80% of the therapists suck, and most of the ones that don’t suck don’t have the skills or training to deal with the particular needs of most patients. If you have a first session with a therapist and feel like you don’t click, you don’t trust them, they’re not listening, etc, don’t make a second appointment. You’ll be wasting everybody’s time trying to make that work.

Ask your therapist if it’s okay to audio-record sessions (if they say no to this, run away as fast as you can and don’t look back). Don’t stop recording (or pretending to record) until you feel truly safe with them. In your first session, ask them “Under what circumstances would you call the police or emergency services on me?” and get the answer from them in writing. Never ever use the words, “suicide,” “kill,” or “die” before getting a sane answer from them. Make sure your therapist understands the basic difference between suicidal ideation and suicidal intent.

Finding a good therapist is hard. Don’t use psychologytoday, most of the Ts on there who are taking new patients in person are good-for-nothing hacks who don’t have the training or expertise they say they do. I’ve had great luck so far with the two therapists I’ve seen at a large non-profit agency operating off of grants from a nearby university and the state (which also offers many other individualized mental health services intended to be an alternative to hospitalization, all of which are free or very cheap). They assigned me based off of their individual specialist skills and they’ve actually both been very competent at helping me with my unique set of debilitating issues.

There really are therapists who really won’t call the police on you. My current therapist strongly believes the current clinical norm of calling police on patients for having feelings is an extremely abusive and exploitative violation of trust and basic medical ethics. She’s been working for many years now and hasn’t yet felt the need to make such a call. My therapist and I have an agreement that she won’t do it unless I’m making active, immediate, and direct threats to harm myself or someone else. But I can talk about recent incidents of self-harm and extreme suicidal thoughts, feelings, and fantasies without worrying about her going behind my back.