The short version
The PHQ-9 (Patient Health Questionnaire) is a nine-question screening tool for depression. The GAD-7 (Generalised Anxiety Disorder scale) is a seven-question screening tool for anxiety. Both were developed for clinical use, are validated against diagnostic criteria, and are widely used in the NHS and private practice as a quick, standardised way to assess symptom severity.
Typically, you have the client fill them in when you first start working with them, and again periodically to assess the progress they have made whilst working with you.
Good to know: Neither is a diagnostic instrument on their own. They are handy screening tools that inform clinical judgment, not replace it.
The PHQ-9
The PHQ-9 asks clients to rate, over the past two weeks, how often they have been bothered by nine symptoms, things like:
- Low mood
- Loss of interest
- Sleep difficulties
- Fatigue
- Thoughts of self-harm
Each item is rated on a four-point scale from “not at all” to “nearly every day”, scored 0–3.
The total score runs from 0 to 27 and maps roughly to severity bands:
| Score | Indication |
|---|---|
| 0–4 | Minimal or no depression |
| 5–9 | Mild depression |
| 10–14 | Moderate depression |
| 15–19 | Moderately severe depression |
| 20–27 | Severe depression |
The ninth question, about thoughts of being better off dead or of self-harm, is often looked at independently of the overall score, as any response above zero warrants direct attention regardless of the total. Considered against professional guidelines, duty of care, and potentially knowing that a client is actively hurting themselves or others.
The GAD-7
The GAD-7 asks clients to rate how often, over the past two weeks, they have experienced seven symptons of anxiety:
- Feeling nervous or on edge
- Inability to stop worrying
- Trouble Relaxing
- Restlessness
- Irritability
- Fear that something awful might happen.
The same four-pint scale rating applies as the PHQ form, giving a total score of 0-21. A score of 10 or above is often used as a threshold for further assessment.
| Score | Indication |
|---|---|
| 0–4 | Minimal anxiety |
| 5–9 | Mild anxiety |
| 10–14 | Moderate anxiety |
| 15–21 | Severe anxiety |
A score of 10 or above is often used as a threshold for further assessment.
How therapists use them in practice
Therapists often use PHQ-9 and GAD-7 forms in private practice as intake assessments, sent to a client before (or at) the start of therapy to establish a baseline. The score gives you an initial read on the severity of the client’s symptoms, and can inform how you prioritise the early work.
They are also used for therapy outcome monitoring, repeating the assessment periodically throughout the therapeutic relationship to track whether symptoms are changing. This can be clinically useful, and is expected by some insurers and EAP providers.
A few things worth being clear about in practice:
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Scores are a starting point, not a conclusion. A PHQ-9 of 18 tells you something, but it doesn’t tell you everything. It should prompt a conversation, not substitute for one.
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The tools are self-reported. Clients answer based on their own perception. Some will underreport, some will overreport — that’s clinical information too.
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Context matters. A GAD-7 of 12 from someone who has just experienced a major life event is different from the same score from someone whose life circumstances are stable.
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Item 9 of the PHQ-9 always warrants direct exploration. Any response above zero should be followed up in session, regardless of the overall score.
Do I have to use them?
Do I have to use PHQ-9 and GAD-7 forms in private practice therapy?
No, there is no regulatory requirement to use the PHQ-9 or GAD-7 forms in private practice therapy. Some therapists use them routinely; some may not use them at all. Whether they are useful for you depends on your ways of working and your client group.
However, some insurers and EAP providers may expect strong outcome tracking as part of their processes. If you are registered with any insurance providers or employee assistance programmes, you should check whether you are expected to collect any additional forms, or paperwork, as part of their working agreements.
How do I get my clients to complete PHQ-9 and GAD-7 forms
Counselling Buddy lets you create a link, and automatically email it to you client, so they can complete their PHQ-9 or GAD-7 forms securely online. It takes less than 5 minutes. Want to see how? Take a look at our guide: sending PHQ-9 and GAD-7 forms to your clients
Forms collected via Counselling Buddy are stored securely in your document storage, and can easily be downloaded or printed. You also have the option to link the form to your client, so their submission will automatically be saved under their profile.