Choosing a therapist can be a daunting process every bit as much as it is a hopeful step in a wonderful direction. Whether you're considering changing therapists or seeing a therapist for the first time, it's perfectly normal not to know where to start. Based on over a decade of experience, here are some questions (along with my answers) that can help you interview potential therapists during your initial contact and ultimately find the one best suited to your needs.
Do you take insurance? This should be a first question simply because many providers, like me, do not take insurance. If out of pocket payments are impossible -- and they can be two to five times the amount of your copay -- you don't want to develop trust and rapport with someone you won't be able to see due to the financial burden.
Are you licensed and how long have you been in practice? This is an important question that may have already been answered during your online search for therapists. Usually the licensure status and length of time in practice are listed on referral sites, where many people go to find a therapist. Here's my profile on Psychology Today as example. Scroll down to see my Years in Practice (11) and License and State (PC005899 PA). Please understand that pre-licensed professionals are absolutely ok to see! It takes years to get the supervised hours needed to obtain a license. As part of accomplishing those hours, you can trust that therapists/psychologists are being well trained/supervised and are probably already very good at what they do. Pre-licensed providers are subject via their supervisor's license to the same state-determined licensure requirements I am as a licensed provider.
How do you protect my personal health information? How confidential is this process, really? Having just completed recertification as a telemental health provider, I can tell you that all therapists are not created equally when it comes to ensuring the privacy and security of clients' health records. Regulations changed in 2014, and many of us are not up to date with how we must store and transmit client related material. Since 2014, clinicians have been and will continue to be audited and fined for harm to clients resulting from not knowing or recklessly neglecting their responsibilities in this regard. Ask your potential therapist how they work to keep your information private and secure, who might have access to your information, and what they would do if there were a data breach that compromised your record.
I'm using a website hosted by Therapy Sites, and a client portal hosted by Simple Practice, each of which companies has signed a binding contract with me that holds them responsible for knowing and implementing current HIPAA/HITECH privacy and security standards at their sites of operation; they are as liable to you as I am for keeping your record safe. I do not keep paper files. I have a minimal amount of near expired client files (we are asked to keep them for seven years) downloaded from email to a computer with appropriate encryption, password, and timeout settings. Those files are being uploaded, as all current and recent client files have been, to the secure patient portal. In the event of a breach of information, I would immediately alert you, the client. If my computer were stolen, I would remotely wipe it from my phone. If my business email were hacked, I would delete the account from my other account. If my website/portal hosts experienced a breach at their facilities, I would keep you apprised of how they are containing the breach.
In an ever technical age, these topics and practices can be hard and costly to keep up with (trust me!) but as mental health providers, we are required not only to keep abreast of, but to put into place, any and all safeguards and policies we can to protect your confidentiality.
How do you operate your practice, e.g., do you work alone or as part of a group, what's your office setup like, etc...? These may sound like conversation filler questions, but it's important that you assess how independent (or not) your therapist is. There's no right answer. If you are really struggling and hoping to find a therapist who has a psychiatrist on site and back up therapists on call, please make sure the provider you're looking into can offer that.
For example, while I do have colleague who can see my clients if I'm away on vacation or professional retreat, I'm not on call myself nor am I in practice with anyone else who is. And while I do have trusted psychiatrists I can refer people to, I don't have one on site. As far as office setup, it's helpful to know whether the space the therapist offers is private and quiet and appealing -- so feel free to ask for pictures and descriptions to be sure.
What's my process for signing up with you? Some therapists don't have very involved registration processes and some have overly complicated ones; I'd bet most of us fall somewhere in between. Be sure the paperwork you fill out is asking questions that will really inform the therapist of what you're struggling with and what you want to accomplish. As well, be sure the paperwork informs you about the therapist's responsibility and yours during the time you'll work together. You're forging an agreement with another fallible human who is charged with handling your private information and interacting with you on a personal level in very important ways. You want your therapist to protect and respect you and your information to the best of her ability and to explain through policies and informed consent documents how she does that. And you want to be aware of the benefits and risks of therapy as well as your therapist's scope of practice and what she can and cannot do for you. All this should be clear in the paperwork you fill out before your first appointment.
For example, my paperwork asks about your experience of therapy so far, your relevant providers, your symptoms, and your goals. It uses measures to assess briefly and preliminarily for depression, anxiety, mood disorders, dissociation, substance abuse/addiction, trauma treatment readiness, and telehealth readiness. It explains my policies and the benefits of risks of therapy with me. It states clearly my practice limitations and whom I can and cannot interact with about you. All important information to be declared and understood up front.
How many clients do you see and how do you keep track of everyone's progress? I think this is a really crucial two-part question.
My answer: (1) I don't see more than five clients per day. I see each in-person client for a full hour. I take half hour breaks in between each session. It's my strong belief that the common practice of seeing many clients for shorter periods without breaks in between is less than ideal -- just not the ideal conditions for change. No healthcare providers will be at their best if chronically working under pressures related to an overinvestment of time and/or an overemphasis on money. (2) I keep track of clients' progress with good notes usually written on the same day of our appointment. There are many ways to keep notes and many ideas about what a "good note" contains that are beyond the scope of this page... Suffice it to say that notes are important and not to be regarded by therapists as merely "required paperwork"! Notes help providers capture immediate points about a client's presenting concerns that day as well as conceptualize and deepen the clinician's view of a client's journey over time. All this helps therapists help clients make real progress on their paths.
What is your therapeutic approach and how/why is it different/good? Some therapists talk much, some little. Some self-disclose, some are blank slates. Some are protocol-oriented, some are insight-based. Some are directive, some are reflective. Some operate like analysts, some operate like coaches. Know what the provider you think you like has studied, how he practices and what he continues to study and practice.
For example, I am somewhere in the middle of the aforementioned talking-time amount, and while some clients report liking that I "don't just listen and say uh-huh and allow venting that doesn't really help me over time..." (I do hear this a lot) some clients need and want to talk more than they have been able to in prior therapy, with me as supportive witness offering occasional significant commentary. I'm insight-oriented, bringing a mindfulness-based approach to trauma, and I also endeavor to give clients practical behavioral ways to apply, between sessions, any insights and mindfulness discovered during sessions.
How do you view and work with my kind of suffering? Ask therapists for examples of their success in working with trauma or depression or anxiety or bipolar disorder, etc. Ask them if there are populations or ages or diagnoses they don't work with. Beware any suggestions that therapists can work with all ages, all populations, all diagnoses, from all treatment angles. I just don't think that's possible. I think it's ok -- good actually -- for therapists to have limits and to know them, i.e., to specialize. Ask therapists to define those limitations/specialties for you.
For example, I've worked well with the diagnoses mentioned above and do give relevant examples during initial phone calls with prospective clients that validate their curiosity about how my work has gone with similarly presenting clients (unnamed and without sharing identifying details of course). I explain that I don't typically work with teenagers or the elderly or people in active addictions or people with psychotic disorders as a rule because providers who do so should have special training and skill and/or emergency availability.
What made you want to go into this field? This may seem like a personal question, but I encourage you to ask anyway -- not so much for the specific story you'll get but for the sense you'll have of how inspired (or not) your potential therapist is for this work. Burnout is real, and though it's time-limited and remediable, you don't want a therapist to be working with you during your hardest times when they're going through an unusually difficult time personally or professionally themselves. It's up to us therapists to take excellent care of ourselves and know when we need to take breaks, but I encourage you to take the initiative to feel out whether your potential therapist seems like they're overwhelmed or energized by the job.
What do you do to keep up with prevailing knowledge in your field? Know how your therapist handles state-required continuing education requirements. It's costly to take worthwhile courses and some therapists for many reasons don't always meet these requirements unless/until they are audited by their state board. It's wise to have a sense that your therapist is progressive, current, and interested in learning how to best help people over the long haul with strategies relevant to changing times in our society and new research and therapeutic approaches emerging all the time.