New Therapist: best things to ask at first appointment?
June 2, 2014 10:02 PM   Subscribe

What kinds of things should I be asking about/finding out while I'm shopping around for a new therapist?

I have a list of things I'm looking for in a therapist, know what treatment modalities I'm hoping they'll use, know what problems I hope to address, etc. but I am having trouble making these into questions that can easily be asked when we first meet.

Whenever I've "shopped around" before, I looked at it as a 'gosh, will they be willing to take me on as a patient', not 'what will I get out of this, as the consumer'. As a result, I ended up seeing a lot of people who were bad matches for me for short periods of time, or people who did things that were unsafe or not useful for me that I hadn't know to check for, and asking basically no questions in the initial interview.

Now, I find myself saying a lot of vague things like "How do you with patients?" instead of concrete questions that express what I really want to know. If you have had this experience, what kinds of things did you ask that were helpful in teasing out a good doctor? What kinds of things should I think of that I'm not thinking of to prepare? It would be great to have a list to take with me for my next appointment.

I'm also interested in getting an updated/more correct diagnosis than the one I already have (or at least check off ticky boxes with my current symptoms or something), but I have no idea how to bring this up. Would that be a thing taken care of in the intake?

Also, do therapists always make you pay for the first face-to-face meeting? I know phone consults are often free, but it seems like this varies a lot.

Thank you for your answers in advance. I thought I knew a lot more about this than it turns out I actually do.
posted by anonymous to Health & Fitness (5 answers total) 17 users marked this as a favorite
So to start, the word "therapist" can mean a lot of different things, and its meaning also changes depending on what country/state you're in. It can mean a social worker, a psychiatrist (a specialized medical doctor), a psychologist, or someone with religious training. Since you're using the word 'patient' and 'diagnosis', I'm guessing you mean a psychiatrist. There are certain advantages and pitfalls to seeing any of these professions.

This is important because you want to know where your therapist is coming from, in terms of theory and approach, and this what you need to ask about. The more educated you about therapy, the better your questions will be. One way to start is to look up various therapuetic frameworks or theories and at least read their Wikipedia entries (e.g. Gestalt, CBT, DBT, solutions-based, strengths-based, psychoanalysis, narrative, Jungian analysis, etc).

More important than that however, is how you feel with them, and how they make you feel. It is literally a therapist's job to make you feel comfortable (at first, anyway). If you can't build what's called a "therapeutic alliance", then nothing is going to happen for you. A great sign is if they ask if they can make you feel more comfortable (glass of water, the lighting, the temperature). You need to feel safe and listened to. If you don't feel that way, you should say so. A good therapist will respond and validate your concerns and attempt to address them.

So here's a grab-bag of questions you can ask (some of these need to be asked towards the end of the session):

What theories/frameworks do you use? Why those theories and not others?
(You're looking for why they think it's effective, not what they personally like)

While researching about this, there are so many new techniques and ideas, how do you stay abreast of all this knowledge?
(looking for "attending training, conferences, reading")

I've read that [X THERAPY THAT YOU ARE NOT PLANNING TO USE] is sometimes indicated for [PROBLEM I HAVE], what are you thoughts about this?

What role do you think medication plays in mental health
(You're looking for an answer like "it depends". Some psychiatrists think "non-compliance" to medication regimens is tantamount to revolt)

I know everyone is different, but what is the time-range for this therapy to show effectiveness?

Have you treated anyone with issues similar to mine? What was the outcome? What ingredients were the cause of that success/failure?

How will we measure progress?

When do you start thinking about termination (ending the relationship), and what will that look like?
(e.g. will it be a shared decision, is there a set number of visits and then review etc).

End of list.

By the end of the first visit, you should be feeling good about yourself, and have a decent idea about what the next 6 sessions will look like. Talk therapy is a hugely developing field, and as such there is great variance in quality of practitioners.

This bit is my biased opinion, but if you want a diagnosis and medication, go see a psychiatrist. If you want talk therapy, generally avoid them. All psychiatrists, by virtue of being medical doctors, have a major handicap in becoming good therapists. They have spent most of their formal training understanding the human body as a machine, from a Descartian mind/body separation point of view.

Anyway, good luck.
posted by Pertz at 11:44 PM on June 2, 2014 [4 favorites]

Pertz's advice is spot on and probably as comprehensive a list of questions that you would be able to ask and get good answers to in a typical 45 min to one hour session. I would also ask how the treatment plan is developed, if objectives are measurable, and what your role in that process is.

In answer to your question about should you be paying for the first session, my experience in the US as a therapist is that it is very unusual for a professional to commit to an hour long office session without payment, and probably unreasonable for you to expect that to happen. I'm always willing to spend a few minutes on the phone with a potential client if they have questions as to my credentials/experience or to answer basic questions about modality, although, my answers, given that I know little about the client, have to be somewhat vague with some disclaimers. You should be able to make a tentative decision based on this information.

Good luck...and, good for you for approaching this in a careful and thoughtful manner.
posted by HuronBob at 5:37 AM on June 3, 2014

Adding to Pertz's list, I'd also ask about your therapist's background and any specialties they might have in addition to their therapeutic philosophies/methods, especially if you're looking to confirm a specific diagnosis. While seeing a specialist for a particular disorder can be great, you also want to make sure that they're not approaching you and your symptoms with too narrow a focus as this could lead to a potential misdiagnosis.

Don't be afraid to bring up that you're not sure of your current diagnosis either. Knowing about your past therapy experience will help your next therapist with how they approach treatment.

Best of luck.
posted by Tulip503 at 6:49 AM on June 3, 2014

When the therapist is on vacation/otherwise unreachable, who will provide coverage? (There have been previous AskMes where the posters are in the midst of personal crises/prescription refill hiccups/other issues, and are unable to get in contact with their provider.) With regard to appointments -- you can ask if phone or Skype sessions are an option, if that's something that appeals to you. Here's a checklist or two, as well as a previous Ask with links.
posted by Iris Gambol at 7:18 AM on June 3, 2014

This is a great question. I think you have a good mindset that you want to evaluate the therapist as a match for you as much as the other way around.

The only thing I can answer is that yes there is a charge for the first appointment. They shouldn't charge you for a 10-minute phone call to establish if they do what you're looking for, are taking new patients, etc., (and you can probably ask a lot of Pertz's questions in that time). But the first appointment (the "intake") is not free.
posted by radioamy at 9:54 AM on June 3, 2014

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