Starting therapy is one of the best decisions you can make. It’s also one of the most vulnerable. You’re about to sit across from a stranger and talk about the parts of your life that are hardest to talk about. The least you can do for yourself is make sure that stranger is actually a good fit.
The questions to ask a therapist before committing aren’t about being picky. They’re about being smart. A therapist who specializes in anxiety but has no experience with trauma isn’t the right match if trauma is what brought you in. A therapist who only works evenings won’t help if you need morning sessions. And a therapist whose personality clashes with yours will make an already difficult process harder than it needs to be.
Think of the first conversation as a two-way interview. They’re assessing whether they can help you. You’re assessing whether you want them to. Both of those evaluations matter equally.
Here are 15 questions organized by theme. Most therapists expect these during a consultation call, so don’t feel awkward asking.
Before Your First Contact
Getting organized before you reach out to a therapist makes the process smoother and helps you ask better questions.
- Clarify what you’re looking for help with. You don’t need a diagnosis. Just a general sense of why you’re seeking therapy: anxiety, depression, relationship issues, grief, work stress, life transitions. This helps you match with someone who specializes in your area.
- Check your insurance benefits. Call the number on the back of your insurance card and ask about mental health coverage. How many sessions per year? What’s the copay? Do you need a referral? Is there a deductible you need to meet first? These details matter.
- Decide on format preferences. In-person, virtual, or either? Individual, couples, or group? Morning, afternoon, or evening? Knowing your logistical needs narrows the search significantly.
- Gather a short list of potential therapists. Use your insurance directory, Psychology Today’s therapist finder, or ask your primary care doctor for referrals. Aim for 3 to 5 names so you have options.
- Prepare a brief summary of your situation. Two to three sentences. You’ll repeat this during consultations, and having it practiced makes those initial calls less stressful. You don’t have to share everything. Just enough for the therapist to assess fit.
Approach and Specialization
1. What’s your therapeutic approach, and how do you typically work with clients?
This is the most important question on the list. Therapists use different methods, and the approach matters. Cognitive Behavioral Therapy (CBT) focuses on changing thought patterns and behaviors. EMDR is designed for trauma processing. Psychodynamic therapy explores how past experiences shape current patterns. DBT teaches emotional regulation skills. Acceptance and Commitment Therapy (ACT) focuses on psychological flexibility.
You don’t need to become an expert in therapy modalities. But you should understand, in plain language, what sessions will actually look like. Will you be given homework? Will you mainly talk freely, or will sessions be more structured? A good therapist explains their approach in a way that makes sense to someone who’s never been in therapy.
2. Do you have specific experience with my issues?
A therapist who lists “anxiety” on their profile might see one anxious client a month. Another might build their entire practice around anxiety disorders. There’s a significant difference in expertise.
Ask specifically: “How many clients have you worked with who have [your issue]?” and “What kind of outcomes do you typically see?” You want someone who has seen your situation before, not someone who’ll be learning alongside you.
3. Are you licensed, and what’s your specific credential?
This matters more than people realize. Licensed therapists have completed graduate education, supervised clinical hours (typically 2,000 to 4,000), and passed state licensing exams. Common credentials include LPC (Licensed Professional Counselor), LCSW (Licensed Clinical Social Worker), LMFT (Licensed Marriage and Family Therapist), and PsyD or PhD (psychologists).
Each has a slightly different training background. None is universally “better” than the others. What matters is that your therapist is licensed in your state and in good standing. You can verify this through your state’s licensing board website. If someone can’t or won’t tell you their license number, end the conversation.
4. Do you have experience working with people of my background or identity?
Cultural competence isn’t optional. If your identity, whether related to race, ethnicity, sexuality, gender, religion, disability, or any other aspect of who you are, plays a role in what you’re working through, your therapist needs to be equipped to understand that context.
This doesn’t necessarily mean they share your identity. But it means they’ve done the work: training, supervision, lived experience, or a combination. Ask directly. A therapist who’s comfortable with this question is more likely to be competent in this area. One who gets defensive probably isn’t.
Logistics and Structure
5. What does a typical session look like, and how long does it last?
Standard therapy sessions are 45 to 50 minutes (the “therapeutic hour”). Some therapists offer 60 or even 90-minute sessions, especially for EMDR or intensive trauma work. Know what you’re signing up for.
Beyond timing, ask about structure. Do sessions start with a check-in? Is there a recap at the end? Will the therapist set an agenda, or is it more free-flowing? Some people thrive with structure. Others need space to go where the conversation takes them. Your preference matters.
6. How often will we meet, and how long do clients typically stay in therapy?
Most therapists recommend weekly sessions, at least at the start. Some issues benefit from twice-weekly work. Others can be managed with biweekly sessions once you’re stable.
As for duration, it varies enormously. CBT for a specific phobia might take 8 to 12 sessions. Processing complex trauma could take a year or more. Ongoing maintenance therapy for chronic conditions might continue indefinitely. Your therapist should give you a realistic estimate based on your specific situation, not a vague “it depends.”
7. Do you offer telehealth sessions, and how do they compare to in-person?
Telehealth therapy has become mainstream, and for many people it’s just as effective as in-person work. It eliminates commute time, works for people in rural areas, and can feel less intimidating.
That said, some therapists and some modalities work better in person. Body-based therapies, EMDR, and couples therapy can lose something through a screen. Ask your therapist’s honest opinion about whether telehealth is appropriate for your situation, not just whether they offer it.
If you do telehealth sessions from home, a white noise machine placed outside your door provides sound privacy so you can speak freely without worrying about being overheard by family members or roommates.
8. What’s your cancellation policy?
Most therapists charge for missed sessions or late cancellations (under 24 to 48 hours notice). Fees typically range from $50 to the full session rate. This is standard practice, not a red flag. But you should know the policy before you book.
Also ask about their policy for emergencies and illness. A reasonable therapist will have some flexibility for genuine emergencies while maintaining boundaries that keep the therapeutic relationship consistent.
Confidentiality and Boundaries
9. What are the limits of confidentiality?
Everything you share in therapy is confidential, with a few important exceptions required by law. Your therapist must break confidentiality if you’re an imminent danger to yourself or others, if they suspect child or elder abuse, or if a court orders disclosure.
Beyond the legal requirements, ask about practical confidentiality: How are your records stored? Who has access? What happens if you run into each other in public? What if a family member calls asking about your treatment? These details help you feel secure about the privacy of the space.
10. How do you handle communication between sessions?
Some therapists are available by email or text for brief check-ins. Others maintain strict boundaries and only communicate during session time. Neither approach is wrong, but you should know what to expect.
Also ask about crisis situations. If you’re in a mental health crisis between sessions, what should you do? A good therapist will have a clear protocol: call 988, go to the nearest ER, contact a crisis text line, or call their emergency line. They should give you this information before you ever need it.
Fees and Insurance
11. What are your fees, and do you accept my insurance?
Therapy costs vary widely. In-network copays range from $20 to $75 per session. Out-of-network rates run $100 to $300+ per session, depending on the therapist’s credentials, location, and specialization. Psychologists and psychiatrists typically charge more than counselors and social workers.
If a therapist is out-of-network, ask if they provide superbills (detailed receipts you submit to your insurance for partial reimbursement). Many PPO plans reimburse 50 to 80% of out-of-network mental health services after you meet your deductible.
12. Do you offer a sliding scale or reduced fee?
Many therapists reserve a few spots in their caseload for reduced-fee clients. Sliding scales are typically based on income, and rates can drop to $40 to $80 per session. If money is a barrier, ask. The worst they can say is no.
If a therapist you really want to work with doesn’t offer sliding scale, ask if they can refer you to someone with similar expertise who does. Good therapists have good referral networks.
Progress and Fit
13. How do you measure progress, and how will I know therapy is working?
“How will I know it’s working?” is a question most people wonder about but few ask. A good therapist sets collaborative goals with you early in the process and checks in on them regularly. Maybe it’s a reduction in anxiety symptoms. Maybe it’s better communication with your partner. Maybe it’s sleeping through the night consistently.
Progress isn’t always linear, and there will be hard weeks. But you should see some measurable movement within 6 to 8 sessions. If you’re three months in and nothing feels different, it’s time to discuss what’s not working.
14. What happens if I feel like therapy isn’t working or we’re not a good fit?
This is the question people are most afraid to ask, and it’s the one that matters most for your comfort. A confident therapist will welcome it.
The honest truth is that not every therapist-client relationship works. Chemistry, communication style, and approach all play a role. A good therapist will tell you: “If we’re not the right fit, I’ll help you find someone who is.” That’s not failure. That’s good care.
If a therapist reacts defensively to this question, take that as information. You want someone who prioritizes your progress over their ego.
15. Can I do a consultation call before committing to a full session?
Most therapists offer a free 15 to 20 minute consultation call. Use it. This is your chance to ask the questions on this list, get a feel for their communication style, and gauge whether you feel comfortable.
You should walk away from that call with a clear sense of whether this person could work for you. If the vibe is off, it’s off. Trust that instinct and keep looking. The right fit is worth the search.
What to Bring to Your First Session
Your first session will be more productive if you come prepared.
- Insurance card and payment method. Confirm payment logistics before the session starts so you can focus on the actual work.
- A brief summary of why you’re seeking therapy. You don’t need a script. Just a general sense of the main issues you want to address. “I’ve been struggling with anxiety that’s affecting my work and relationships” is plenty to start.
- Any relevant medical history. Current medications (especially psychiatric medications), past diagnoses, previous therapy experiences, and any medical conditions that affect your mental health.
- Your goals for therapy. What does “better” look like for you? Even a rough idea gives your therapist something to work with. “I want to manage my anxiety without it controlling my daily routine” is more useful than “I want to feel better.” A therapy journal can help you clarify your thoughts before sessions and track progress between them.
- Questions you still have. If your consultation call didn’t cover everything on this list, bring the remaining questions to your first session.
- An open mind (and realistic expectations). The first session is mostly intake and rapport-building. You’ll share your history, discuss goals, and start building the therapeutic relationship. Deep work usually begins in session two or three.
Typical Cost Range and Factors
Mental health care costs are a real barrier for many people. Here’s what you can expect so you can plan.
In-Network Therapy (with insurance): $20 to $75 per session copay, depending on your plan. Some plans require you to meet a deductible first, which means paying the full session rate (often $100 to $200) until you hit that number.
Out-of-Network Therapy: $100 to $300+ per session. Psychologists and psychiatrists tend to charge $150 to $350. Licensed counselors and social workers typically charge $100 to $200. Location matters: rates in major cities are higher.
Out-of-Network Reimbursement: If your PPO plan covers out-of-network mental health, you may get 50 to 80% reimbursed after your deductible. Ask your insurer about your “out-of-network outpatient mental health benefit.”
Sliding Scale Therapy: $40 to $100 per session, based on income. Available from many private practice therapists and community mental health centers.
Community Mental Health Centers: $0 to $50 per session on sliding scale. Wait lists can be long (2 to 8 weeks), but these are an essential resource for people without insurance or with limited income.
Online Therapy Platforms (BetterHelp, Talkspace, etc.): $60 to $100 per week for unlimited messaging and weekly sessions. More affordable than traditional therapy, but therapist matching can be hit-or-miss, and these platforms have faced criticism around data privacy.
Psychiatry (medication management): $200 to $500 for an initial evaluation, $100 to $250 for follow-up medication management visits. Psychiatrists prescribe medication. Most therapists do not.
What Drives Cost Up: Out-of-network providers, specialized modalities (EMDR, DBT groups), doctoral-level clinicians, urban locations, and therapists with niche expertise or long waitlists.
What Drives Cost Down: In-network providers, community mental health centers, sliding scale fees, graduate training clinics (supervised students offering therapy at $10 to $50 per session), and group therapy (which typically costs 50% less than individual sessions).
Red Flags vs. Green Flags
| Red Flag | Green Flag |
|---|---|
| The therapist guarantees specific outcomes or timelines (“I’ll cure your anxiety in 6 sessions”). | The therapist sets realistic expectations and acknowledges that progress varies by person. |
| They share personal opinions about your life decisions, religion, or politics unprompted. | They maintain professional boundaries while creating a warm, non-judgmental space. |
| Confidentiality limits aren’t explained, or they seem vague about privacy practices. | They clearly outline confidentiality and its exceptions in the first session or consultation. |
| They discourage you from seeking a second opinion or consulting with other providers. | They support collaboration with your primary care doctor, psychiatrist, or other providers. |
| Cancellation or billing policies are unclear, hidden, or seem punitive. | Fees and policies are transparent, provided in writing, and discussed before treatment begins. |
| You consistently leave sessions feeling worse without any explanation or processing of why. | Difficult sessions happen, but your therapist helps you understand why and how it connects to your growth. |
| They push a single approach rigidly, even when it’s clearly not working for you. | They’re willing to adapt their approach, try different techniques, or refer you to someone better suited. |
Money-Saving Tips
- Use your insurance mental health benefits. Under the Mental Health Parity Act, most insurance plans must cover mental health treatment comparably to physical health. Check your plan’s specific benefits for outpatient therapy.
- Ask about sliding scale fees. Many therapists offer reduced rates based on financial need. It’s a standard practice in the field, and there’s no shame in asking.
- Try graduate training clinics. University counseling programs operate clinics where graduate students provide therapy under close supervision. Sessions cost $10 to $50, and the quality is often excellent because supervisors review every case.
- Consider group therapy. Group sessions typically cost $40 to $80 per session (compared to $100 to $200 for individual) and can be equally effective for issues like anxiety, depression, grief, and social skills. Many people find the peer support component uniquely valuable.
- Use your HSA or FSA. Therapy copays and out-of-pocket costs are eligible HSA/FSA expenses. Paying with pre-tax dollars saves you 22 to 37% depending on your tax bracket.
- Submit superbills for out-of-network reimbursement. If your therapist is out-of-network, ask for a superbill after each session. Submit it to your insurance for partial reimbursement. Many people don’t know this option exists and leave money on the table.
- Check your Employee Assistance Program (EAP). Most employer EAPs offer 3 to 8 free therapy sessions per issue, per year. These can help you get started while you sort out longer-term arrangements. The sessions are confidential and separate from your insurance.
- Ask about reduced-fee initial sessions. Some therapists offer the first session at a reduced rate (or free) as a trial. It reduces your financial risk while you evaluate fit.
Quick Reference Checklist
Print this and use it during your consultation call or first session.
Approach and Specialization
- What’s your therapeutic approach?
- Do you have specific experience with my issues?
- Are you licensed, and what’s your credential?
- Do you have experience with my background or identity?
Logistics and Structure
- What does a typical session look like, and how long is it?
- How often will we meet, and how long do clients typically stay?
- Do you offer telehealth?
- What’s your cancellation policy?
Confidentiality and Boundaries
- What are the limits of confidentiality?
- How do you handle communication between sessions?
Fees and Insurance
- What are your fees, and do you take my insurance?
- Do you offer sliding scale or reduced fees?
Progress and Fit
- How do you measure progress?
- What happens if therapy isn’t working or we’re not a good fit?
- Can I do a consultation call before committing?
Glossary
CBT (Cognitive Behavioral Therapy): A structured, goal-oriented therapy that focuses on identifying and changing negative thought patterns and behaviors. Typically shorter-term (12 to 20 sessions for many issues). Strong evidence base for anxiety, depression, OCD, and insomnia.
EMDR (Eye Movement Desensitization and Reprocessing): A therapy designed to help process traumatic memories. It uses bilateral stimulation (often guided eye movements) while you recall distressing events. It’s evidence-based for PTSD and is increasingly used for anxiety, phobias, and grief.
Sliding Scale: A fee structure where the session cost is adjusted based on your income and ability to pay. A therapist who charges $150 per session might offer a sliding scale range of $60 to $150. It’s a common and accepted practice in mental health care.
Superbill: A detailed receipt your therapist provides that includes their license number, diagnosis codes, procedure codes, and session dates. You submit this to your insurance company for out-of-network reimbursement. Not all therapists provide superbills automatically, so you may need to request one.
Therapeutic Alliance: The collaborative relationship between you and your therapist. Research consistently shows that the quality of this alliance is one of the strongest predictors of therapy outcomes, sometimes more important than the specific modality used. If the relationship feels right, the work tends to go better.
Helpful Tools and Resources
Writing between sessions helps you process emotions, track patterns, and prepare topics for your next appointment. A structured therapy journal with guided prompts can be especially helpful if you're new to journaling.
Many therapists recommend specific books as supplements to therapy. Having a few well-reviewed mindfulness or CBT workbooks on hand gives you practical tools to practice outside of sessions.
Essential for telehealth therapy sessions at home. Place it outside your door for sound privacy, so you can speak openly without worrying about being overheard. Also helpful for sleep and general anxiety management.
- Psychology Today Therapist Finder (psychologytoday.com/us/therapists) - The most widely used directory for finding therapists. Filter by insurance, specialty, approach, and location. Most therapists list whether they offer free consultations.
- 988 Suicide and Crisis Lifeline (988lifeline.org) - Call or text 988 for immediate crisis support, 24/7. Free, confidential, and available in English and Spanish.
- Open Path Collective (openpathcollective.org) - A nonprofit network of therapists who offer sessions for $30 to $80. You pay a one-time membership fee of $65, then access reduced-rate sessions with vetted, licensed therapists.
- SAMHSA Treatment Locator (findtreatment.gov) - Find local mental health treatment facilities, including community mental health centers that offer sliding-scale care.
Frequently Asked Questions
How do I know if I actually need therapy?
If you’re asking the question, you probably do. That’s not meant to be glib. Therapy isn’t only for people in crisis. It’s for anyone who wants to understand themselves better, manage stress more effectively, improve relationships, or work through something that’s been stuck. You don’t need to wait until things are unbearable to get help. In fact, starting earlier typically leads to faster progress.
What if I cry during my first session?
You probably will, and that’s completely fine. Therapists expect it. Their office has a box of tissues for a reason. Crying in therapy isn’t a sign of weakness. It’s often a sign that something important is being accessed. Let it happen.
How long does it take to find the right therapist?
For many people, the first therapist they try works out. Others consult with 3 to 5 before finding the right match. The consultation process usually takes 1 to 3 weeks. It can feel frustrating, but it’s worth the effort. A strong therapeutic fit accelerates your progress significantly compared to sticking with a mediocre match.
Can I switch therapists if my current one isn’t working?
Absolutely. It’s more common than you’d think, and no good therapist will take it personally. If possible, discuss your concerns with your current therapist first. Sometimes the issue can be resolved. If not, ask them for referrals. They’ll often know colleagues who might be a better fit for what you need.
Is online therapy as effective as in-person?
For most issues, research shows comparable outcomes. Online therapy is particularly effective for anxiety, depression, and stress management. It may be less ideal for severe trauma work, crisis situations, or conditions that benefit from in-person nonverbal observation. The biggest factor isn’t the format. It’s the quality of the therapeutic relationship.
Next Steps
You’ve done the research. Now take the step.
Pick two or three therapists from your shortlist and schedule consultation calls. Most are free and take 15 to 20 minutes. Use the questions from this checklist. Pay attention to how you feel during the conversation. Do you feel heard? Comfortable? Hopeful? Those feelings matter more than credentials on paper.
After your consultations, choose the therapist who felt like the best fit and schedule your first session. Show up, be honest, and give the process a real chance. Most people feel noticeably better within 6 to 8 sessions.
Starting therapy is an act of courage and self-respect. You’re investing in yourself, and that’s never a bad investment. The hardest part is making the first call. Everything after that gets easier.