, one area, already tried test
- 1. DurationHas it lasted more than two weeks?Not one hard day. Not a bad week after something happened. Two clear weeks of the same weight, most days. The NHS uses the same two week mark for low mood, and the National Institute of Mental Health uses it for depression.1, 3
- 2. FunctionIs it costing you something?Look at five areas: your sleep, your appetite, your work or study, your relationships, and the things you normally enjoy. One area is enough. It does not have to be wrecking all five.
- 3. EffortDid your own fixes hold?Rest, exercise, a break, prayer, talking to a friend, less caffeine, a holiday, deciding to snap out of it. If none of it worked, or it worked for four days and then came back, that counts. The NHS says to see someone when what you are trying yourself is not helping.2
- One of threeKeep an eye on it. Run the same check again in two weeks.
- Two of threeBook a session. Not think about booking. Book.
- All threeBook this week, rather than at a better moment that keeps not arriving.
This check works because it takes the judgement out of your hands. You are no longer rating your pain against other people's, which is a comparison you cannot win. You are answering three plain questions: how long, what is it costing, and did my own attempts hold. A clinician will ask you the same three things in the first ten minutes of a first session.
The signs, written the way you would actually notice them
Clinical lists say "anhedonia" and "psychomotor agitation". Here is what that looks like from inside an ordinary week. You do not need many. Two or three you clearly recognise, running longer than two weeks, is already a reason to book.
- Your sleep has changed in either direction. You lie awake for two hours, or you sleep ten hours and still wake tired.
- You wake at 3am with your mind already running, mid sentence, on a problem you did not choose to think about.
- Your appetite has shifted. Meals have become a chore you skip, or you eat past hunger without noticing.
- You are getting through the day feeling nothing. Not sad exactly. Flat. Watching your own life from a slight distance.
- Your temper is landing on the people you love. Your mother, your spouse, your children get the sharp voice. The colleague who deserved it got the polite one.
- You are dreading Monday by Saturday afternoon, so the weekend has effectively stopped existing.
- You are crying at things that never used to make you cry, or you cannot cry at all when you badly want to.
- You are avoiding calls and messages, letting them stack up, then feeling worse about the stack than about the calls.
- You are smoking, scrolling or eating more to switch off, because it is the only reliable way you have found to quiet the noise.
- You are replaying the same conversation for days, rewriting what you should have said, unable to close it.
- You have physical symptoms with no medical cause. Chest tightness, stomach trouble, headaches, dizziness, and your doctor has already checked and found nothing.
- You have lost interest in things you chose because you liked them. Cricket, cooking, a friendship group, a subject you used to read about for fun.
- You are having thoughts that life is too much, or that people would manage without you. This one does not wait two weeks. Bring it to a clinician now, and if there is immediate danger use the emergency numbers further down this page.
This list is not a diagnosis
Recognising yourself here does not mean you have depression or an anxiety disorder. It means something has been running a while that a trained person should look at properly. That is all a first session is: a proper look. If you want something structured before you book, there is a free mental health assessment that takes a couple of minutes.
Where your answers fall
Find your row, then find your column. If any single row puts you in the right hand column, treat that as the whole table's answer.
| What you are checking | Keep an eye on it | Book a session | Get help this week |
|---|---|---|---|
| Duration | Under two weeks, and clearly tied to something that happened | Two to six weeks of the same weight, most days | More than six weeks, or it has been building for months and is now worse |
| Sleep | A few bad nights in a fortnight | Three or more disturbed nights a week, for two weeks or longer | Barely sleeping, or sleeping through the day and unable to get up |
| Daily function | Everything still gets done, it just takes more effort | One area is slipping: work, study, home, or people you have stopped replying to | Missing work or classes, not leaving the house, not managing basic self care |
| Mood | Low patches that lift within a day or two | Flat or anxious most of the day, most days, with no off switch | No relief at all, or sudden extreme swings in mood, energy or spending |
| Thoughts | Worry you can set down when you are busy | Constant self criticism, rumination you cannot stop, feeling like a burden | Any thought of ending your life, or of harming yourself or anyone else |
Every threshold on this table is a judgement about timing, with one exception. The bottom right cell has no waiting period attached to it and never will.
What is not a reason to wait
These five sentences keep people out of a therapist's room the longest. Each deserves a straight answer.
"Others have it worse"
They do. That is not how healthcare works. Nobody with a fractured wrist loses their place in the queue because someone else broke a leg. Suffering is not a fixed quantity you take from someone else by using it. The comparison is also unfair in one direction only: you are comparing your inside to other people's outsides, and outsides are managed. Your distress is the thing in front of you, and it is the thing that can be treated.
"It is just stress"
It may well be. Stress is a real clinical target, not a lesser one. Stress running for months does measurable things to sleep, concentration, memory and mood. The word "just" is doing all the work in that sentence. Ask two better questions instead: is the stressor still there, and do you have a method for handling it that actually works. If the answer is yes and no, that is exactly what stress and burnout counselling is for.
"I should be able to handle this myself"
You have been handling it. That is what the last several months were. The question is not whether you are capable, it is whether your method is working. If you had one that worked you would not be reading this page. Willpower is not a treatment for a sleep problem, a panic response or a grief that has stalled. Therapy is not the opposite of handling it yourself. It is where you go to get a method that holds.
"My family will find out"
Online sessions are private by design, and this is the main reason many people choose them. There is no clinic waiting room, no reception desk in your neighbourhood, no chance of meeting a cousin on the stairs. Sessions happen on a private Google Meet link. You can take one with your camera off, from a room with the door shut, with headphones. Your records are confidential and nothing goes to your family without your consent. If speaking aloud is the risky part, text chat counselling exists for exactly that.
"I would not know what to say"
This stops more people than anything else, and it rests on a misunderstanding. You are not expected to arrive with a prepared account, a timeline, or a neat explanation of what is wrong. Most people cannot produce one, which is often part of why they are unwell. The clinician asks the questions. Your job is to answer honestly, including "I do not know" and "I have never thought about that". Sitting down and saying "something has been off for a while and I cannot explain it" is a completely standard opening.
Clinicians you can book this week
Every clinician on SehatYab is verified before listing. Psychologists provide talk therapy. Psychiatrists are medical doctors who can also assess medication. Full details are on each clinician's profile.
Clinical Psychologist
Ms. Maryam Khan
Depression, anxiety, trauma, PTSD, stress and low self esteem. A good first appointment if you are not sure what is going on and want someone to work it out with you.
Clinical Psychologist
Ms. Nawal Ali
Anxiety, depression, burnout, anger, self esteem and life transitions. Often the right fit when the problem is a situation rather than a diagnosis.
Relationship Counsellor
Ms. Fatima Sana
Marriage and family difficulties, in law conflict, communication breakdown and boundaries. Choose her if the problem sits between you and someone else rather than inside you.
Consultant Psychiatrist
Dr. Muhammad Faheem Ashraf Khan
Depression, bipolar disorder, panic, OCD, sleep problems and more severe illness. See a psychiatrist if you need a diagnosis, a medication review, or symptoms are worsening quickly.
Psychologist, psychiatrist or emergency
The second thing that stalls people, once they accept they should book something, is not knowing what to book. It is a smaller problem than it feels. A clinical psychologist provides talk therapy and works with thoughts, behaviour, relationships and stress. A psychiatrist is a medical doctor who can diagnose formally and prescribe. An emergency is a different thing altogether, and it is not a booking at all. The chart below sorts almost everyone with one question.
Signs in a person you are worried about
You cannot run the three checks on somebody else's inner life, but there are changes worth noticing from outside.
- Withdrawal. They have stopped coming to things they used to come to, and the excuses have become thin and repetitive.
- Giving things away. Possessions they cared about handed on, accounts tidied, affairs put in unusual order.
- Sudden calm after a bad period. Distress lifting with no explanation behind it. Take this seriously rather than as relief.
- Changes in routine. Sleep, eating, prayer, work attendance or grooming shifting noticeably and staying shifted.
- Talking about being a burden. Any version of "everyone would be better off", said lightly or otherwise.
Say something plainly
You do not need the right words, and you will not put an idea in their head by asking directly whether they are safe. If there is any immediate danger or risk of self harm, this is not a booking decision. Call 1122, 15, 115 or 1020, or take them to the nearest government hospital emergency department, and stay with them. Where there is no immediate danger, sitting with them while they look at available clinicians is usually more useful than advice.
What actually happens in a first session
A first session is a structured conversation, usually about fifty minutes, and it is far more ordinary than people expect. The clinician introduces themselves, explains confidentiality and its limits, then asks questions. What brought you here. When did it start. What does an average day look like now compared with a year ago. How are you sleeping and eating. What have you already tried. Who is around you. You answer as best you can. There is no couch, no interpretation of your childhood on day one, and no test to fail.
You will not be diagnosed on the spot, and you should be a little wary of anyone who does. A first session is an assessment. It usually ends with an impression, a rough plan, and a sense of how many sessions the work might take. If a diagnosis is appropriate, it comes once there is enough information to make it responsibly.
You can stop at any point. If a question is too much today, say so and the clinician moves on. "I do not want to go into that yet" is a complete and respected answer. You are not signing up to a course. And you can change clinician, for any reason or none, including simply not warming to them. Fit matters more than credentials in therapy, and no reasonable clinician takes it personally. Both of these are written out in full: your first online session and can I change my therapist. For a sense of the likely commitment, see how many therapy sessions you might need.
One last thing, for the reader still hovering. If you have read this far, checked yourself against three questions, recognised yourself in the signs, and read the objections thinking "yes, but", then you already know. Booking one assessment session commits you to nothing except finding out. That is a much smaller decision than the one you have been avoiding.
Booking takes about four minutes
Choose a clinician
Browse psychologists and psychiatrists by focus area, language, gender and experience on our specialists page.
Pick a slot
Choose a time that suits you, including evenings. Check clinician timings if you need a specific window.
Pay securely online
Debit or credit card, EasyPaisa, JazzCash, or bank transfer. No clinic visit, no cash at a reception desk.
Join your private call
A private Google Meet link arrives by SMS and email. Audio only is fine, camera off is fine, headphones are a good idea.
Two of three? Then it is worth one session.
You do not have to be certain, and you do not have to be in crisis. You only have to be willing to find out.
When to see a therapist, common questions
SehatYab is an online clinic, not an emergency service
If you or someone close to you is in immediate danger, at risk of self harm, or facing a medical emergency, contact the nearest emergency facility right away. Rescue and ambulance 1122, Police 15, Edhi 115, Chhipa 1020, or the nearest government hospital emergency department. Do not wait for an appointment slot, and do not wait to see whether it passes.
References
- National Health Service (UK). Low mood, sadness and depression. Advises seeing a GP if low mood has continued for more than 2 weeks.
- National Health Service (UK). Anxiety, fear and panic. Advises seeking help when the things you are trying yourself are not helping.
- National Institute of Mental Health (USA). Depression. Describes symptoms present most of the day, nearly every day, for at least 2 weeks.
- World Health Organization. Mental disorders fact sheet. Defines mental disorders by distress or impairment in important areas of functioning, and notes that effective prevention and treatment options exist.
- World Health Organization, Eastern Mediterranean Regional Office. Mental health and substance abuse, Pakistan. Reports roughly 0.19 psychiatrists per 100,000 people and around 24 million people in need of care.
- Journal of the Pakistan Medical Association. Mental health care in Pakistan. Reports approximately one psychiatrist for every 360,000 people.
You have already done the difficult part by checking
Two weeks. One area. Already tried. If that describes where you are, the next step is a single fifty minute conversation with someone trained to make sense of it.
Next steps and useful pages
Innovista Rawal, DHA Phase 1, Rawalpindi, Punjab, Pakistan.
Registered with the Punjab Healthcare Commission, licence R-05172. Operating since 2016.
Phone +92 304 111 2310 · WhatsApp +92 300 100 3140
Consultations are online only, by video call, audio call or text chat. There is no walk in clinic.