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DR. JAN NEWMAN
After you’ve made the decision that therapy could be helpful for you, how do you approach finding the best one for you?
Therapy requires a significant investment of time, money, and effort. Although doing the research can be complicated and more complex, in the end, it could save you a great deal of pain.
We’ve created a list of 30 questions that will, hopefully, help you get the most out of your first consultation or intake session with a therapist.
And remember, you can shop around for a therapist!
If you are concerned about cost, you can see if the therapist would be willing to do a free 15-minute consultation session. If they don’t offer one, they may be willing to answer some of your questions before the session.
Although it would be difficult to ask all of these questions, some might be more important based on your unique needs or past therapy experiences. Some may be easier to find out from the therapist’s website (e.g., fees, insurance), and you could only ask those more difficult to assess from publicly available information.
These 30 questions span the following 6 topic areas:
Cost and coverage
Sessions and scheduling
Use of evidence-based treatments
Emphasis on honoring client values and preferences
Clinical expertise and qualifications
Interpersonal style
COST AND COVERAGE
1.“How much does a session cost? How long are your sessions?”
2. “Why are your fees so high?”
Therapy is a significant investment of money. You may feel uncomfortable asking the therapist about their fees or why their fees are higher than other therapists. That is completely understandable. Some therapists are uncomfortable discussing money with their clients. Yet being direct and clear about the financial aspects is helpful to make sure everyone is on the same page from the get-go.
Also, if a therapist can’t discuss this with you, what else might they not want to talk about? In therapist training, avoiding difficult topics is called “ostrich behavior.” Not surprisingly, ostrich behavior is not associated with good therapeutic relationships or client outcomes.
If the therapist’s fees are high, then asking and understanding why can be helpful.
Highly qualified therapists with advanced degrees and certifications can charge more in the marketplace. While that doesn’t necessarily mean, they are more effective than other therapists; the advanced training and certifications could be meaningful for your care. It could be helpful to ask questions to understand how and why.
If a therapist has a reputation among other professionals or past clients for solid outcomes, they likely get more referrals and can charge more. In a sense, you’re not paying just for an hour of time; you’re paying for all the education and training they’ve done, what they do now in terms of furthering their education and skills, their investment in clinical tools and resources, and their dedication and commitment to you.
Yet you don’t always get what you pay for. Just because a therapist charges a high rate doesn’t mean they are the best therapist for you.
Also, ask about the length of the therapy session. For example, some therapists have 45-minute and 60-minute session that would be priced differently. Ask if there is a different charge for the intake fee and regular sessions. Most therapists charge a higher fee for their intake session
Under the No Surprises Act, all clients are entitled to an estimate of fees for their services, and this must be posted on the practice website.
3. “Do you offer sliding scale services?”
Some therapists offer pro-bono or sliding-scale services. Some offer free courses or resources.
Many qualified therapists volunteer reduced sessions through Open Path Collective, where sessions vary between $40 and $70 per session ($30 for student intern sessions).
Some, but not all, therapists offer free 10- or 15-minute consultations before paid intake sessions. It doesn’t hurt to ask!
4. “What insurance do you accept? If you don’t take insurance, do you file insurance for your clients or use a service like Reimbursify? How much does that cost?”
Check with your insurance company to see if the provider is in-network. Even if the therapist says he or she takes your insurance, double-check on your side as well.
If they don’t take insurance, review your out-of-network coverage and see if it might work for you. Some therapists provide superbills or facilitate filing. Others don’t.
At Momentum Psychology, we don’t take any form of insurance or third-party payment. If you’re curious about our policies, check out our Investment FAQ and Insurance Tips page.
5. “What is your cancellation and no-show policy? Are there any exceptions?”
In the past, it was fairly uncommon for healthcare providers to charge for missed appointments—perhaps that approach showed how little we all valued healthcare.
Things have changed. Many primary care providers, dentists, and medical specialists charge for late cancellations and no-shows.
Many therapists charge for late cancellations and no-shows. If this bothers you, then you should talk about it with the therapist. If you have a problem with it, it might be best to find another provider instead of asking someone to change their policy. As therapists, it can be very helpful to model for clients how to compassionately hold boundaries with people we care about.
At Momentum Psychology, we charge the full session fee for late cancellations (with less than 48 hours’ notice) and no-shows. Please review our Investment FAQ for more information.
If you may need to miss a session for any reason, it is better to tell your provider sooner rather than later. Most will waive the fee if the provider can fill the appointment. At Momentum, our Client Services Coordinator does try to fill cancellations.
SESSIONS AND SCHEDULING
6.“How often will we meet?”
7. “How long are our sessions?”
8. “How long will treatment take?”
In practice, the majority of therapists offer once-weekly therapy. Many evidence-based treatment methods are studied using a benchmark of weekly sessions. However, that DOES NOT mean that therapy needs to be once a week to be effective for you.
Some shorter treatments have been shown to be more effective than longer ones. A metanalysis found that session frequency not the number of sessions, duration of therapy, or length of sessions was the most effective predictor of treatment efficacy for depression (Cuijpers et al., 2013). In fact, twice-weekly therapy was the most effective option. Higher session frequency in the first three months was also associated with better outcomes.
If you know that you can’t attend weekly sessions, you should discuss this with your therapist so that he or she can determine how that would impact your treatment.
The length of treatment depends on various factors that can change. However, some therapies do have a generally recommended number of sessions. Brief therapy has been found to be effective for certain behavioral health problems. Consider asking the therapist what factors could make therapy increase or decrease. For example, prolonged exposure therapy is designed for 10-12 sessions. However, if the therapist integrates it with ACT or the client hasn’t done their homework regularly, the number of sessions would increase.
9.“How do I book and reschedule sessions?”
Some therapists offer online scheduling. Others do not. Some therapists with lengthy waitlists and cancellation lists must monitor their schedules more closely.
We’re all human, yet your therapist or his or her staff should be responsive to your needs. It should not take days and days to schedule or hear back.
10. “What’s your availability?”
Inconvenience is another barrier to therapy. Be honest with your provider about what you can and can’t do. Early morning and late afternoon and evening slots are typically the most desirable for adult clients. Later slots are preferred for kids and teens.
You may need more flexibility if you want to work with a provider in high demand. Honestly assess if that can work for you upfront.
11.“What are the risks or benefits or pros and cons of telehealth or online therapy? How do they compare with in-person appointments?”
If you’re considering online therapy, consider if this fits your need.
Ask the therapist if they have training or experience in providing online therapy before the pandemic or outside of just doing it. Some adjustments can help to make this format more effective and beneficial. If you want to learn more about online therapy, please read our article here.
12.“Would you give me work to do outside of the session?”
Many, but not all, EBTs involve outside practice or homework. You only have one hour per week in therapy and 167 hours outside of that. Your therapist should be dedicated to helping you meet your goals and get your desired results, yet your efforts will make that process much faster and more likely.
Another question to consider asking is, “What would you do if I don’t do it?”.
If you are struggling to do assignments, please tell your therapist!
If my clients aren’t able to do assignments, I view that as data, never failure on their part, I want to consider:
Have I done all I can to ensure that this assignment is a good match for the client? Is the assignment relevant or helpful?
Is it something that they can actually do in terms of time, difficulty, and skill? Maybe there they need more practice with the skill or maybe the difficulty level is too high, and we need to start smaller?
Could I help the client troubleshoot any internal (e.g., avoidance) or external barriers (e.g., lack of time, competing demands) to completing the assignment?
13. “What does a typical appointment look like?”
Ask the therapist to describe what do you actually “do” in sessions.
If, in the past, your sessions have mainly been talking about your problems to a silent therapist and not taking action, there’s no research to support that approach.
If you have had therapy before and not liked how it went, also consider telling the therapist what you did or didn’t like.
For example, my sessions after intake look like this:
Check in with clients on any action-based homework or practice that they’ve done or anything they’ve sent for me to review before the session
Review measures that they completed between sessions to show them progress on their treatment goals
Practice skills in session as much as possible through experiential exercises – it can be different but talking and doing more “here and now” is really where the rubber hits the road, so to speak, in therapy
Troubleshoot any practice or exercises they are going to do outside of the session
Work together to decide what practice on values-based actions or other assignments would be best to work on for the next week
Troubleshoot when the client will work on these assignments
14. “Will you diagnose me?”
If you are planning on seeing a provider who takes insurance, they will have to include a DSM-5 or ICD-10 code for reimbursement. If you are planning on submitting your superbills for an out-of-network provider, then they will also have to include a diagnosis. Your therapist should discuss any diagnosis with you, so ask them how they would determine that and notify you.
15. “Is everything that we say confidential?”
Your client services agreement or informed consent will cover this, but it may be helpful to talk with your therapist. There are limitations to a therapist’s duty of confidentiality such as service of a valid court order. Moreover, therapists are also “mandated reporters” and generally MUST report suspected abuse or neglect of a minor or elder or dependent person regardless of the client’s right to confidentiality.
16. “Can I email or text you? What happens with these?”
Some therapists allow clients to email them, and others don’t. If email is used, then it must be encrypted. In general, the therapist must only have their end of the conversation encrypted. You may be assuming the risk of disclosure on your side. Most therapists don’t allow texting. Some therapists do this because it allows them to support their clients better. For example, 24/7 access is part of evidence-based DBT treatment.
Please discuss any concerns with your therapist. In our practice, we encourage clients to use secure messaging through the portal, but most out-of-session communication is limited to scheduling.
It is very important that you understand that your texts and emails become part of your clinical record, so please be thoughtful about what you send.
USE OF EVIDENCE-BASED TREATMENTS
17. “What is the scientific basis for your techniques? Are those techniques grounded in scientific research, and can you provide that to me?”
18. “What type of training did you receive in the techniques you are using?”
19. “What therapy do you think would be most helpful for me? Why? What’s the scientific support behind it for my particular issue?”
20. “How will you assess my progress?”
In this article, we address what to look for in a therapist. One of the key things we discuss is looking for a therapist who is committed to evidence-based practice.
As outlined in the article, evidence-based practice involves three considerations:
Is the therapist using the best available scientific evidence in therapy?
Is the therapist committed to honoring your values and preferences?
Does the therapist have the clinical training and expertise to treat you in terms of your presenting concern and symptoms, background, etc.?
The best available scientific evidence would mean rigorous, controlled research such as support from randomized controlled trials (RCT’s)
Here are some examples of evidence-based treatment models with RCT support:
cognitive behavioral therapy (CBT) for anxiety and depression,
dialectical behavior therapy (DBT) for borderline personality disorder,
acceptance and commitment therapy (ACT) for anxiety and depression
Ask how the therapist will assess your progress. Evidence-based practice involves frequent monitoring of symptoms and goal progress. Some of our therapists use a monitoring service like PsychSurveys.
HONORING YOUR VALUES AND PREFERENCES
21. Questions about cultural competency
“Have you worked with clients [insert your gender, ethnicity, background, identity, religious affiliation or faith, and/or belief system]?”
“What training do you have in treating people with my [insert above]?”
“What is your approach to working with people with my [insert above]?”
“How do I know that you will respect and affirm core aspects of my identity?”
Working with individuals of particular backgrounds, identities, or belief systems is another type of competency. Additional training and expertise may be required to be fully competent in working with certain populations.
For instance, at this time, the predominant model of understanding sexual minority health risk is the minority stress model. If a provider is aware of this, and even better, if they could explain it, then that’s a good sign that they are competent to work with and recognize disparities for LGBTQ+ people.
22. “What is your approach to therapy?”
It can be helpful to think about how you would your therapist to approach therapy for you. Would you like to be focused on meeting specific goals or mastering certain skills? Do you enjoy therapy that is more action-focused? What have you liked or disliked about therapy or therapists in the past?
It can be difficult to ask these questions, yet therapy is a deeply personal experience. You are entitled to someone who values and respects you and your needs. The more aligned you are with your therapist, the better the relationship and your outcomes will be!
CLINICAL EXPERTISE AND QUALIFICATIONS
23. “How long have you been practicing?” “How much experience do you have in treating concerns like mine?”
24. “Where did you receive your training in X therapy? How much training did you have? What did that training entail?”
25. “What licenses and certifications do you have?”
26. “What type of degree do you have? How does that impact what you do?”
27. “What types of therapy do you specialize in?”
Another aspect of evidence-based practice is ensuring that the provider has expertise in using the therapy that they are planning to use and treating the problem that you are struggling with.
In most states, each type of mental health professional is licensed differently and must meet specific requirements to their license. The type of training can also matter a great deal.
A licensed marriage and family therapist (LMFT) has different training from a licensed clinical social worker (LCSW) or a licensed psychologist. Each type of provider may also have to meet different training requirements.
Some providers have more hours of supervised clinical training before they are licensed. The quality and nature of pre-licensure training.
After licensure, most organizations don’t require additional supervised training and experience. Although most providers must take a certain amount of continuing education each year, they don’t usually have to get additional supervision hours.
If a therapist has told you that they are trained or qualified in a particular evidence-based treatment or specialty, it is helpful that you feel that those credentials and training are sufficient.
THERAPIST INTERPERSONAL SKILLS
28. “What do you think makes a good therapist? A good therapeutic relationship?”
29. “Describe your ideal client.”
30. “How do you apply the skills you teach in aspects of your own life?”
By far, these questions are probably the most difficult to ask. However, we would love a client to ask us these questions; many therapists would likely feel the same way.
If you have a trusting and collaborative relationship with your therapist and your therapist is effective, it will maximize your treatment gains.
Current research has shown that therapist’s with better interpersonal and relationship skills are associated with better outcomes in therapy. Specifically, a 2013 study examined treatment outcomes for veterans with PTSD who were participating in cognitive processing therapy (CPT). They found that approximately 12% of the decrease in PTSD symptoms was attributable to the therapist.
When examining what therapist characteristics produced better patient outcomes, the researchers found that more effective therapists:
Effectively address client avoidance
Use a flexible interpersonal style
Are able to develop a strong therapeutic alliance
Other related questions here that you could ask would include things like:
On addressing avoidance: “How would you handle it if I didn’t do my homework?” “If you disagree with me on something, how would you tell me?”
On the relationship: “What if, at some point, I think we might not be a good fit? What would you recommend that I do?”
On interpersonal style: “Have you ever made a mistake with a client? What do you do if a client gives you feedback and you realize you’ve made a mistake”?”
Again, these are tough questions to ask, yet these are some examples of questions that could help you determine if the therapist would be a good fit for you.
If you’re curious about other factors that can make certain therapist’s more effective than others, check out our article on what to look for in a therapist here.
30 questions is a lot! You don’t need to ask your prospective therapist all of these to have a great first session. However, it can change your entire experience to go into therapy, eyes wide open and confident from the beginning!
Your best therapist would never judge you for asking you these questions and would support you wholeheartedly in taking meaningful action to emphasize your psychological health.
Schleider, J. L., Dobias, M. L., Mullarkey, M. C., & Ollendick, T. (2020). Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy. Administration and Policy in Mental Health, 48(1), 4-8. https://doi.org/10.1007/s10488-020-01090-7
OTHER SERVICES OFFERED BY MOMENTUM PSYCHOLOGY
As well as having extensive training in the treatment of anxiety and its related issues, our team of therapists also offers a wide variety of online therapy services in North Carolina and all PSYPACT states. We work with lawyers, entrepreneurs, students, parents, and teens who are dealing with stress and burnout, trauma and loss, ADHD, depression, and life transitions. Our goal is to help you find success both professionally and personally so you can gain Momentum to excel in a bright future.
RESOURCES OFFERED BY MOMENTUM PSYCHOLOGY IN NORTH CAROLINA AND IN PSYPACT STATES
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