How to Choose a Therapist: Questions to Ask Before Your First Session
Finding a therapist can feel strangely like online dating, minus the awkward bill-splitting. You scroll through profiles, read phrases like "warm, collaborative, evidence-based," and try to guess whether a stranger in a headshot will understand the hardest things you have ever tried to say out loud. It is no wonder many people put off the search for months, or even years. If you are asking yourself how to choose a therapist, and how to know you picked the right one, this guide is for you.
I'm Dr. Matthew McKeithan, a licensed clinical psychologist with 15 years of experience. I have also sat on the client side of the couch, so I know both views of the process. In this article I'll walk you through what to look for when you find a therapist, the questions worth asking before your first session, the red flags to watch for, and what to expect when you begin. If you live in Pleasanton or anywhere in the Tri-Valley and want a therapist you can meet by secure video, I'll cover that too.
Key takeaways
The relationship between you and your therapist is one of the strongest predictors of progress, so fit matters as much as credentials.
Check the basics first: license, training, and experience with the specific problem you want help with.
A short consultation call is a low-pressure way to test the fit before committing to a full session.
Good therapists welcome your questions, explain their approach, and do not promise quick fixes.
It is okay to switch therapists if something does not feel right. That is a normal part of finding good care.
Why choosing well matters
Therapy works for most people who commit to it, but not every therapist is the right match for every person. Research on the "therapeutic alliance," the bond and shared sense of purpose between client and therapist, has found that it consistently predicts how well therapy works, across different methods and different problems. In other words, feeling understood is not a nice extra. It is part of the treatment.
That is good news, because it means you have more power than you think. You are not being evaluated in the first session. You are evaluating, too, and your gut reaction is useful information.
Step one: get clear on what you want help with
Before you start searching, spend a few minutes naming what is bringing you in. You do not need clinical language. "I am anxious all the time," "I keep fighting with my partner," "I cannot focus at work," or "something happened and I cannot stop thinking about it" are all excellent starting points.
Knowing your main concern helps you look for someone with relevant experience. A therapist who has worked extensively with trauma will approach things differently from one who primarily helps with career transitions. If you are dealing with several concerns at once, which is very common, that is okay. A good therapist will help sort out what comes first.
Step two: check credentials and training
In California, licensed providers include psychologists, marriage and family therapists, clinical social workers, and professional clinical counselors, along with psychiatrists who can prescribe medication. You can verify a license through the state licensing board's online lookup, and you should feel comfortable doing so.
Beyond the license, ask about specialized training. If you are looking for help with trauma, for example, you might ask about experience with EMDR, trauma-focused CBT, or somatic approaches. If you want help with focus, ask about ADHD experience. Training in an approach matters more than a long list of buzzwords.
Step three: ask the right questions
Many therapists offer a brief phone or video consultation. Here are questions that tend to be genuinely useful:
"How do you work with people who are dealing with what I'm dealing with?" You are listening for specifics, not just general reassurance.
"What approaches do you use?" Look for clear, plain-language answers, such as CBT, ACT, EMDR, or somatic work.
"What does a typical session look like?" Some therapists are structured, others more open-ended. Neither is wrong, but one may suit you better.
"How will we know if it's working?" A good therapist talks about goals and checks in on progress.
"How often do we meet, and for how long?" It helps to understand the commitment up front.
"What are your fees and policies?" Ask about session cost, cancellations, and payment. My practice is private pay, so I explain this clearly at the start.
A confession from the other side of the couch
Psychologists spend a lot of time on the other side of the therapy room during training, and I was no exception. I can tell you that I did not click with the first therapist I tried. Nothing was wrong with him. We simply did not fit. I remember feeling guilty about leaving, as if I had failed a test, and it took me a minute to realize that I was allowed to say, "This is not quite right for me." The second therapist I met made all the difference.
Plato wrote that "the beginning is the most important part of the work." I think that applies here. The work you do in finding the right person is not wasted effort. It is the foundation of everything that follows.
Red flags worth taking seriously
Most therapists are ethical and caring, but it is worth knowing the warning signs. Consider looking elsewhere if a therapist:
Guarantees a cure or promises results in a specific number of sessions.
Dismisses your concerns, interrupts frequently, or makes you feel judged.
Shares too much about their own life or makes sessions about themselves.
Pressures you into decisions, such as leaving a relationship or job.
Is vague about their training or avoids your questions.
Does not respect boundaries around confidentiality, scheduling, or touch.
If something feels off, trust that feeling. You do not owe anyone an explanation for choosing a different provider.
Green flags that suggest a good fit
On the other side, look for a therapist who listens carefully, reflects back what you said accurately, explains things in clear language, and invites feedback. Good therapists are comfortable with questions like "Is this working?" and respond with curiosity rather than defensiveness.
You may also notice small signs of safety: you feel a bit more relaxed by the end of the session, you feel understood even when the conversation is hard, and you leave with something to think about or try. It is normal to feel nervous in a first session. What matters is whether the person across from you helps you feel a little steadier.
What the first session will probably look like
The first full session is mostly about understanding you. Expect questions about what has been happening, how long it has been going on, your history, relationships, work, sleep, and any past therapy or treatment. You can share as much or as little as feels right. Good therapists do not rush you into the deepest material.
By the end, you should have a rough sense of what the work will look like, what the first few sessions will focus on, and what you can do between sessions. If you are not sure, say so. "I need to think about whether this is the right fit" is a perfectly good response.
Tri-Valley therapy by secure video: Pleasanton, Livermore, Dublin, and beyond
If you live in Pleasanton, you may be used to the commute along I-680 or I-580, and you probably know how quickly a therapy appointment can swallow an afternoon. Secure video therapy removes that cost. You can meet from your home in Pleasanton, Dublin, Livermore, San Ramon, or Danville, or from any private space in California.
A systematic review by Greenwood and colleagues found comparable outcomes between video-based and in-person psychotherapy for the conditions they examined. Video is not right for everyone or for every situation, and we would talk about that openly, but many people find that the comfort and convenience helps them stick with it.
What if it is not the right fit?
Switching therapists is common and not a failure. If you have been working with someone for a few sessions and feel stuck, you can bring it up directly. Sometimes naming the issue improves the fit. If it does not, a good therapist will help you transition to someone who may suit you better.
Give the process a fair chance, usually a few sessions, but do not stay in a relationship that feels wrong simply because you are worried about hurting someone's feelings. They will survive. Their job is to help you get what you need.
What you can try this week
Write your goal in one sentence. Keep it simple and honest.
Pick two or three providers to contact. You do not need to interview twenty.
Schedule a short consultation. Treat it as a conversation, not a commitment.
Jot down your questions. Use the list above.
Notice how you feel afterward. That is data.
Taking the first step is often the hardest part. Once you are in the room, or on the screen, you may find that you are relieved you started.
Your next step
Choosing a therapist is a big decision, and you do not have to make it alone or in a hurry. If you would like to see whether we are a good fit, Book a free 15-minute consultation or schedule a full session. You can also browse more articles on the Your Kind of Happy blog.
About the author
Dr. Matthew McKeithan, Psy.D., is a licensed clinical psychologist licensed in California and South Carolina, with 15 years of experience working extensively with trauma. He provides integrative, trauma-informed counseling for individuals and couples, including CBT, ACT, EMDR, somatic work, and DBT-informed individual therapy. He is a husband and father of four. Sessions are offered by secure video across California. Learn more about Dr. McKeithan.
Serving Pleasanton, Livermore, Dublin, San Ramon, Danville, and the Tri-Valley by secure video, along with clients across California.
This article is for educational purposes and isn't a substitute for an individual evaluation, therapy, or medical advice. If you are in crisis, call or text 988.
Sources
Flückiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy. 2018;55(4):316-340.
Greenwood H, Krzyzaniak N, Peiris R, et al. Telehealth versus face-to-face psychotherapy for less common mental health conditions: systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health. 2022;9(3):e31780.
Plato. Republic, Book II.