In my experience as a psychologist, effective therapeutic questions don’t come from a prepared list. Both therapist and client should enter their first session of therapy with an open mind.
Good therapy process dictates that getting a feel for one another will emerge spontaneously, without a script. In fact, following a rigid list of questions too closely might interfere with this process.
Can you go into a first session with a plan? Sure! A therapist might enter the first therapy session with a list of important questions to address. Similarly, a client might be prepared with some ideas of what they want to discuss.
That’s great. But the most effective therapy questions are open-ended, come from careful listening, and flow from the natural unfolding interaction. This means that both parties might be surprised by session’s end about what they discuss and how they discuss it.
Additionally, questions about specific mental health symptoms are necessary, but can often be lacking in their ability to reveal meaningful information about a person you are meeting for the first time. Yes, it is important as a therapist to ask mental health questions that hone in on possible diagnoses while ruling out others.
For example, you want to ask questions which help you understand whether your client experiences symptoms of anxiety, depression, mania (or hypomania), or psychosis. You want to inquire about suicidal thinking and behavior. It is also important to get a sense of whether someone shows signs of an ‘Axis II’ (DSM-V) personality disorder.
However, in this article I try to help the reader understand the kinds of therapeutic questions that get clients reflecting on underlying thoughts, feelings, and experiences. In my experience, curiosity and reflection are the qualities that drive a strong therapeutic process.
Sometimes, clients enter therapy already possessing these abilities. When that is the case, they often volunteer such information without even being asked. But oftentimes, effective therapy questions help stimulate greater reflection that leads to insight and growth.
Therapeutic questions in a first therapy session should be open-ended. We are looking to learn, not coming in with with the assumptions that we already have the answers. Although there can be times in a first session that a closed question (yes/no) can be useful in narrowing down possibilities, this is the exception rather than the norm.
So, after telling you to avoid prepared lists, here are 5 therapeutic questions that every therapist should ask you in the first session. But its not the questions themselves that are significant. It’s why we ask them that matters.
Let’s dive in…
5 Therapeutic Questions Every Therapist Should Ask
1. What brings you here today?
This sounds like such an obvious therapy question. And it is. But this question is as important for what it doesn’t say as what it does. Notice there is no use of the word “problem.” Why assume that it is a problem(s) that brings a client to therapy?
My point is that although this is often the case, we don’t want to make assumptions about why someone is here. We want to let our clients tell it it us in their own way without predisposing them to be problem-focused. I also think of the response to this question as the first in a Wordle game. What they include and what they leave out provides clues about where we might go next in our session.
2. How do you imagine therapy might be of help to you?
This is a therapeutic question that assesses clients’ perceptions of how the process of therapy will benefit them. I ask this type of therapy question because I want to understand how a client imagines therapy will help them.
Are they focused on learning skills, techniques, and solutions? Or are they more interested in the curative effects of an empathic, attuned therapeutic relationship? Do they perceive the process of therapy (how they and their therapist interact) to be most important? Or are they more focused on outcomes? The language a client uses to answer this question will tell me a lot about their personality and the kind of therapy experience and approach that would be the best fit.
3. What concerns do you have about starting therapy?
When new clients imagine the pros and cons of therapy, some unfortunately focus more on negative fears or concerns. For example, they may be afraid about feeling exposed, vulnerable, or judged by their therapist. I find that these concerns are often what is referred to as projections. This means that what they fear others will think and feel about them is what they actually think and feel about themselves. Answers that have this type of theme may be indicative of issues with shame, which are a difficult but important emotion to address in therapy.
4. Tell me about any previous experience with therapy. Why are you interested in working with me now?
Previous therapy experience can be very revealing. If a client has previously seen a therapist(s), I’m always curious to learn what the experience was like for them. What did they like and dislike? How did they fit with their therapist? Where was the relationship a poor fit? How did this past therapeutic relationship influence what they are looking for in a therapist now? I find in particular that how a client talks about their previous therapist can tell me a lot about how they relate (or wish to relate) with others.
Regardless of whether one has past therapy experience, their interest in working with me can also be quite illuminating. Clients do varying degrees of preparation before choosing a therapist to meet with. Perhaps they read my profile or a piece of content that I wrote. Maybe they watched an informational video that I was in. What was it that engaged them? Was it something about my specialties or approach to treatment? Was there something in my tone or non-verbals that they felt comfortable with?
These same questions apply after a client has made initial contact, but prior to the first session. There is always some degree of interaction before a first session, whether it is by phone or email. This process can have a meaningful degree of impact in a client’s decision to work with me. Understanding these important and sometimes subtle influences and reactions can tell me a lot about the person I am meeting with.
5. What are your strengths? Where do you get stuck?
The psychoanalyst and attachment researcher Jeremy Holmes describes mentalizing (e.g. holding mind in mind) as “seeing yourself from the outside and others from the inside” (Allen, Fonagy & Bateman, 2008). Let me be clear. I view such a competency as a therapeutic mastery more typically associated with experienced therapy clients rather than ones just getting started. But when I ask clients about their strengths and growth edges, I’m curious about their ability to step outside of themselves and look at themselves from the outside in.
What is their ability to do this? How do they describe their strengths? How do they describe their growth edges or challenges? What they share can tell me a lot about the degree of self-awareness that they possess. Or, in the same vein, their answers can inform me about where they have room to grow.
You’ve had a chance to sample five therapeutic questions often asked in a first therapy session. The most effective therapy questions tend to be open-ended ones. More importantly, I’ve shared with you my underlying rationales for asking these questions. Keep in mind that the easiest part is always the initial question. The greater challenge is listening carefully and asking good follow-up therapeutic questions based on the always unique and subjective responses that you get.
Now that you’ve learned more about the role of the first session in therapy process, read more about related therapeutic issues.