Finding a therapist is part research project, part gut check. In a city like San Diego, you have plenty of choices, from La Jolla offices with ocean light to group practices in Mission Valley and telehealth therapists licensed across California. Choice is good until you’re staring at 30 similar profiles and a blinking cursor. The right questions can narrow the field, set expectations, and help you feel steadier as you walk into a first session.
I’ve sat on both sides of the room, as a clinician and as someone seeking help after a messy season. The first session often sets the tone. Clients who ask thoughtful questions tend to get what they came for faster, whether that is clarity in individual therapy, traction in couples counseling, or relief from a thicket of anxiety. Below are the questions that matter most, why they matter, and what the answers can tell you.
Start with fit, not perfection
People try to find the perfect therapist. That frame often backfires. Therapy works when there is steady rapport and a shared understanding of the problem and the path. You’re looking for a good fit: a therapist who understands your concerns, has tools suited to your goals, and feels like someone you can be honest with on a hard day. Fit is part credentials, part style, part practicalities like location and fees. It is also your personal comfort, which you may not fully gauge until you sit down together.
A few clients have told me they chose a therapist because the bio “felt human.” Others wanted strict structure and homework. Both are valid. Your job is to find someone who aligns with your preferences, not with a generic ideal.
What brings you in, in your own words
Before we get to the therapist’s answers, sharpen your own. Take a minute to write, in two or three sentences, why you’re seeking help. Name the problem and the impact. “I’m having panic symptoms at work and missing deadlines.” “We fight about money and shut down for days.” “After the pandemic and a loss, I feel flat and withdrawn.” If therapist san diego ca you are considering family therapy or pre-marital counseling, add who is involved and what success might look like.
You don’t need a textbook label. A grounded description helps the therapist give you a useful answer to every question that follows, especially when you are choosing among therapist San Diego options with varied specialties.
What is your training, license, and specialty?
This question is basic and indispensable. In San Diego and across California, you’ll mostly see licensed marriage and family therapists (LMFT), licensed clinical social workers (LCSW), psychologists (PhD or PsyD), and sometimes licensed professional clinical counselors (LPCC). All can deliver strong therapy. What matters is whether their training matches your concerns and their experience runs deep enough.
Ask: What license do you hold, and how long have you been practicing? What are your main areas of focus? If you’re seeking anxiety therapy, ask how often they treat anxiety disorders and what approaches they use. If you need grief counseling, ask about their experience with complicated grief or grief after specific events. For couples counseling San Diego has many therapists who focus on relationships; look for someone trained in evidence-based models like Emotionally Focused Therapy (EFT) or The Gottman Method. For anger management, ask if they offer a structured program with skills practice, not just talk.
Credentials don’t guarantee fit, but they keep you inside the right lane. A therapist who says “I work with everything” can still be excellent, yet you want clarity that your specific concerns are a weekly reality in their caseload.
Which approach do you use, and what will that look like in session?
Names like CBT, EMDR, ACT, EFT, and IFS mean different things in practice. The model matters less than how it shows up in the room. Ask the therapist to translate technique into your lived experience. “How will sessions feel for me?” The answer should be concrete. For example, in individual therapy for anxiety, cognitive behavioral therapy might include monitoring thought patterns and brief exposure exercises between sessions. Acceptance and Commitment Therapy often brings values work and mindfulness, with clear commitments you practice daily. If you’re considering EMDR for trauma, ask how they pace preparation and reprocessing, and what support they offer if symptoms spike.
For couples counseling, ask how they handle conflict in the room, whether you will have individual sessions as part of the process, and how they decide when to focus on communication skills versus deeper gridlocked issues like trust injuries or sexual disconnect. In pre-marital counseling, ask how they structure topics. Strong programs cover money, timelines for kids, in-law boundaries, sexual expectations, and conflict styles, plus a method for repair after fights.
A good sign: the therapist connects their model to your goals and describes the work with specificity. “We’ll identify your panic triggers, teach you three breathing techniques, and practice a short exposure this month” lands differently than “We will explore your anxiety.”
What does success look like, and how will we measure it?
Therapy is not a black box. It is a process with milestones. Measurement does not kill the soul of therapy, it protects the outcome. Ask what short-term change you might expect in four to six sessions. For anxiety therapy, you may look for fewer avoidance behaviors and a 20 to 30 percent reduction in symptom flare-ups. In grief counseling, you may not feel “better” quickly, but you might see more stable sleep, fewer numbing behaviors, and a bit more capacity to engage with your daily routines. For anger management, you might track a reduction in frequency and intensity of outbursts, along with increasing the time between trigger and reaction.
Ask how they track progress. Options include brief check-ins, validated measures like the GAD-7 for anxiety or PHQ-9 for depression, and simple behavior logs. Therapists who welcome feedback and data tend to adjust the plan faster when something stalls.
How long do sessions last, and what is the expected course of therapy?
In San Diego, a standard session is 50 minutes, though some offer 60 or 75 minutes, especially for couples counseling or EMDR. Clarify session length and whether extended sessions are available when needed. If your schedule is tight or you commute from North County or South Bay, travel time matters.
Ask for a rough timeline. Not a promise, a forecast. For focused individual therapy on a circumscribed issue, 8 to 16 sessions can produce clear gains. Complex trauma work, longstanding relational patterns, or co-occurring conditions can take longer. With couples counseling, expect 12 to 20 sessions for a solid reset if both partners are engaged, longer if affairs or substance use are in the mix. Pre-marital counseling often runs 6 to 10 sessions if you’re using a structured program.
Timelines vary. What matters is that the therapist can discuss dosage and reassessment points rather than leaving you in an open-ended drift.
What is your policy on homework and between-session contact?
Some change requires practice between sessions. Others need breathing room. Ask where the therapist stands. If you thrive with structure, you might prefer clear assignments and checklists. For anxiety therapy, that could include exposure tasks or journaling thought records. For anger management, you may practice time-outs, tracking early cues, and post-conflict repair. In grief counseling, therapeutic activities might include memory rituals, letters unsent, and gentle social reentry plans. If you dislike homework, say so, and listen for flexibility.
Also ask about contact between sessions. Many therapists in San Diego encourage brief check-ins by secure messaging for scheduling or quick updates, not ongoing coaching. Crises require a different plan. Ask what to do if you hit a wall on a weekend or at night. If your situation carries risk, the safety plan should be explicit and realistic.
How do you handle culture, identity, and values in the room?
San Diego’s neighborhoods hold real cultural diversity, from military families to immigrant communities, LGBTQ+ clients, surfers with seasonal work, and tech workers on heavy schedules. Therapy works better when the therapist understands context. Ask how they approach cultural humility and whether they have experience with your community. If faith or spirituality matters to you, ask how it will fit. If you are seeking family therapy, ask how they navigate generational and cultural differences without pathologizing them.
A grounded answer does not require perfect overlap in identity. It requires openness, training, and respect. You are checking for curiosity and a stance that centers your lived experience.
How will we handle boundaries and confidentiality?
Therapy confidentiality has clear limits. In California, therapists must act when there is risk of harm to self or others, suspected abuse of vulnerable populations, or certain court orders. Ask your therapist to walk you through their policies, not as a bureaucratic script but as a relational commitment. For couples counseling, ask about secrets. Some therapists keep no-secrets policies, meaning information shared individually that affects the couple will be brought into the joint work. Others manage secrets case by case, which can complicate trust dynamics. Know what you’re agreeing to.
If you are using insurance, ask what information will be shared with your plan and how diagnosis codes are handled. This matters for privacy and future underwriting, especially if you are considering life or disability insurance. If privacy is paramount, you may choose to self-pay even if it costs more. For some, the discretion is worth it.
What are your fees, billing practices, and cancellation policies?
San Diego therapy fees vary. In private practice, you might see rates from 140 to 250 dollars for individual therapy, 180 to 300 for couples counseling, sometimes higher in coastal areas. Group practices may cluster mid-range. Some therapists offer reduced-fee slots; ask if cost is a barrier. If you have out-of-network benefits, ask whether they provide superbills and how often. If you want to use in-network benefits, ask about availability and waitlists, since insurance panels are often full.
Clarify cancellation policies. The most common is a 24 to 48 hour window, with late cancellations billed at the full rate. Life happens. Ask how they handle emergencies and occasional conflicts, especially if your work or caregiving role is unpredictable.
Do you offer telehealth, in-person sessions, or hybrid?
Post-pandemic, many therapists in San Diego offer video sessions, some remain fully remote, and others returned to in-person with air filters and wider spacing. Ask which formats they support and whether you can mix them. If you plan to do couples counseling by telehealth, check whether your partner can reliably join from a private space. If you prefer in-person, ask about parking, accessibility, and office comfort. Small things matter when you’re doing vulnerable work. The feel of a waiting room, the quiet of the space, the chair that doesn’t squeak every time you shift.
What is your experience with my specific goals?
General competence is good. Targeted experience is better. Name your goal plainly and listen for specifics. A client once told me that the most reassuring moment in their consult was when the therapist said, “I see two or three clients a week with panic and public speaking fears. We’ll build a ladder of exposure assignments, and I can share a rough sequence today.” Confidence anchored in pattern recognition matters.
For family therapy, ask how they structure sessions with multiple voices, how they prevent triangulation, and how they keep the work moving when one member is hesitant. In pre-marital counseling, ask if they use assessments like PREPARE/ENRICH or Gottman’s Relationship Checkup, and how those results translate into practice. For grief counseling, ask about the difference between supporting a normal grief process and treating prolonged grief disorder, and how they decide which frame fits.
What is your stance on medication, and do you collaborate with prescribers?
Not everyone wants medication. Some do. Some benefit from a combined approach. Therapists Lori Underwood Therapy therapist cannot prescribe in California unless they are psychiatrists or certain medical providers. Ask how your therapist collaborates with prescribers, whether they can refer to trusted psychiatrists in San Diego, and how they coordinate care while protecting your privacy. If you are already on medication, ask how therapy will complement it. Clear collaboration reduces mixed messages and gaps.
What happens if we get stuck?
Every therapy hits friction. The difference between average and excellent therapy often shows in how the therapist handles it. Ask what they do when progress stalls. Do they revisit goals, change tactics, bring in consultation, or refer out when needed? An experienced therapist will not take offense at this question. They will tell you how they monitor outcomes and when they might suggest a different fit. That transparency gives you permission to speak up if the work starts to feel off.
How do you handle high-conflict couples or safety concerns?
If you’re seeking couples counseling and arguments escalate, ask how the therapist ensures safety in and out of session. In high-conflict cases, a therapist might pause conjoint sessions and bring in individual stabilization or referrals to anger management groups. If there is any violence or coercive control, ask for a safety assessment and a specialized referral. Traditional couples therapy is not appropriate when one partner is not safe.
Scripts that help during the consult
Some clients freeze during the consult call or first session. A few short prompts can keep you on track.
- “Here’s what brings me in, and here are two things I hope to change in the next month.” “Can you describe what our first four sessions would look like?” “What homework do you tend to give for this issue, and what does a light week versus a heavy week look like?” “How will we know this is working, and when would you suggest adjusting course?” “If you weren’t available, who else in San Diego would you recommend for this?”
These lines do two things. They give the therapist a clear brief, and they let you listen to how the therapist thinks, not just what they promise.
What to expect in session one
The first session is a structured conversation with room for your story. Most therapists begin with a brief review of consent, limits of confidentiality, and logistics. Then they ask for your account of the problem. Expect guided questions about timeline, triggers, strengths, and previous attempts to solve it. If you’re in couples counseling, the therapist will often track how you interact in real time, not to judge, but to understand patterns. In family therapy, the therapist will balance participation so that quieter members are heard and the most verbal member does not dominate.
A good first session ends with a shared map of the work. That might include an initial goal, a first skill to practice, and the next appointment scheduled. If you leave with a vague blur, ask for a clearer plan before you go.
Red flags and yellow lights
Not every mismatch is fatal. Some are fixable. Others mean you should keep looking.
Yellow lights: you feel mildly talked over, the therapist spends too long describing their method without tying it to you, or they seem fuzzy on logistics. You can address these directly in the moment: “Can we connect this to my panic at work?” or “Can we walk through fees and cancellations before we wrap?” Most therapists will adjust.
Red flags: the therapist dismisses your concerns, pressures you into long-term treatment without rationale, makes promises of quick cures for complex issues, or blurs boundaries around availability and payment. For couples counseling, a red flag is a therapist who openly takes sides without naming and correcting the process, or someone who downplays safety concerns.
A quick note on specializations common in San Diego
San Diego’s therapy landscape has pockets of expertise shaped by local life. Military families often seek therapists who understand deployments, reintegration, and Tricare. Surf culture brings seasonal work and injuries; some therapists have sports psychology backgrounds. Universities feed a steady stream of young adults seeking individual therapy for anxiety, identity questions, and early-career stress. Biotech and tech workers show up with high performance and high burnout. Knowing the local context lets you ask sharper questions. “How do you balance privacy and documentation with Tricare?” “Do you have weekday evening slots during the semester?” “How do you support clients who travel often for fieldwork?”
Cost and accessibility trade-offs
People ask whether they should choose a higher-fee private therapist or an in-network option with a waitlist. The answer depends on urgency, budget, and fit. If you are in acute distress, a higher fee to start now may save weeks of suffering and downstream costs. If finances are tight, look for group practices with sliding scales, community clinics, or counselors-in-training supervised by seasoned clinicians. Skilled trainees can deliver excellent care, especially for focused goals like anxiety therapy or grief counseling.
Telehealth can save time and allow more frequent sessions, but some clients do deeper work in person. Parking costs in certain neighborhoods add up. Decide what matters more right now: immediacy, format, or financial ease. There is no shame in choosing based on practical realities.
After the first session: how to evaluate fit
Don’t overthink the first appointment, but do debrief yourself while it’s fresh. Ask three questions:
- Did I feel seen and not judged? Do I understand the plan for the next few weeks? Can I imagine telling this person something I’ve never said out loud?
If you hesitate on all three, consider a second consult elsewhere. If you’re mixed, share that with your therapist. Name what felt off. A small adjustment in pace, structure, or focus can change your experience substantially.
Examples of questions tailored to common needs
For individual therapy targeting anxiety: “What exposure hierarchy might we build for my public speaking, and how will you support me between presentations?” For grief counseling after a recent loss: “How will we pace honoring my person and rebuilding routines without forcing closure?” For anger management: “What early cues should I track, and what specific de-escalation steps will we practice this week?” For couples counseling San Diego style, where schedules are packed: “Can we alternate 75-minute and 50-minute sessions to fit childcare, and what should we practice between sessions to keep momentum?” For pre-marital counseling: “How will you help us write a conflict repair script we both feel good about, and can we test it in a roleplay?”
Specifics reveal process. You are not just hiring empathy. You are hiring a method.
How therapists think about readiness and timing
From the clinician side, readiness is not perfection. It is a willingness to tell the truth about the problem and to try new behaviors, even if it feels awkward. If life circumstances are chaotic, therapy can still start. We might adjust frequency, shorten homework, or set micro-goals. If your partner is ambivalent about couples counseling, the therapist may begin with a structured commitment talk to clarify what attendance means and what change each person is willing to attempt.
Timing matters with grief. Early work centers on stability and permission, not forcing meaning. Timing matters with trauma. We build stabilization before processing. Timing matters with pre-marital counseling. Starting three to six months before the wedding gives you time to practice, not just learn.
You can change course
Therapists expect clients to shop around. It is not disloyal to switch if the fit proves wrong. Ideally, you tell your therapist what isn’t working and ask for referrals. A good therapist will help you transition and may even suggest colleagues better suited to your goals. Therapy is your investment. Protect it.
A compact checklist for your consult
Keep this near your phone when you make that first call.
- License, years in practice, and specialty relevant to your goals Approach in action, described in plain language with examples Session length, frequency, expected duration, and homework stance Fees, insurance or superbills, cancellation policy, telehealth options What success could look like in 4 to 6 sessions and how you’ll measure it
If you cover these five, you will have enough data to decide whether to book that first session or keep calling.
Final thought
Therapy is a human craft. The right therapist balances structure with warmth, insight with practical steps. In San Diego, you have choice, from seasoned clinicians downtown to focused specialists in North Park, Point Loma, and beyond. Ask clear questions, listen for specificity and steadiness, and trust your sense of whether this is someone you can do honest work with. The goal is not to impress each other. It is to build a working alliance that moves your life in the direction you want, whether that is steadier mornings, fewer fights, or a way to carry grief without dropping everything else.
Lori Underwood Therapy 2635 Camino del Rio S Suite #302, San Diego, CA 92108 (858) 442-0798 QV97+CJ San Diego, California