How to Find and Choose the Right Counselor for You. Questions to ask when interviewing a new therapist.

Finding the right counselor or therapist for you can seem like a very difficult and pain-staking task.     There are many considerations one must think about when selecting a counselor.  To that end, some of these questions might help a person find the right therapist for them.  
  
Can you describe to me how a typical counseling session would go?  What is the process of counseling?    This is typically referred to as “informed consent”.   This, in my opinion, should be a top priority your therapist should discuss with you before entering into any counseling agreement.   This is usually a form your therapist has you read before signing a consent to treat agreement.  However, it is also good to have this summarized verbally to you in person as well.  In fact, the governing board in Ohio, (Ohio Counselor, Social Worker, & Marriage & Family Therapist Board), makes informed consent a requirement, as stated in the Ohio Administrative Code for Standards of Ethical Practice for counselors.   Informed consent should include, but not be limited to:  Potential benefits/risks of counseling.   Fees.  What happens in case of emergencies?  Confidentiality.   How long does counseling last?   Who decides when counseling is no longer needed?   What if I want to discontinue counseling for now and come back later?  


​​What are your areas of specialty?   An important question to start asking any potential therapist when seeking the right therapist for you.   It is also good to ask how many years of experience or what kinds of training they may have in their professed areas of specialty.    While a therapist’s personality is very important in finding a counselor of “best fit” for you, I’m sure you can agree that you would like to work with someone that is qualified to address the problems or concerns you bring to the therapeutic process.   There are many ways to measure this, including years of experience, areas of formalized training, and quite simply, how much does the therapist you are interviewing seem genuinely interested in you?  

​What kinds of clients do you most enjoy working with?  More important than areas of specialty, you might want to ask your therapist what kinds of people they most enjoy working with, and why?   This might generate a more honest and thought through response.  

Describe to me your approach to counseling.    You have a right to know from what theoretical framework your counselor typically works.   Is it psychodynamic - which can potentially mean years of long-term insight oriented therapy, Solution-focused brief therapy - which may mean 6-10 sessions of a very specific focus, Cognitive Behavioral - which explores the relationship between thoughts, feelings, and behavior and seeks to correct potential thinking errors or irrational thoughts, or perhaps a person-centered approach, which largely allows the client wide latitude to choose the agenda, content, course, duration, frequency, and other aspects of the counseling process?  If your counselor prefers to answer this question with a response of “I’m eclectic”, be careful.   This can be a catch all phrase from someone who may be less trained to address specific mental health concerns.   While an “eclectic approach” is certainly a valid approach for very experienced counselors, a potential client can respond to a therapist who professes to use this approach by asking, “How would you use an eclectic approach  to help me with my problems?”  

What is your privacy policy and how do you ensure my privacy is maintained?  This is also something that should be discussed in the area of “informed consent” and the limits thereof.   Records should be stored safely and in such a way that would reasonably minimize unauthorized access.   The therapist should also talk to you about exceptions to confidentiality, duty to warn/duty to protect, and obligations of reporting when abuse/neglect/endangerment issues are raised during the counseling session.   When a therapist contacts you, you have a right to request how you are contacted and by what means, either by phone, mail, email, or other electronic means, and the therapist must inform you of the steps they take to ensure your privacy is maintained as much as possible.

What is your cancellation / no-show policy?   Most therapists do not like it when you cancel at the last minute.   Worse yet, if you do not show for an appointment, that is akin to you showing up for work and then not getting paid for it.  It is always important to ask this question of any therapist as there are generally fees associated with appointments cancelled less than 24 hours from the scheduled time, or no-shows.  These can range from a percentage of the fees to the entire cost of the session.    More important to note is that there are few things that can spoil a therapeutic relationship faster than a person who frequently cancels, reschedules, or fails to show for scheduled appointments, which may result in the therapist refusing to schedule any further appointments and referring you elsewhere.   Cancellation policies can usually be found in Informed Consent.

What are your fees?  Do you accept a sliding fee scale?   This is nearly always a question that is asked of me, and if it isn’t, I make it a point to be as transparent as possible, as there should be no surprises in this area when it comes to counseling.   Some therapists may charge higher fees than average as they have developed a niche specialty of their practice.   For these therapists that charge a higher fee, (anything approaching $200/hour or more), you should have similar high expectations as to the quality of services and potential outcome.   Conversely, a therapist that charges a very low fee, ($50 or less), may generate correspondingly low expectations from their clients.    When it comes to quality services, sometimes the old adages of “Buyer beware!”   and “You get what you pay for!”  come to mind.   In my experience, most therapists of reasonable experience and quality charge between $90 and $150 /hour.   A therapist should be able to provide you with a complete list of their fees, including in-person and phone time, when appropriate.

Do you accept my insurance?    To be frank, working with insurance companies is becoming more challenging for all types of health care providers.  Some insurance companies have been closed to new providers for many years.  (You may have also experienced the consequence of this when you call therapists in your insurance network who have long wait times before they can schedule their first appointment.)   Some providers may choose to only work with self-pay clients, largely due to a history of unpaid claims and lots of administrative time spent chasing down those claims.  Or, as is becoming more of a reality, contract rates for some insurance companies may not be keeping pace with inflation and expenses required to run a practice.   As a provider, it can be a big headache.  As the insured client, it can equally frustrating and you may feel you are stuck in the middle.   Just recently in my area, a very large provider network and hospital discontinued their in-network status with a very large insurance company over a contractual dispute.  This is a very big deal and received lots of media attention by the local TV networks.  It essentially means that consumers seeking medical attention through this provider network and hospital will be treated as out of network and subject to higher deductibles & co-pays, provided those consumers even have out of network benefits.    Whomever you choose as a therapist, it is an important discussion to have with any provider and how they approach these insurance challenges.  If that therapist is not contracted with your insurance company, the conversation should not stop there.   The therapist may be willing to work with you on an out-of-network basis where you may still be able to utilize your insurance.   This is a good option if you are not able to find an in-network provider that can see you in a timely manner.   While insurance is important, it should not be the only factor in choosing a quality therapist, or other health-care provider for that matter.   

What specialized training do you have?  How many years of experience?    What are your credentials?  Training is important.  A therapist should at least be able to tell you any specialized formal training or years of experience they may have in a particular area.   It may also be worth asking to what degree do they see themselves as successful in working with a particular kind of problem?    Maybe they can anecdotally talk about a success story or two.   This may give you more insight as to how successful they truly are at working with a particular mental health issue.

How many years have you been providing direct counseling services?    Many therapists can be eclectic in their experience.   While some may have been licensed for 20+ years, maybe they have only provided direct services for a fraction of those years, while the majority of that time was spent in an administrative position.    This is not necessarily a bad thing as they may have been selected to fulfill a supervisory role with other therapists, which speaks to the provider’s  expertise being valued as a resource to other therapists.  
 
Have you ever supervised other therapists?    If your therapist has supervised other therapists, this may be indicative of someone who’s expertise is recognized by other providers as of sound quality, and with several years of experience under their belt.   Someone with a supervisory designation to their title, (represented by an “S” that follows their credentials), is recognized by the state as someone who is qualified to supervise therapists in training to become licensed therapists.   While it is only one of many potential indicators of a quality therapist, it is a good one to make note of.   

How long are your sessions?    Can you do video or tele-conferencing?   Sessions can range widely from a 30-minute session to a 45, 50, 55, or 60 minute hour.  Some therapists offer over the phone sessions.   With the advent of new technology, some therapists also provide virtual counseling through the use of apps such as Skype, or Face Time.   While the convenience of these new technologies cannot be ignored, it also becomes more difficult for a therapist to ensure confidentiality if the counseling session occurs over the world-wide web.  Regardless, getting this question out early when interviewing a potential therapist may alleviate misunderstandings and disappointments later as to what you can expect.  

How many sessions on average do you see your clients before the end of treatment?  How many sessions do you estimate I will need?   Depending on the therapist’s theoretical orientation, this can vary widely.    This can mean as few as 6 sessions for a Solution-Focused Brief Therapy orientation, or many years for a psychodynamic approach.   This is an important question to ask I’m sure you will agree.  And while no therapist can accurately predict exactly how long you will need counseling, or how many sessions, they should at least be able to give you a ball-park estimate and then be able to tell you later why it may be longer or shorter than originally thought.  

How would I reach you in case of emergencies?   In case of crises, which are likely to occur on occasion, a therapist should be able to tell you how to reach them in case of emergencies, or who to contact if they are unavailable.   

How many clients do you typically see in a day or week?    This can be a nice way of knowing if your therapist is seeing too many clients.   On average, if a therapist sees 25 clients in a week, that means an average of 5 clients per day.   That also potentially means an additional 20-30 minutes of writing, documenting, reviewing, and preparing for each client.   If you also consider if that therapist does their own invoicing and administrative overhead, you are quickly into the 40 hours of work range.   A therapist that sees more than 30 clients per week may start to approach burnout, which can lead to “compassion fatigue”.    A therapist that provides services at a greatly discounted rate might find themselves in need of seeing more clients to offset any revenue shortfalls, thereby making them more susceptible to burnout or compassion fatigue, which should be a consideration when you ask a therapist about their fees.   Another direct question to ask any therapist is how they manage compassion fatigue which can provide you insight as to how the therapist takes care of him or herself.   

Do you provide spiritual counseling?   Some therapists do utilize spiritual-based methods in their counseling approach.    If you find that you are looking for spiritual guidance to address your counseling needs, this becomes a very important question to ask.    Most faith-based leaders offer some counseling in their areas of expertise.     This becomes an equally important question to ask if you find that a spiritual based approach does not suit your lifestyle.    I’m sure you would agree that a Christian-based counselor may not be reasonably good fit for someone who considers themselves agnostic or atheist, or vice versa.   

What are the ages with whom you typically work?    This question seems obvious but is often neglected when interviewing a potential counselor.   You probably would not want a 7 year-old trauma victim to see a counselor who largely works with 20-50 year old adults.  

Do you prescribe medications?   Do you see medications as necessary in treating my problems?    Counselors do not prescribe, nor should they recommend medications for any of their clients as they are not trained or qualified to do so.    However, counselors should have reasonable training in the various pharmacological approaches to different mental health concerns and should be able to refer you to a medical doctor or psychiatrist if they believe such a referral would be beneficial to the client.

How do you track progress in treatment?    Treatment planning should occur at the very first meeting you have with your therapist, and goals should be addressed in every session thereafter.   In my experience, my clients generally report greater satisfaction with the counseling process the more specific they can be with their treatment goals.   These treatment goals should be reviewed during each session, and in theory, should frame the content of your sessions, and should match the agenda you bring to each session.  During the course of counseling, new issues may arise, and are opportunities to add to or modify your individualized treatment plan.   

Are you friends with any of your clients?      In every state in the union, counselors are strictly prohibited to have any other kind of personal relationship with their clients.   In the state of Ohio, there are strict rules for therapists not to enter into any kind of “dual role” relationship with their clients.    This would include “friending” any client in a social media format.

What other things can I be doing to help me with my problems, in addition to counseling?  Sometimes a therapist may not be able to schedule you right away to begin helping you with the problem for which you are seeking counseling.    In this case, the therapist might be able to point you to recommended readings, articles, or other ways that you might be able to being addressing your problem even before any formal sessions take place.  

Who does most of the talking in session?     How much advice can I expect from you?
There are as many different kinds of therapists as there probably are personalities in the world.    There is research to show that finding a therapist that best fits and complements your personality can have a significant impact on the outcome of the counseling process and your satisfaction with therapy.    Some therapists present a more authoritative, psycho-educational approach that some clients find appealing.   In these sessions, the therapist may do as much, or more of the talking, than the client.    Other therapists take a more person-centered or non-directive approach and largely let the client set the agenda, while the counselor actively listens and asks evocative questions to help guide the session.    There are  varying degrees of approaches in between.     Whatever your preference, the more information you can glean from the therapist in an initial over-the-phone consultation, the better informed you can be in making a choice with a positive outcome for yourself.  In my experience, clients that perceive an equal partnership in the therapeutic process typically derive greater satisfaction from it.   

Under what circumstances do you let a client know that you think counseling is not working for them and how do you do this?    Counseling may not benefit everyone.    If the therapist perceives the client may not be benefiting from counseling, or is simply stuck, it is incumbent on the therapist to inform the client of this and have a meaningful conversation about it.    Many times, this can overcome a therapeutic impasse and help the client move forward in their counseling goals.   At other times, this may lead to a referral to another professional or service where greater expertise or specialty may be needed.