Questions to Ask a Trichotillomania Therapist Before Booking

Booking help for hair pulling can feel like a big step, whether it’s for you or your child. A short conversation first tells you a lot about whether a practitioner is right for you, and asking questions is completely normal.

This checklist gives you the questions to ask a therapist about trichotillomania (trich), what good answers sound like, and the red flags to watch for. It works the same way whether you’re contacting a psychologist, counsellor, psychotherapist, hypnotherapist or coach. There’s a printable version near the end.

Why ask questions before you book?

Because experience with hair pulling varies a lot between practitioners, and you deserve someone who understands it. Trich is a body-focused repetitive behaviour (BFRB), one of a group of conditions where people repeatedly pull, pick or bite at their own hair, skin or nails. Most research on treating it has happened since the 1990s, and surveys keep finding that many practitioners had little training in it.

A few questions up front can save you time, money and the draining experience of explaining trich to someone who doesn’t take it seriously. They also show you how it feels to talk to this person, which matters: a review of nearly 300 studies found the working relationship between client and therapist is closely linked to how well therapy goes.

What should I ask a therapist about trichotillomania?

Ask about three things: their experience with hair pulling, how they’d work with you, and the practical details. You don’t need to ask every question below. Pick the ones that matter most to you and note the answers.

Their experience

1. Have you worked with people who pull their hair before? Roughly how many?
2. What training have you had in hair pulling or other BFRBs?
3. Are you registered or licensed with a professional body? Which one?

How they’d work with you

4. How would you work with my pulling, step by step?
5. What does the research say about your approach for hair pulling?
6. What would I do between sessions?
7. How will we know if it’s working?

Practical details

8. How often would we meet, and roughly how many sessions do people usually need?
9. Do you offer sessions online, in person or both?
10. What do sessions cost, and what’s your cancellation policy?
11. Will I need to show you where I pull?

If you’re weighing up video sessions, our guide to online therapy for trichotillomania covers the pros and cons.

Our guide to what trichotillomania therapy costs explains typical fees and insurance.

Which answers are good signs?

Good answers are clear, specific and about pulling itself, not only stress or anxiety in general. You’re looking for someone who understands how trich works, has a plan, and is open about what they can and can’t promise.

For reference, approaches built on Habit Reversal Training (HRT) have the most research behind them for hair pulling. HRT teaches you to notice when you’re about to pull and to do something else with your hands instead. A 2026 review of around 30 trials found that therapies including habit reversal did better than those without it.

Many practitioners combine HRT with other methods, such as acceptance and commitment therapy (ACT), which helps you make room for urges without acting on them, or the ComB model, which matches a strategy to each thing that drives your pulling. Other approaches, including hypnotherapy and coaching, have less research behind them for trich, and some people find them helpful. Whatever someone offers, they should be able to explain it.

Our guide to Habit Reversal Training explains how it works step by step.

You can read more about the ComB model in our plain-English guide.

What are the red flags?

Think twice, and ask more, if a practitioner:

• Promises to fix it for good, or guarantees a result in a set number of sessions. There’s no cure for trich, and nobody can promise an outcome.
• Calls it a bad habit, attention-seeking or a lack of willpower. Trich is a recognised condition, not a character flaw.
• Suggests anything that hurts, stings or punishes you. Pain and punishment add shame, and shame tends to feed pulling.
• Tells you to just stop, without a plan for what to do instead.
• Pushes you to show your hair loss before you’re ready, or makes you feel judged about it.
• Gets vague or defensive when you ask about their experience or approach.
• Asks you to pay for a long block of sessions upfront with no point where you review progress together.
• Brushes off your physical health, for example if you mention swallowing hair or sore, broken skin.
• Hasn’t heard of trich and shows no interest in finding out more. Someone new to hair pulling can still be a good fit if they take it seriously and are keen to learn.

One flag doesn’t always rule someone out, so ask a follow-up if you’re unsure. If something still feels off, it’s fine to keep looking.

What if I’m booking for my child?

Ask how they’ll involve you and how they adapt their approach for your child’s age. The NHS lists encouragement from family as one part of treatment for trich. Your role should be steady and supportive, never policing.

Useful extra questions:

• Have you worked with children or teenagers who pull? Which age groups?
• How will you involve me, and how much time will my child spend with you alone?
• How do you make sessions work for a child my child’s age?
• What should I say, or not say, at home when I notice pulling?
• Can you help us talk to school if we need to?

Good signs are a practitioner who talks to your child directly, lets them help set their own goals, and gives you a calm part to play. A red flag is anyone who suggests telling your child off or punishing pulling.

Behaviour therapy has been tested in children too, though the research is small-scale. In a 2011 trial of 24 children and teenagers aged 7 to 17, three in four of those who had 8 weekly sessions of behaviour therapy improved a lot, compared with none of those who had a few brief check-ins instead.

For support at home while you look, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

How do I ask without feeling awkward?

Treat it like any other enquiry. Practitioners expect questions, and a good one will be glad you asked.

• Email first if a call feels like too much.
• Keep your opening short, for example: “I pull my hair and I’m looking for someone who understands trichotillomania. Before I book, could I ask a few questions?”
• Share only what you want to. A sentence or two about your pulling is enough.
• Make notes so you can compare people afterwards.

If you’d like to know what happens once you’ve booked, our guide to what happens in trichotillomania therapy walks through the first session and beyond.

Printable checklist

Print this, or keep it open on your phone, when you call or email.

Questions to ask before you book

• Have you worked with people who pull their hair before? Roughly how many?
• What training have you had in hair pulling or other BFRBs?
• Are you registered or licensed with a professional body?
• How would you work with my pulling, step by step?
• What does the research say about your approach?
• What would I do between sessions?
• How will we know if it’s working?
• How often would we meet, and for roughly how many sessions?
• Online, in person or both?
• What do sessions cost? What’s your cancellation policy?
• Will I need to show you where I pull?
• For parents: how will you involve me, and how do you adapt things for my child’s age?

Print this checklist

When should I reach out for help?

Whenever pulling is causing you distress, taking up a lot of your time, or getting in the way of work, school or relationships. You don’t need to wait until it’s “bad enough”.

Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory and use the questions above when you get in touch.

Our guide to finding someone who understands trich explains where else to look and what training to look for.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call your local emergency number or go to your nearest emergency department.

• Find a helpline (international directory) (findahelpline.com)

Questions people ask

Sources

1. Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J., Walther, M.R. & the Trichotillomania Learning Center-Scientific Advisory Board (2006). The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. Journal of Clinical Psychiatry, 67(12).
2. Capel, Petersen, Woods, Marcks & Twohig (2024). Mental health providers’ knowledge of trichotillomania and skin picking disorder, and their treatment. Cognitive Therapy and Research, 48(1), 30–38.
3. Flückiger, C., Del Re, A.C., Wampold, B.E. & Horvath, A.O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55, 316–340.
4. Fisak, B., Shorb, C., Patel, D. & Ezcurra, V. (2026). The efficacy of psychotherapeutic and pharmacological interventions for trichotillomania: A review and meta-analysis. Journal of Psychiatric Research, 197, 264–274.
5. Franklin, M.E., Edson, A.L., Ledley, D.A. & Cahill, S.P. (2011). Behavior therapy for pediatric trichotillomania: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 763–771.
6. International OCD Foundation (2019). Finding the right therapist.
7. International OCD Foundation. Body-focused repetitive behaviors (BFRBs).
8. NHS. Trichotillomania (hair pulling disorder).