Therapy Questions for Adults: 200 Questions by Session Phase

Most pages of therapy questions for adults are written for clients choosing a therapist, or for one school of therapy. This one is for the clinician in the other chair. Below are about 200 questions to copy, one per line, grouped by when you'd use them: the first session and intake, building the alliance, assessment (mood, sleep, alcohol and drugs, relationships, work, health, trauma and strengths), risk, five approaches (CBT, solution-focused, motivational interviewing, person-centered and ACT), check-ins, progress reviews, a stuck or quiet session, ending a session and ending therapy. Before the lists comes the part most pages skip: how to ask, one question at a time, open or closed, at what pace, and with cultural humility.

The questions are for licensed clinicians working with adults, 18 and over, in outpatient or private practice. For clients of about 12 to 17, our therapy questions for teens article adds what parents hear, school and adolescent cut-offs.

Every client in this article is invented. Any resemblance to a real person is a coincidence.

How to ask: one question at a time

Adults usually arrive with a story ready, and too many questions can bury it. A handful of habits does more than any list of therapeutic questions to ask clients:

Pacing by phase

How many questions you ask, and which kind, changes over the course of therapy:

Example: a stacked question, and the rewrite

Invented client: Rosa, 41, in her third session for work stress and poor sleep.

The stacked version:

The rewrite:

Why it works: one question at a time, the client chose where to start, every answer got a reflection, and a thought surfaced ("he'll see I can't cope") that the CBT or ACT questions further down can work with.

Cultural humility in your questions

Hook and colleagues defined cultural humility as an interpersonal stance that is other-oriented rather than self-focused, with respect for the client's cultural background and no sense of superiority toward it. In their studies, clients who rated their therapist higher on cultural humility reported a stronger working alliance and more improvement in therapy (Hook and colleagues, 2013). In practice: ask instead of assuming, and let the client define which parts of their background matter, whether that's race, ethnicity, faith, sexuality, gender, disability, class, language, immigration or the town they grew up in.

The DSM-5-TR Cultural Formulation Interview (CFI) is a set of 16 questions in four areas: how the client and the people around them define the problem; what they believe caused it, and the context and support around it; how culture shapes coping and past help seeking; and what shapes help seeking now, including the relationship with you. The American Psychiatric Association lets clinicians reproduce it for use with their patients, but not change it, so use the original form when you want its exact wording. These questions, in our own words, work in the same spirit:

Listen for: words for distress that differ from clinical ones ("nerves," "stress," "a spiritual problem"), family or faith supports you can build on, and past experiences with services that make trust slower.

First-session and intake questions

The intake form and the first session do different jobs. The form collects facts the client can write down at home; the session is for what needs a conversation. Our therapy intake form article covers what goes on the form, and the biopsychosocial assessment example has every assessment area with a full report. Before the questions, go over confidentiality and its limits, fees and cancellations, how to reach you and what happens in an emergency; our informed consent example has wording to adapt.

Opening the first session

What brings them in

History, briefly

Save the long history for later sessions. A first session that's all history leaves no time for the client to feel heard.

Hopes, goals and expectations

Ask every new client the core risk questions in the first session as well (see the risk section below), in the same tone as the questions about sleep.

Example: the first ten minutes

Invented client: Marcus, 34, who booked online after two panic attacks at work.

Why it works: privacy came first; the client's goal is in his own words; there's a reflection before each question; the medical check is acknowledged; and "I ask everyone" makes the screen routine.

Questions for building the alliance

Edward Bordin described the working alliance as three things: agreement on the goals of therapy, agreement on the tasks that will get there, and the bond between client and therapist (Bordin, 1979). It matters across approaches. A meta-analysis of 295 studies covering more than 30,000 patients found a correlation of .278 between the alliance and outcome in face-to-face therapy, consistent across treatment approaches and patient characteristics (Flückiger and colleagues, 2018). Ask about all three parts, early and again later.

Goals:

Tasks:

Bond:

Listen for: polite agreement with no energy behind it, missed sessions after a hard topic, and "you're the expert" answers. When you notice a strain, name it and own your part: "Last week, when I suggested the worksheet, you went quiet. I wondered if I'd pushed too fast. What was that like for you?"

Assessment questions by area

These are counseling questions to ask adults when you need a fuller picture of their life. You don't need them all at intake: start with the areas the presenting problem touches, and fill in the rest over the first few sessions.

Mood and anxiety

Listen for: low hope, which leads straight to the risk questions, and past periods of elevated mood, which matter before you treat depression (our CBT for bipolar disorder guide covers that work). For a total you can track, the PHQ-9 and GAD-7 scoring pages add up the answers and show the severity bands.

Sleep

Listen for: loud snoring or pauses in breathing, which deserve a doctor's check before you treat poor sleep as anxiety, and sleep that depends on a substance.

Alcohol and drugs

Normalize first: "I ask everyone about alcohol and drugs, because they affect mood and sleep." Two single questions from primary care research make a good start. The National Institute on Alcohol Abuse and Alcoholism's single alcohol screening question asks how many times in the past year the person had 4 or more drinks in a day (for women) or 5 or more (for men); one or more times warrants follow-up (NIAAA). In 286 primary care patients it was 81.8% sensitive and 79.3% specific for unhealthy alcohol use (Smith and colleagues, 2009). A matching drug question, where one or more times is positive, was 100% sensitive and 73.5% specific for a drug use disorder in a similar primary care sample (Smith and colleagues, 2010).

Listen for: use alone, use to manage feelings or sleep, and driving. Follow a positive screen with the AUDIT-C or the full AUDIT and a conversation, not a lecture. If the client is unsure about cutting down, the motivational interviewing questions article is organized by task.

Relationships and support

Ask the safety questions with the client alone, never with a partner in the room. On video, ask first whether anyone can hear (see the telehealth questions below). The US Preventive Services Task Force recommends that clinicians screen women of reproductive age, including during and after pregnancy, for intimate partner violence (USPSTF, 2025); in therapy, it's worth asking every adult.

Work, money and daily life

Health and medication

Listen for: new or unexplained physical symptoms worth a medical check before you treat them as anxiety or depression, and medications that affect mood or sleep.

Trauma screening, done carefully

At intake you need to know whether trauma happened and how it affects the client now. You don't need the details. Asking for a full account early can overwhelm a client before they have ways to steady themselves, and they may not come back. SAMHSA's six principles of a trauma-informed approach are safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical and gender issues (SAMHSA, 2014). In a question, that means you say why you're asking, say that details aren't needed, let the client choose, and check in afterward.

A script you can adapt: "I ask everyone about very frightening or overwhelming experiences, because they can affect sleep, mood and relationships years later. You don't need to tell me what happened, or any details, today. A yes or no is enough, and you can stop at any point."

For a structured screen, the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) starts with one question about lifetime exposure to traumatic events. If the answer is no, the screen ends with a score of 0; if yes, five yes or no questions ask how the trauma has affected the person over the past month. The VA's National Center for PTSD reports that a cut-point of 4 balanced false negatives and false positives in a large VA primary care sample, and that a lower cut-point may be worth considering for women (National Center for PTSD; Prins and colleagues, 2016). A positive screen calls for further assessment, such as the PCL-5 or a structured interview.

Example: a trauma screen without the details

Invented client: Lena, 29, in her second session for anxiety and poor sleep.

Why it works: the therapist said why, asked for no details, asked permission before each step, left the timing to Lena and checked in afterward. A grounding exercise such as the one in our 5-4-3-2-1 grounding worksheet fits the minute to slow down.

Strengths and resources

Listen for: answers you can use twice: as protective factors in a risk assessment, and as resources in the treatment plan. A review of solution-focused therapy process research found the most support for strength-oriented techniques (Franklin and colleagues, 2017).

Risk questions: ask every adult, in plain words

Ask about suicide directly, using the words "killing yourself," and ask every adult client, not only the ones who seem at risk. Asking doesn't plant the idea. A meta-analysis of 13 articles using prospective designs found no significant harmful effect from assessing suicidality, and its authors concluded that the findings support universal screening (DeCou and Schumann, 2018). An earlier review found no study showing a significant rise in suicidal thoughts after asking (Dazzi and colleagues, 2014). Ask at intake, when mood drops, after a loss or a crisis, and whenever PHQ-9 item 9 is above 0.

These are our own words, for a conversation. For a structured screen, use the Columbia Suicide Severity Rating Scale as Columbia writes it; our C-SSRS screener guide explains the questions, how answers map to a risk level and how to note it.

If the answer is yes

Example: "My family would be better off without me"

Invented client: Sam, 52, in his fourth session for depression after a layoff.

Why it works: plain words; frequency, method, preparation and intent asked one at a time; the protective factor reflected back; and the firearm raised by name with a specific next step. The exchange shows the questions, not a complete risk assessment: a method with access is a reason for a structured screen and a safety plan under your protocol.

Therapy questions by approach

The questions below are therapist questions to ask clients within a specific model. Each links to a sibling article that goes deeper.

CBT questions

For finding and testing thoughts. Our Socratic questioning examples article has 100 more, by purpose, and the cognitive triangle worksheet links thoughts, feelings and actions.

Solution-focused questions

Solution-focused brief therapy, developed by Steve de Shazer and Insoo Kim Berg, asks what the client wants and what's already working rather than what caused the problem. Its best-known question asks the client to picture life after the problem is gone. In our words: "Imagine you wake up tomorrow and, without knowing how, the problem that brought you here has gone. What's the first small thing you'd notice that tells you something is different? What would the people around you notice?" Follow it with details: what they'd do, who'd notice, and when part of that already happens.

Example: a scaling question

Invented client: Nadia, 45, working on mornings at home with two school-age children.

Why it works: Nadia found her own exception and her own next step. The therapist built on what already worked instead of analyzing what didn't.

Motivational interviewing questions

Open questions that draw out the client's own reasons for change. Our motivational interviewing questions article has 80, organized by the four MI tasks, with example exchanges.

Person-centered reflections

Of the conditions Carl Rogers described for therapeutic change, three rest on the therapist: genuineness, unconditional positive regard and accurate empathic understanding (Rogers, 1957). In this approach, reflections do more of the work than questions. Reflections to use where you'd otherwise ask:

And a few questions in the same spirit:

ACT questions

Acceptance and commitment therapy works with six processes: acceptance, cognitive defusion, contact with the present moment, self as context, values and committed action (Hayes and colleagues, 2006). Our ACT therapy worksheets include a values worksheet and a defusion exercise to go with these.

Check-in questions for the start of a session

Agree the agenda together in the first few minutes, so the most important topic doesn't surface with five minutes left.

Progress review questions

Every four to six sessions, or at the review date in the treatment plan, step back and look at whether therapy is working. Repeat the measures you used at intake so you can compare. Asking for feedback isn't only polite: a meta-analysis of 24 studies of routine outcome monitoring found that feedback reduced deterioration, and nearly doubled rates of clinically significant or reliable change among clients predicted to have a poor outcome (Lambert and colleagues, 2018). Our treatment plan template article includes a review template to record the answers in.

Example: a progress review when the scores haven't moved

Invented client: Tom, 63, in his eighth session for low mood since retiring.

Why it works: the therapist shared the numbers honestly, asked for Tom's reading of them first, looked for what helped, invited feedback about the therapist, and changed the plan. Our behavioral activation worksheet has sheets for the weekly plan.

Questions for a stuck or quiet session

When a client says "I don't know," or the session circles:

"I don't know" is often an answer in itself: too much feeling, not enough words yet, or not enough trust yet. Try a guess they can correct: "Some people in your spot would feel relieved and guilty at once. Is it anything like that, or something else?"

Questions for ending a session

Questions for ending therapy

The APA Ethics Code asks psychologists to end therapy when it becomes reasonably clear the client no longer needs it, isn't likely to benefit or is being harmed by continuing, and, except where the client's actions or a third-party payer prevent it, to provide pretermination counseling and suggest other providers as appropriate (APA, standard 10.10). Start a few sessions before the last one. Our therapy termination activities article has a plan for the last four sessions, a relapse prevention worksheet and a final note example.

Telehealth questions for every video session

Under HHS guidance, you need to be licensed or legally permitted to practice in the state where the client is located during the session, and you should have an emergency plan (Telehealth.HHS.gov, Licensure for behavioral health). Ask at the start of every video session, not only the first:

If privacy might drop mid-session, agree a signal in advance, such as switching to yes or no answers. Our telehealth consent form covers what to agree in writing.

How to note it

Write what you asked and what the client said, in their words where it matters. "Client denies SI" hides the question; "Asked about thoughts of suicide in the past month; client said, 'No, never, I want to see my grandkids grow up'" shows it. Lines you can add to your note template:

For risk wording and the clinical words that make notes clear, see our progress notes cheat sheet.

A question card you can copy

Twenty-five questions, one or two from each group, for a clipboard or the back of your notebook:

How this works in TranqBay

TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions, session notes and client forms in one place. Here's where it fits with the questions above:

To see the practice website designs, including the trauma therapist and counselor examples, and the booking page your clients would use, look around practice.tranqbay.health.

Frequently asked questions

Before your next session

Copy the card, pick the two or three habits from the first section you most want to practice, and decide which questions belong on your intake form and which belong in the room. Then ask the risk questions of every adult, in the same calm voice as the questions about sleep.

If you're setting up a private practice for adult clients, see how TranqBay works for private practice: you can look at the trauma therapist and counselor website examples and the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.

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