This month, we explore the questions clients should — and can — ask in the first consultation, but often don’t.
How will you ensure you understand and respect my beliefs, values, and background?
It’s perfectly OK to ask your therapist this question. Regardless of their therapeutic approach, every therapist needs to respect their client’s beliefs, values and background. You may have come across the term Unconditional Positive Regard, which originates from Rogerian person-centred counselling. This nonjudgmental attitude is one of the key principles of therapeutic work.
I would only add that if you happen to be expressing harmful views that stigmatise others or signal abuse and harm, your therapist – still respecting your humanity – should be able to softly, skillfully and with care explore the impact of those statements on others.
How will you ensure confidentiality?
It’s perfectly OK to ask that too. It’s still surprising to me how many therapists openly discuss their clients in public. We have all probably read those troubling stories from public transport and pubs! Such examples of privacy and confidentiality breaches make it even more important for us to ask our prospective therapist about how they ensure confidentiality. For example, when I qualified, I quit drinking to ensure client confidentiality. I have firm rules with myself on not discussing client work in public and only bringing it to relevant conversations (supervision, therapy, line management meetings).
What types of interventions have you found most effective for clients with similar issues?
When clients come to therapy, they are facing a new person, a stranger, really. Asking for a few examples of work may ease our initial anxiety. It’s not uncommon to shop around for a good therapist, so it’s OK to ask for examples of interventions or practices that you might find helpful.
Have you ever worked with clients who have had negative experiences in therapy before? How do you rebuild trust?
This is a very important question because it normalises that we are all different and not every therapist is a good fit. It also signals to us how the therapist can handle difficult conversations – in counselling, we refer to this skill as congruence. Stating the hard truths of a relationship is critical to safe holding of us in the therapeutic space. Those difficult conversations don’t have to be heavy. A small level of discomfort and interpersonal conflict can feel challenging, but it is the therapist who needs to model how to resolve those conflicts. Additionally, you want to know if this person will take care of your needs.
Do you have experience working with people of my culture, gender identity, or background?
There is no golden rule around this, and our needs may differ across our life span. You may want to work with a therapist who shares some aspects of your identity. For example, I work with a lot of migrants who manage complex cultural situations. However, it can also be helpful to sit with someone who represents and, more importantly, can hold the difference in the room. I work with men, and those male clients report feeling understood regardless of our gender difference. A good therapist will find a balance between celebration of similarities (without making assumptions that they “get you”) and bridging of differences.
Can you share how you continue your professional development and stay updated on best practices?
Therapists need to be in continuous training to keep up with the latest science in psychology and related fields. You can ask about this. Additionally, you may learn more about your prospective therapist’s interests and passions, which can ease those initial worries and anxieties a bit.
If I feel uncomfortable or disagree with your approach, how should I raise that with you?
This question links to the congruence I have mentioned earlier, but also to your rights as a client. One of the key ethical values we honour as therapists is clients’ autonomy. However, when we feel mentally depleted, unwell or in crisis, we can struggle to share our worries about the actual counselling process. First thing I would say is this: if you are in therapy and feel that you cannot be honest and authentic about this with your therapist, I wonder if you are actually feeling safe? What is getting in the way of speaking up? Please remember that you have the right to make complaints to your counsellor and they will need to respond, make adjustments and honour your preferences. That’s a critical part of their job. And if they don’t, then maybe it’s a confirmation that they are not the right fit for you?
How do you set and maintain boundaries in the therapeutic relationship?
What you want to hear here is the explanation of how the therapist remains professional. You want to hear the rules about contact outside of sessions (mostly, it is a big no!). You want to hear rules around channels and content of communication (mostly, we recommend only sharing personal information and stories about your mental health in sessions, not over email or text). You want to know how to react if you bump into your therapist in public – how will they react if you do not disclose the fact that you are accessing their support?
What’s your process for handling missed appointments or emergencies?
This is an important question because every therapist has their own rules. Some therapists charge a full fee for missed appointments. Others may charge a small fee to secure that slot or not charge in case of emergencies. Some therapists only charge for attended sessions. You need to be aware of those rules and anything else related to money and invoicing before you commit and sign the agreement. In fact, a good counselling agreement will outline those rules in print clearly.
I hope this list is a good start to encourage your confidence in asking difficult questions of your prospective therapist. This way, you are honouring your future self, who will be coming to those sessions to heal and to explore the possibility of living well.
