Therapy Questions Every Therapist Should Be Asking
Therapy Questions Every Therapist Should Be Asking
Therapy Questions Every Therapist Should Be Asking
Asking
Beata Souders, MSc., PsyD candidate
3
11-02-2020
The ultimate goal of talk therapy is to enable the process of psychological and emotional healing
along the continuum from the problematic toward a sense of greater mental wellbeing.
Although we often come to therapy with a problem, we also come as persons who want to be heard
and understood, who want to feel like we matter, who wish to learn self-compassion, and who want
to find partnership in helping us heal and see ourselves and our life situation in a different light.
I would rather have questions that can’t be answered than answers that can’t be questioned.
Richard Feynman
Progress in a therapeutic relationship cannot be made unless the client feels safe to speak his or her
mind, and it is on the practitioner to create that climate of openness and transparency.
The process also often requires the clinician’s willingness to work diligently to help clients
understand what they want, the patience to help them learn to own all aspects of themselves,
including contradictory feelings, and the ability to create a safe space to allow for transformation to
occur.
Most of what happens in talk therapy are accomplished through the skillful use of questions, but
only second to a lot of active listening.
This article surveys different approaches to asking therapeutic questions meant for both
practitioners and their clients and gives examples of how the quality of questions we ask can
improve our lives.
Ideally, the first therapy session should be a form of positive inception so the practitioner can set
the stage for future interactions. Carl Rogers used to say that the therapist must create an
environment where everyone can be themselves (1961).
Courage doesn’t happen when you have all the answers. It happens when you are ready to face the
questions you have been avoiding your whole life.
Shannon L. Alder
The very first question in therapy is usually about the presenting problem or the chief complaint for
which the client comes to therapy, often followed by an exploration of the client’s past experience
with therapy, if any, and his or her expectations of future outcomes of therapy.
For clients who need encouragement in opening up, it may be helpful to remark on their bravery in
seeking therapy.
For those who are at the other extreme and go into a lengthy and detailed explanation of their
issues, perhaps having been in therapy before, it is best to listen empathically first before
complimenting them on how well they appear to know themselves, and how they have thought a lot
about what they would like to talk about in therapy.
2. Have you ever seen a counselor before?
For those who are in therapy for the first time, observing how comfortable and confident they are in
talking about the challenges in their life can help set the stage for further disclosure.
It may be helpful to set some expectation of what is going to happen in the therapeutic process by
explaining how asking questions is at the core of the process and reassuring the client that they
should feel free to interrupt at any time and to steer the conversation to where they need it to go.
If the client has seen a counselor before, it can prove very valuable to inquire further about their
previous experience in therapy by asking about frequency, duration, and issues discussed during
their previous engagements, as well as, what is one thing they remember most that a former
counselor has told them.
An important aspect for gaging clients’ engagement in the process of therapy is asking them about
what went right, or what didn’t turn out the way they would have liked in their previous therapeutic
engagement, as this can point to where they place the sense of responsibility for their situation.
Inquiring if the client achieved the results they sought, and if they have been successful in
maintaining them outside of the therapeutic relationship can also provide valuable insight into their
motivation for change.
Establishing a mutual agreement and setting expectations for the engagement is crucial to making
progress. Clients’ goals and preferences for the form and the level of interaction need to be taken
into consideration.
Some clients like to vent and have the counselor listen; others want a high level of interaction and a
form of spirited back and forth. It is also important to inquire how the client learns best and if they
like to receive homework.
Other examples of questions that can point to the tone and the flow of future communications can
be fashioned after the following:
4. How many meetings do you think it will take to achieve your goals?
5. How might you undermine achieving your own goals?
6. How do you feel about using good advice to grow from?
7. How will we know when we have been successful in achieving your goals for therapy?
Therapy Intake Questions to Ask Patients
Many aspects of clients’ lives can influence their engagement and progress in therapy. Having a
clear picture of clients’ physical health and daily functioning is often a part of the initial intake.
Questions about preexisting medical conditions, current and past treatments, medications, and
family history are essential to the effective assessment of needs and the successful provision of
therapeutic treatment.
Although most therapists do not prescribe medication, many often partner with other medical
professionals by making recommendations, particularly in instances where clients have been
referred for therapy. A complete adult intake form is included below and can be a useful guide for
some of the issues that may require further exploration.
Patient’s name:
Interpret
Self Father Mother Son Daughter Spouse
er
Problem
s:
Check any mental or emotional problems which you have:
Learning problems (needed special classes in school, learning disabilities, slow learner, brain
damage)
Trouble concentrating
Violent behavior
Memory problems
Other:
Bipolar (Manic
Autism Seizure Disorder Mental Retardation
Depressive)
Family History:
If widowed, when?
If you were born outside the USA, when did you come to this country?
Educational History:
Educational
HS Grad GED Assoc Bach Masters Doc.
degrees:
Vocational History:
What types of work have you done (i.e., labor, cashiering, gardening, teaching, construction, etc.):
What was the longest time you stayed at a job?
Medical History:
List any medical (not psychiatric or behavioral) problems which you have been diagnosed with:
For what
Medication Dose (m.g.) Times per day problem
?
Have you ever had surgery? List your age when you had surgery and the reason below.
Reaso
Age:
n:
Have you ever been hospitalized overnight for medical reasons other than surgery? List your age when you
were hospitalized and the reason.
Reaso
Age:
n:
If yes, list your age when you were hospitalized and the reason.
Reaso
Age:
n:
Has a doctor ever prescribed medication to you to help with depression, anxiety, behavior, or mental
problems (such as Ritalin, antidepressants, etc.)
Type of medication?
Legal problems:
How many times have you been arrested or charged with a crime?
Never 1 2 3 4 5 or more
How old were you the first time you were in trouble with the law?
Every
Few times a week Few times a month Once a month or less Never
day
Has drinking alcohol ever caused problems for you? (other people tell you to drink less, legal issues,
relationship problems)?
If yes, which
Marijuana Cocaine PCP Sniff glue/paint Heroin
ones?
Amphetamin Barbituat
LSD Other:
es es
Daily Functioning:
I still drive
Are you able to shower, bathe, and groom yourself without help?
Are you able to pay bills, and keep track of money without help from other people?
One such approach can be found in vastly popular notebooks that provide inspirational therapy
quotes, or reflective writing prompts that get our cognitive wheels spinning.
The most important questions in life can never be answered by anyone except oneself.
Another important form of self-inquiry is to ask yourself those questions that we can’t answer
honestly in the presence of anyone else, those probing and burning questions that we can often only
answer for ourselves. They may require some reflection, some examination of values, and perhaps
some writing, if only to organize one’s thoughts.
assessing our life satisfaction – tools like the Wheel of Life (accessible via the linked post)
or one of the many Happiness Assessments are a great place to start
exploring meaning in our lives – our masterclass in Meaning and Valued Living is a great
place to start
defining our values – value exploration exercises
finding character strengths – VIA Strengths Assessment
visualizing goals – SMART goal setting, tracking how we invest our time with Experience
Sampling Method (ESM), or Miracle Question (included below)
cultivating gratitude – Three Good Things exercise
practicing forgiveness – Empty Chair Technique (included below)
making bucket lists.
Another category of useful questions is those that we can use to motivate ourselves. For example,
Appreciative Inquiry type of questions focuses on strengths and the propelling power our past
successes can have on self-efficacy and motivation toward goal pursuit.
Think back through your career. Locate a moment that was a high point, when you felt
most productive and engaged. Describe how you felt, and what made the situation
possible.
Without being humble, describe what you value most about yourself and your work.
Describe your three concrete wishes for your future.
Describe the most energizing moment, a real “high” from your professional life. What made
it happen?
How do you stay professionally affirmed, renewed, enthusiastic, and inspired?
Sometimes, however, self-therapy will feel like chasing our tail, particularly for those who already
live in their heads a bit too much and may feel a bit stuck.
The most important questions to ask ourselves at this point are those that allow us to evaluate
whether we should be reaching for help and if our situation would warrant considering therapy:
How do we cope with those unfavorable odds? Through acceptance, the practice of active
listening, and the realization that relational conflict is an opportunity for growth.
The need to be right prevents us from actively listening to each other. Communicating fundamental
acceptance instead of rejection of the other person’s personality is therefore basic to all effective
problem-solving.
Active listening requires practice and comes down to moving from self-informed certainty to
curiosity about the other person. It helps to adopt “And Stance” where both stories are valid, the
world is complex, both partners can get angry, both contribute to the situation, and both are doing
their best.
According to John Gottman, couples can improve their odds of having a productive talk by:
finding things in common (he recommends having good Love Maps of each other)
getting to know each other’s flexible and inflexible areas for negotiations
offering to help meet the core needs of another person, and finally
if gridlock seems unavoidable, figuring out if we need a temporary compromise (2015).
What often happens in couple therapy is an equivalent of the two people getting to know each other
in a different way, improving communications, and learning that conflict can be an opportunity for
growth.
When a family seeks counseling, the questions focus on the relationship’s dynamics, everyone’s
met and unmet needs, and goals for the relationships. Assessing these factors, while it may seem
complicated at first, is nevertheless worth the time. Dysfunctional communication patterns within
the family can be identified and corrected through teaching family members how to listen, ask
questions, and respond non-defensively.
The genogram is one such tool used in family therapy. It’s mostly a family tree that provides a
visual representation of three to four generations and explores how patterns or themes within their
families influence their current behavior and identifies whether relationships in the family have
been close, distant, or ridden with conflicts.
It asks about family values, beliefs, and traditions, characteristics or habits of family members,
particularly those relevant to your role: health issues, alcohol, and drug use, physical and mental
health, violence, crime and trouble with the law, employment, education. See Simple Guide to
Genograms.
The following questions may also help explore the family background and family dynamics:
Who is important to you in your life? Why are these particular people important?
Who provides the most support in your life?
How have members of your family reacted to the problems that you are currently
experiencing?
Are members of your extended family aware of what you have been experiencing?
What was it like growing up in your family?
Perhaps you could talk about some of the memories, both good and not so good.
What is it like for you right now – living in your family?
How do you think your family might describe you? What qualities or strengths might they
say you have?
Are there members of your extended family that you feel close to or feel that you have
something in common with?
Did you feel safe in your family?
How does your family handle disagreements?
Is it okay to express your emotions in your family? To feel happy, sad, frustrated, angry,
content, etc.?
Tell me about your different family members and how they express their emotions.
Were there times when you were worried about any of your family members? Why were
you worried? How were these concerns handled?
What qualities do you bring to your family that is special or unique?
Were there any special activities that you did together?
Did your family mix with other families?
What other information would you like me to know about your family that will be helpful
during our time together?
While it is fun for the children, it also allows the adults to regress for a moment and get down to the
level of being playful and spontaneous. In the end, we find out that after all, we don’t know as
much as we thought we did about the most important people in our lives.
The below family conversation starters can be used in a family therapy session as well as at home.
They can and should be personalized in a way that is age-appropriate and has a specific goal in
mind; be it to bring family members together, to help them communicate effectively, to express
their emotions, and move toward constructive problem-solving.
Another great activity known as ‘What will they say?’ is for family members to be able to guess
what another family member will say in response to a question (Lowenstein, 2010).
It allows not only for the family members to get to know each other better, but also to develop
skills in asking each other questions, understanding that there are things that are similar between
family members and things that are different, and finally to make a point that family members,
especially parents, may not know about each other as much as they think they do.
Create at least 20 questions, such as:
To use these games effectively, it helps to make sure the questions connect to a family goal, the
game can move reasonably quickly giving everyone a turn in short order, and to end the session on
a high note. Finally, many of the existing games, especially games and activities the family is
already familiar with, can be adapted to provide an opportunity for a meaningful conversation.
As our teens grapple with discovering their identities and setting directions for their lives, this
presents an excellent opportunity to set standards for a self-reflective and inquisitive mind that is
open to honest discussions and not afraid to ask questions.
As the saying goes, if we ask good questions, we get better answers. Below is a list of questions
most frequently used in therapy with pre-teens to young adults, and which anyone might find
interesting:
One assessment tool that is particularly useful in work with young people with complex needs is
the ecomap. It is a visual representation of current family relationships and also community and
social networks where clients are encouraged to identify whether their relationships with their
peers, school, social clubs, professionals, are strong, weak, or stressful. See Queensland
Government Interview Resource – Ecomap.
Just as in individual therapy, clients often enact the same tendencies they bring to all their other
relationships, and the client interaction within a group can often be a good reflection of how they
show up in the relationships with other people in their lives (Yalom, 1983).
While the therapist is trained in delivering structure for the discussion and guiding the questions,
the biggest benefit lies in the exchange between participants. Leaders within the group are usually
appointed and tasked with looking for commonalities among members and encouraging everyone
to be supportive of each other.
Most group therapies are done in a round-robin discussion format. Rules of conduct are established
and adhered to, roles assigned for leaders of the group, and room set up usually in a circle to
encourage collaboration and everyone having a voice. Questions used in group therapy often focus
on very much the same themes as individual therapy and include the reasons for being there and the
expectations for the future:
Why don’t we start by spending a few minutes talking about the benefits of group therapy
and what groups are about?
Let’s go around and have each member tell us what you expect to get out of the group
Where else might you have been at this moment if you hadn’t come to this group session
today?
What might you have chosen to do?
Is it your own decision to come here, or did someone else encourage you to do so?
How do you feel about coming here each week?
What do you like best about this session?
Is there something you don’t enjoy about this group session?
Are you particularly looking forward to anything?
Depending on the purpose of the group, be it anger management, bereavement, substance abuse,
etc., the content and the topics of discussion may vary. Although in a typical session several topics
and questions are provided, group leaders need not ask all questions or address all topics; instead,
questions and topics should be selected as they relate to what is happening in the group. Some
general questions could include:
Homework assignments and progress logs can be used between sessions, and educational material
and handouts may be distributed. Many sessions start with reviews of progress and end with a recap
of the activities.
A Take-Home Message
The value of deep, probing questions need not be reserved for the therapy session. There is no
reason why we can’t have more of this type of healing conversations in our lives, but it is both an
art and science and requires some practice. We can all get better at asking questions we want
answers to, and applying the therapeutic approach to the process of self-discovery can prove a
worthwhile endeavor.
The scientist is not a person who gives the right answers, he’s one who asks the right questions.
Claude Levi-Strauss