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Therapy Questions for Teens: 120 Questions by Purpose

Therapy questions for teens by purpose, from rapport to risk, plus how to ask them, what parents hear, PHQ-A and GAD-7 cut-offs and invented examples.

Updated 10 min read
In this guideTemplate to copy11 questions answered

Most lists of therapy questions for teens are conversation starters, written as much for parents as for clinicians. In a session, the question is the easy part. Whether a teenager talks depends on the order you ask in, whether they know what stays private, and what you do when an answer worries you. Below you'll find 120 questions grouped by what they're for: building rapport, the first session, school, friends and online life, family, mood and anxiety, identity, substance use, risk and safety, strengths and goals, and ending a session. You'll also find how to ask them without it turning into an interrogation, what parents hear and what the ethics codes and HIPAA say about it, screening tools with their adolescent cut-offs, mandated reporting basics, telehealth with teens, and how to write it all in a note.

The questions are for licensed clinicians working with clients of about 12 to 17. Adjust the words for development: a 13-year-old and a 17-year-old need different versions of the same question. For clients 18 and over, see our therapy questions for adults.

Every teen and parent in this article is invented. Any resemblance to a real person is a coincidence.

How to ask teens questions without it feeling like an interrogation

Teens spend their days answering questions from adults who want a right answer: teachers, parents, coaches, doctors. A therapy hour that feels like more of the same ends in shrugs. These habits change that:

  • Open more than you close. "What's school like this year?" invites a story. "Do you like school?" invites "no." Save closed questions for facts and for risk, where you need a clear yes or no.
  • Skip "why." "Why did you do that?" sounds like blame. "What was going on right before?" or "What did it do for you?" gets the same information.
  • Offer choices. For a teen who freezes: "Was this week more like a 3 or more like a 7?" or "Is it more school, more home, or something else?"
  • Normalize before a hard question. "A lot of teens I see have been offered a vape. I ask everyone: has that happened to you?" Saying you ask everyone makes the question your routine, not your suspicion.
  • Say why you're asking. "I ask about sleep because it changes everything else."
  • Reflect before the next question. Say back what you heard, then ask. Two reflections for each question is a good balance. Our motivational interviewing questions article pairs each question with the reflection that usually comes next, which matters with ambivalent teens who were sent by someone else.
  • Let them pass. "You can say 'pass' to any question, and I'll come back to it another time or not at all." Honor it, with one exception you explain up front: you will always ask about safety.
  • Ask about other people first. "What are kids at your school stressed about?" is easier to answer than "What stresses you?" and often leads to the same place.
  • Use their words. If a teen says "I'm just done," ask what "done" means instead of translating it into "depressed."
  • Ask one question, then wait. Ten seconds of silence feels long to you and normal to a teen who is thinking.
  • Question a belief gently. For a teen stuck on "everyone hates me," the guided questions in our Socratic questioning examples work well once rapport is there.

Example: an interrogation, and the rewrite

Invented client: Theo, 14, in his second session, referred after his grades dropped.

The interrogation:

  • Therapist:Do you like school?
  • Theo:No.
  • Therapist:Why not?
  • Theo:Don't know.
  • Therapist:Are you doing your homework?
  • Theo:Sometimes.
  • Therapist:Why only sometimes?
  • Theo:(shrugs)

The rewrite:

  • Therapist:Walk me through yesterday at school, from when you got there. I'm curious what a normal day looks like for you.
  • Theo:First period is math. It's whatever.
  • Therapist:Math is whatever. What's the part of the day that's the opposite of whatever?
  • Theo:Lunch, I guess. And robotics on Thursdays.
  • Therapist:So some parts work. And the parts that don't?
  • Theo:English. She makes people read out loud.
  • Therapist:Reading out loud is the worst part. What happens for you when she might call on you?
  • Theo:My face goes hot. I just watch the clock.

One open question, a reflection after each answer and no "why": the second version found a likely target, anxiety about performing in one class, in under a minute.

Using activities instead of questions

Many teens talk more when they're doing something with their hands and nobody is looking straight at them.

  • Side by side.Draw, play cards, build with clay or blocks, or walk if your setting allows it. Ask a question between turns.
  • Sentence stems."The worst part of my week was..." "I wish my parents knew..." "I feel most like myself when..." Teens finish them out loud or on paper.
  • A scale they can mark.Draw a 0 to 10 line. The teen marks this week, and you ask what would move it one point.
  • Card sorts.Feelings, values or worry cards sorted into piles: "a lot," "a little," "not me."
  • Their phone, with permission."Show me a photo from a good day this month," or "Play me a song that sounds like this week." Ask before looking at anything, and don't scroll.
  • A timeline.Draw the past year as a line with highs and lows, then ask about the biggest dip.
  • A question deck.Mix light questions with real ones from the lists below and take turns drawing. You answer the light ones too, briefly, which takes the spotlight off the teen.

On video, ask the teen to keep paper and a pen nearby and hold drawings up to the camera.

Rapport questions: getting to know the teen first

Rapport questions show interest in the person, not only the problem. Ask a few in the first session and keep asking for weeks.

  • "What should I know about you that has nothing to do with why you're here?"
  • "What do you do when you get to choose what to do?"
  • "What are you into right now that most adults don't get?"
  • "What's a show, game or song you'd recommend to me?"
  • "Who's someone you look up to, real or fictional?"
  • "What's usually the best part of your week?"
  • "What are you good at that people don't notice?"
  • "If your friends described you in three words, what would they pick?"
  • "What made you laugh recently?"
  • "What would make this hour less awkward?"
  • "Do you want me to ask questions, or would you rather start?"

Listen for: what lights them up (you can use it later as a goal, a reward or a metaphor) and who shows up in their stories.

First-session questions for teens and parents

Decide who's in the room before you ask anything. A common pattern: a few minutes with the parent and teen together to agree how privacy works, time with the teen alone, a few minutes with the parent alone, and a short wrap-up together. Guidance on adolescent interviews stresses seeing young people alone and explaining confidentiality before the assessment starts (Doukrou and Segal, 2018).

With the teen

  • "What did you hear about why you're coming here?"
  • "Whose idea was it to come? What do you think of the idea?"
  • "What do your parents think the problem is? What do you think it is?"
  • "Have you seen a counselor before? What did they do that helped, or didn't?"
  • "What's one thing adults usually get wrong about you?"
  • "If coming here worked, what would be different a few months from now?"
  • "What's going well enough that you don't want me to mess with it?"
  • "From 0 to 10, how much do you want to be here today?" Then: "What made it that number and not lower?"
  • "What would make you want to stop coming?"
  • "What would make it worth coming back?"
  • "What do you want your parents to hear from today, and what stays between us?"
  • "What questions do you have for me?"

With the parent or guardian

  • "What are you most worried about right now?"
  • "What have you already tried, and what helped, even a bit?"
  • "What do you hope stays the same about your teen?"
  • "What would you need to hear from me, without details, to feel kept in the loop?"

Example: the first ten minutes

Invented client: Dani, 15, brought by her mother after the school counselor raised missed classes.

  • Therapist (to both): Before anything else, I'd like us to agree how privacy works here. Dani, what you tell me stays between us, with a few exceptions I'll go through. Mom, you'll hear from me if I'm worried about Dani's safety, and you'll get general updates, like whether things seem better, worse or the same. Does that work for you both?
  • Mother: I just want to know if something's really wrong.
  • Therapist: If something is seriously wrong, you'll know. What I keep to myself is the day to day, like who said what at lunch. That privacy is a big part of why therapy works at this age.
  • (The mother steps out.)
  • Therapist: What did you hear about why you're here?
  • Dani: That I'm skipping. Which, okay, sometimes.
  • Therapist: Sometimes. And whose idea was coming here?
  • Dani: The school's. Mom's. Not mine.
  • Therapist: Not yours. If you have to come anyway, what would make it not a total waste of your time?
  • Dani: If you didn't just tell me to go to class.
  • Therapist: Fair. I'm not here to make you go to class. I'd like to understand what happens on the days you don't. Would that be OK?
  • Dani: I guess.

Why it works: the privacy agreement came first, with both in the room; Dani's view of the referral came before the problem; and the therapist named what they won't do.

Questions about school

  • "Walk me through a normal school day, from when you wake up."
  • "Which class is easiest to sit through? Which is hardest?"
  • "Where at school do you feel most like yourself? Least?"
  • "Which teacher gets you? What do they do differently?"
  • "What happens in your body on a test day?"
  • "How are grades talked about at home?"
  • "Have you missed school lately? What was going on those days?"
  • "Is anyone at school making things harder for you?"
  • "What would make school 10% easier?"
  • "What do you want to do after high school, or is that a question you're tired of?"

Listen for: school avoidance (often anxiety, bullying or something at home), a single hard class, and a gap between the teen's view of grades and the family's.

Questions about friends, dating and online life

  • "Who would you text first if something good happened? Something bad?"
  • "How have your friendships changed since last year?"
  • "What do you and your friends do when you hang out?"
  • "Do you ever feel left out? What happens when you do?"
  • "What's your group chat like: fun, stressful, both?"
  • "How do you feel after an hour on your phone, compared with before?"
  • "Which apps or accounts make you feel worse about yourself?"
  • "How late are you usually on your phone at night?"
  • "What's something you'd never post, and what makes it off limits?"
  • "Are you seeing anyone, or interested in anyone? How is that going?"
  • "How does the person you're with act when they're upset with you?"
  • "Has anything online made you feel unsafe or pressured?"

Listen for: isolation, a friendship that just ended, sleep lost to the phone, and a partner who controls, checks or threatens. The risk section below has the direct questions to follow up with.

Questions about family

  • "Who lives in your home? Who's around a lot?"
  • "If I were a fly on the wall at dinner, what would I see?"
  • "Who in your family are you closest to? Who's hardest to be around?"
  • "When there's a fight at home, what does it usually look like?"
  • "What does your family do when someone is upset?"
  • "What do you wish your parents understood about you?"
  • "What's a rule at home that feels fair? One that doesn't?"
  • "How has your family changed in the last year or two?"
  • "If you split time between homes, how are they different?"
  • "Who in your family would you go to if you were in trouble?"

Listen for: recent losses, moves or separations; who the teen can turn to; and anything that suggests a teen isn't safe at home, which needs the direct questions and the reporting steps further down.

Questions about mood, anxiety, sleep and eating

  • "From 0 to 10, how has this week been? What made it that number?"
  • "When you feel down, what does it look like from the outside? From the inside?"
  • "What does anger feel like for you, and what do you do with it?"
  • "What do you worry about most when you're trying to fall asleep?"
  • "What time do you actually fall asleep, and when do you wake up?"
  • "Have you stopped doing things you used to enjoy?"
  • "What does your body do when you're anxious?"
  • "Is there anything you avoid because it makes you nervous?"
  • "How has eating been lately? Have you been worrying about your weight or your body?"
  • "When was the last time you felt really OK? What was different then?"
  • "What do you do when it gets bad? Does it help?"
  • "Do you ever feel like things won't get better?"

Listen for: irritability, which is often how low mood shows up in teens (the adolescent version of the PHQ-9 adds "irritable" to its mood item), sleep that has shifted by hours, and avoidance that is growing. A yes to the last question leads straight into the risk questions.

Questions about identity

  • "How would you describe yourself to someone who had never met you?"
  • "What parts of who you are do you feel you have to hide, and where?"
  • "What name and pronouns would you like me to use here? Is that the same with your parents, and on paperwork?"
  • "What does your culture or faith mean to you? Does it ever clash with home or school?"
  • "Where do you feel you fit in? Where don't you?"
  • "Who in your life knows the real you?"
  • "Have you been treated differently because of who you are?"
  • "What do you wish people would stop assuming about you?"

The name and pronoun question has a practical side. A teen may use one name with you and another at home, and parents may be able to read the record (see the confidentiality section). Agree with the teen how you'll refer to them with their parents and in your notes, within your setting's policy, so you never out a teen by accident.

Questions about substance use

Normalize first: "A lot of teens I see have been around vapes, alcohol or weed. I ask everyone about it." Then:

  • "Have friends or people at school been vaping, drinking or using weed?"
  • "Have you tried any of it? What did you think?"
  • "In the past year, have you used anything to get high, including vapes, edibles or someone else's pills?"
  • "What does it do for you? What do you like about it?"
  • "When do you usually use, and who are you with?"
  • "Have you used when you were alone, or to calm down or get to sleep?"
  • "Have you been in a car with a driver who had been drinking or using?"
  • "Has using ever gotten you into trouble or made you miss something?"
  • "What's the downside, if there is one?"
  • "If you wanted to cut down, what would make it hard?"

Listen for: use alone, use to cope with feelings or sleep, and riding with impaired drivers. For a structured screen, the CRAFFT (below) was built for this age group.

Risk and safety questions: ask directly and calmly

Ask about suicide in plain words: "killing yourself," not "doing something silly" or "hurting yourself," which a teen may hear as a question about self-harm only. Asking doesn't plant the idea. In a randomized study of 2,342 high school students, those asked about suicide were no more distressed or suicidal two days later than those who weren't asked, and depressed students who were asked appeared less distressed than depressed students who weren't (Gould and colleagues, 2005). A review of studies in adults and adolescents found none showing a significant rise in suicidal thoughts after asking (Dazzi and colleagues, 2014). Ask in the same even voice you used for sleep.

  • "Sometimes when people feel this bad, they think about dying or about killing themselves. Have you had thoughts like that?"
  • "In the past few weeks, have you wished you were dead, or that you could go to sleep and not wake up?"
  • "Have you thought about how you would kill yourself?"
  • "Have you ever tried to kill yourself, or started to and stopped?"
  • "Are you having thoughts of killing yourself right now?"
  • "What has stopped you from acting on those thoughts?"
  • "Have you ever hurt yourself on purpose, like cutting, burning or hitting yourself? When was the last time?"
  • "Has anyone hurt you, touched you in a way you didn't want, or made you scared to go home?"
  • "Do you feel safe at home? At school? Online?"
  • "Has anyone online asked you for pictures, threatened to share pictures, or asked you to keep a secret from your parents?"
  • "Has someone you dated hit, pushed or threatened you, or made you share your passwords?"
  • "Have you had thoughts of hurting someone else?"
  • "Are there guns in your home, or in any home you stay at?"

Ask the parent the firearm and medication questions too, about every home the teen stays in. Our safety plan template covers lethal means with teens, including both homes in a custody arrangement.

If the answer is yes

  1. Stay level and thank them. "Thank you for telling me. I'm glad you did."
  2. Follow up. How often, how long, how strong, any plan, intent or preparation, past attempts, access to means, and what keeps them going. Use your training and your setting's risk protocol; these questions start an assessment, they don't replace one.
  3. Build a plan with the teen, with warning signs, coping steps, people to reach and crisis numbers, and keep it where they'll look: usually their phone.
  4. Say what happens next before it happens. "Because of what you've told me, I need to talk with your mom about keeping you safe. Let's decide together what I say, and whether you want to be in the room."
  5. Know your crisis steps. In the US, the teen or family can call or text 988; if the risk is imminent, use emergency services.

Example: "Sometimes I wish I wasn't here"

Invented client: Priya, 16, in her sixth session for anxiety about school, a few weeks after a breakup.

  • Priya:Honestly, sometimes I wish I just wasn't here.
  • Therapist:Thank you for saying that out loud. When you say you wish you weren't here, do you mean thoughts about dying, or about killing yourself?
  • Priya:Not killing myself. More like, if I didn't wake up, that would be fine.
  • Therapist:Thoughts of not waking up. How many times in the last two weeks?
  • Priya:Like three nights. After I see his stories.
  • Therapist:Three nights, after seeing his stories. Have you thought about a way you would end your life, even briefly?
  • Priya:No. I wouldn't do that. My little sister.
  • Therapist:Your sister matters a lot to you. Have you ever tried to hurt or kill yourself, or started to and stopped?
  • Priya:No.
  • Therapist:Are you having any of those thoughts right now, here with me?
  • Priya:No. I'm OK right now.
  • Therapist:I'm glad. I'd like us to write a plan for those nights: what you notice first, what you can do, and who you can reach. And I'd like to talk about how your mom can know enough to help, without the details about him. What do you think?

Why it works: plain words; the wish not to wake up is separated from thoughts of suicide, then followed by plan, past attempts and right now; the protective factor is reflected; and the next steps include the teen in what her parent hears. The exchange shows the questions, not a complete risk assessment.

Strengths and goals questions

  • "What's something hard you got through that you're proud of?"
  • "What helps, even a little, when things are bad?"
  • "Who's in your corner?"
  • "What would your best friend say you're good at?"
  • "What do you want for yourself, apart from what anyone else wants for you?"
  • "If therapy went really well, what would you be doing in three months that you're not doing now?"
  • "What would be different at home if things were better? At school?"
  • "What's one small thing that would make next week a little better?"
  • "How will we know this is working?"
  • "What's one thing about your life you want to keep exactly as it is?"

Listen for: goals in the teen's own words. A goal the teen owns ("stop fighting with my mom every morning") beats one the referral wrote ("improve compliance").

Questions for ending a session

  • "What was the most useful part of today? The least?"
  • "Was there anything I asked that felt off, or too much?"
  • "What do you want to remember from today?"
  • "Is there anything from today you want your parent to know? Do you want to tell them, or should I?"
  • "What's one thing you'll try before next time?"
  • "From 0 to 10, how are you feeling now, compared with when you came in?"
  • "Is there something we didn't get to that you want to start with next time?"
  • "If things get hard before next week, what's your plan?"

Leave five minutes for these. A teen who leaves upset, with a parent waiting in the car, needs a softer landing than an adult who drives home alone.

Confidentiality: what parents hear, and what the rules say

The confidentiality talk is the most important question-asking tool you have with teens, because it decides what they'll tell you. It rests on three layers: your ethics code, HIPAA and your state's law.

What the ethics codes ask

  • ACA.Counselors "seek the assent of clients to services" when counseling minors and balance the client's choices against "parental or familial legal rights and responsibilities" (A.2.d). "At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality" (B.1.d). Counselors inform parents "about the role of counselors and the confidential nature of the counseling relationship" and work toward "collaborative relationships with parents/guardians" (B.5.b), and they seek permission from an appropriate third party before releasing a minor's information (B.5.c) (ACA Code of Ethics).
  • APA.For people who can't legally consent, psychologists "provide an appropriate explanation," "seek the individual's assent," consider their "preferences and best interests," and get permission from a legally authorized person (3.10(b)). They discuss the limits of confidentiality with them "to the extent feasible" and with their legal representatives, at the outset of the relationship (4.02) (APA Ethics Code).
  • NASW.When clients lack the capacity to consent, social workers seek permission from an appropriate third party and inform clients "consistent with the clients' level of understanding" (1.03(c)). They discuss "the nature of confidentiality and limitations of clients' right to confidentiality" with clients and other interested parties "as soon as possible" (1.07(e)), and in family work seek agreement on each person's right to confidentiality (1.07(f)) (NASW Code of Ethics).

What HIPAA says about parents and minors' records

  • A parent is usually the minor's personal representative and can exercise the minor's HIPAA rights, including access to the record (HHS, personal representatives).
  • Three exceptions. The parent is not the personal representative for that care when state or other law doesn't require a parent's consent and the minor consents (HHS's own example: a state law that lets an adolescent obtain mental health treatment without a parent's consent); when a court or another person authorized by law consents; or when the parent agrees to a confidential relationship between the minor and the provider (45 CFR 164.502(g)(3)).
  • State law comes first on parental access. HIPAA permits disclosure to a parent when state or other law permits or requires it, and prohibits it when state law prohibits it. Where state law is silent and an exception applies, a licensed professional decides, using professional judgment.
  • Abuse and endangerment. You may choose not to treat a parent as the personal representative if you reasonably believe the teen has been or may be abused or neglected by that parent, or that doing so could endanger the teen, and you judge it isn't in the teen's best interest (164.502(g)(5)).
  • Denying a parent's request for the record. A licensed professional may deny a personal representative's access when it is "reasonably likely to cause substantial harm to the individual or another person," and the denial can be reviewed (45 CFR 164.524(a)(3)(iii)).
  • Psychotherapy notes kept separately from the record fall outside the right of access (164.524(a)(1)(i)). Progress notes don't: assume a parent may read them.

What varies by state

Some states let minors consent to outpatient mental health care on their own from a set age, and the age and conditions differ from state to state; in others a parent's consent is needed in most cases. Where a teen lawfully consents alone, the parent may not be the personal representative for that care. With separated or divorced parents, who can consent depends on state law and the custody order: our therapy intake form article covers what to ask for. Check your state's statutes and your licensing board before your first teen client, and put the answer in your consent form.

An agreement to make at the start

With the parent and teen together, agree what parents will hear (attendance, general progress, safety concerns, anything the teen agrees to share), what they won't (the content of sessions), how you'll handle a parent's call, and what happens in an emergency. Put it in writing in your consent; our informed consent example has a general template you can add it to. Then say it out loud. A script you can copy and adapt:

What stays between usTemplate · 1 part to fill in
What stays between us
What you tell me stays between us, with a few exceptions.I will tell someone if:- you are in danger of seriously hurting yourself- you are in danger of seriously hurting someone else- someone is hurting you, or a child is being hurt- a court orders me to share recordsYour parents will hear general updates:whether you come, and whether things seem better or worse.They won't hear details unless you and I agree.If I ever need to tell them something, I'll tell you first,and we'll decide together how to say it.[Your state's rule on what parents can see: fill in]What questions do you have about that?

Example: a parent asks for details

Invented: Dani's mother calls after the fourth session.

  • Mother:Is she drinking? I found a bottle in her room.
  • Therapist:Thank you for telling me. That sounds worrying. As we agreed at the start, I don't share what Dani says in sessions, and if I thought she was in danger, you'd hear from me. What I can do is help the two of you talk about the bottle, in a joint session, if she agrees.
  • Mother:So you know something.
  • Therapist:I don't confirm or deny details either way, the same as if there were nothing to tell. That's what keeps her talking to me. Would a joint session next week work for you?

At the next session, tell Dani about the call and ask whether she'd agree to the joint session.

Screening tools for teens

A screen tells you where to look; the interview tells you what's there. These are the measures most often used with adolescents in outpatient practice.

  • PHQ-A (the PHQ-9 modified for adolescents).The same nine symptoms as the PHQ-9, worded for teens: the mood item adds "irritable" and comes first, and the concentration item names "school work." NIMH's version adds a question about feeling depressed or sad most days in the past year and a question about how difficult the problems have made things (NIMH, PHQ-A). Scoring runs from 0 to 27 with the PHQ-9's bands: 0 to 4 none, 5 to 9 mild, 10 to 14 moderate, 15 to 19 moderately severe, 20 to 27 severe. The American Psychiatric Association's adapted version uses those bands, notes the PHQ-A is in the public domain and lets clinicians reproduce it for their patients without permission (APA, Severity Measure for Depression, Child Age 11 to 17). One difference: NIMH's version asks about the past two weeks and the APA's about the past seven days, so pick one and keep it for that client.
  • The adolescent cut-off is 11, not 10.In 442 youth aged 13 to 17, a PHQ-9 score of 11 or more had a sensitivity of 89.5% and a specificity of 77.5% for major depression, and 11 was the optimal cut point (Richardson and colleagues, 2010). The total adds up the same way as the PHQ-9's, so you can use our PHQ-9 scoring page for the arithmetic, then read the total against 11. Any answer above 0 on item 9 needs a risk assessment that day, whatever the total.
  • ASQ (Ask Suicide-Screening Questions).Four yes or no questions from NIMH that take about 20 seconds, plus a fifth about thoughts right now if any answer is yes. In an NIMH study, a yes to one or more identified 97% of youth aged 10 to 21 who were at risk for suicide. It was built for medical settings, and NIMH publishes a combined PHQ-A and ASQ form (NIMH, ASQ toolkit).
  • GAD-7.Seven items, 0 to 21, with the usual bands at 5, 10 and 15 and 10 as the usual flag for further assessment (GAD-7 scoring page). With teens: in 40 adolescents with diagnosed generalized anxiety disorder, scores of 11 and 17 were the best thresholds for moderate and severe anxiety (Mossman and colleagues, 2017), and in 111,171 Finnish adolescents aged 14 to 18 the GAD-7 performed much as it does in adults, though its authors call for studies against diagnostic interviews (Tiirikainen and colleagues, 2019). Keep 10 as your flag and confirm with an interview; the adolescent evidence is thinner than for adults.
  • CRAFFT 2.1.A substance use screen for ages 12 to 21, recommended in the American Academy of Pediatrics' Bright Futures guidelines, in a self-report version and an interview version (CRAFFT). The site has instructions for reproducing and scoring it.

For context, the US Preventive Services Task Force recommends screening adolescents aged 12 to 18 for major depressive disorder (USPSTF, depression) and children and adolescents aged 8 to 18 for anxiety (USPSTF, anxiety), and found the evidence insufficient on screening for suicide risk. Those statements apply to young people without a diagnosis or recognized symptoms. A teen in your office has already been referred, so ask the risk questions anyway. Our clinical scoring tools list every measure we have a page for.

Mandated reporting basics

  • Every state has a law. Federal law (CAPTA) requires states to have provisions for reporting known or suspected child abuse and neglect, and every state names in statute who must report (Child Welfare Information Gateway).
  • You are almost certainly a mandated reporter. As of May 2023, counselors, therapists and other mental health professionals were named in about 38 states and the District of Columbia. Indiana, New Jersey, North Carolina and Wyoming list no professions but require every person to report, and about 17 states require anyone who suspects abuse to report. Check your own state's statute.
  • The standard is suspicion, not proof. Typically a report is due when you suspect or have reason to believe a child has been abused or neglected. Your job is to report, not to investigate.
  • Therapy privilege usually doesn't excuse you. Most states restrict privileged communication for mandated reporters.
  • Ask only what you need. When a teen discloses, use open questions to learn roughly what happened, who was involved, when, and whether they're safe tonight. Avoid leading questions ("Did he touch you?"); the detailed interview belongs to trained investigators, and leading questions can make it harder.
  • Tell the teen what happens next, when it's safe to: who you'll call, what you'll say, and what usually follows. If a parent is the person suspected, don't tell that parent first.
  • Report on your state's timeline and write down the date, time, agency, the person you spoke to and any reference number. Consult a supervisor if you're unsure, but don't let a consultation delay a report that's due.
  • Other duties vary by state: a duty to warn or protect when a client threatens someone, and in some states, reporting rules for sexual activity involving minors based on their ages, even when the teen calls it consensual. Learn yours before your first teen client, because it changes what you say in the confidentiality talk.

Telehealth with teens

  • License follows the teen. "Health professionals must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located" (Telehealth.HHS.gov, Licensure for behavioral health). Teens move around: a weekend at the other parent's home across a state line, a summer camp, a college visit. Ask where they are at the start of every session. The Counseling Compact and PSYPACT are widening this for some licenses.
  • Make an emergency plan before the first video session. HHS lists the address where the client is, emergency numbers for that location, a local emergency contact or support person, other providers' contacts and a plan for a dropped connection (Telehealth.HHS.gov, emergency plan). For a teen, the contact is usually a parent or caregiver who stays nearby during the session.
  • Get the parent's telehealth consent and the teen's agreement. Our telehealth consent form has a section for minors, including asking the adult nearby not to listen in.
  • Check privacy every time. "Where are you right now, and can anyone hear you?" Headphones and a closed door help. Agree on a word or gesture that means "someone just walked in," and switch to yes or no questions when it comes up. A parked car can work; a moving one can't.
  • Shorten the talk, add the doing. Paper and a pen next to the screen, a drawing held up to the camera, or a song the teen plays you. Keep the camera on for risk questions.

Example: privacy drops mid-session

Invented client: Marcus, 17, at home on a weekday afternoon.

  • Therapist: Before we start: where are you right now, and can anyone hear you?
  • Marcus: My room. My brother's home, but he's gaming with his headset on.
  • (Twenty minutes later, Marcus glances at the door.)
  • Marcus: ...yeah, so, anyway.
  • Therapist: Looks like someone's there. Want to switch to yes or no answers for a bit?
  • Marcus: Yeah.
  • Therapist: Is it your brother?
  • Marcus: Yep.
  • Therapist: Do you want to come back to what we were talking about later today, or start with it next week?
  • Marcus: Next week.

How to note it

A teen's note needs a few lines an adult's doesn't, and it should be written on the assumption that a parent may read it. Under HIPAA, a parent who is the personal representative generally has the same right of access as the teen.

  • Who was present, and for how long: "Client seen alone for 40 minutes; mother joined for the last 10."
  • Consent and assent: who consented to treatment, and that the teen agreed.
  • The confidentiality agreement: when it was reviewed, and with whom.
  • What was shared with a parent, and that the teen agreed to it.
  • Measures: totals, the cut-off you used, and the item 9 or ASQ answers.
  • Risk: the questions you asked and the teen's answers in their own words, not "denies SI."
  • Reports: date, time, agency, the person you spoke to, any reference number, and what you told the teen and the parent.
  • Telehealth: where the teen was, whether the space was private, and which adult was nearby.
  • Other people: keep friends' and partners' names and stories out unless they're clinically necessary.

Lines you can add to your note template:

Wording to copy10 lines · 9 parts to fill in
Teen session: extra lines
Present: [teen alone / parent joined, minutes]Consent: [who consented; teen's assent noted]Confidentiality agreement: [reviewed when, with whom]Shared with parent: [what, with the teen's agreement]Measures: [PHQ-A or GAD-7 total, cut-off used]Item 9 or ASQ: [answers]Risk questions: [what you asked, teen's words]Report made: [date, time, agency, reference number]Telehealth: [teen's location, private space, adult nearby]

For risk wording and the words that make notes clear, see our progress notes cheat sheet. The safety plan template above covers how to document a safety plan.

A question card you can copy and print

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

Wording to copy32 lines
Therapy questions for teens: a pocket card
RAPPORTWhat should I know about you that has nothing to do with this?What are you into that most adults don't get?FIRST SESSIONWhat did you hear about why you're coming here?If coming here worked, what would be different?SCHOOLWalk me through a normal school day.Is anyone at school making things harder for you?FRIENDS AND ONLINEWho would you text first if something bad happened?How do you feel after an hour on your phone?FAMILYIf I were a fly on the wall at dinner, what would I see?MOODFrom 0 to 10, how has this week been? What made it that?What do you worry about when you're trying to sleep?IDENTITYWhat name and pronouns should I use, here and at home?SUBSTANCESHave you used anything to get high in the past year?RISK (ask everyone)Have you had thoughts about killing yourself?Has anyone hurt you or made you scared to go home?Are there guns in any home you stay at?STRENGTHS AND GOALSWhat helps, even a little, when things are bad?What's one small thing that would make next week better?ENDINGWhat was the most useful part of today?If things get hard before next week, what's your plan?

How this works in TranqBay

TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions and session notes in one place. Here's where it fits when your clients include teens:

  • Forms before the first session. The form library has ready-made templates you send a client for a session, including a child and adolescent intake that a parent or guardian completes ahead of the first session, consent to treat, telehealth consent, release of information, safety and emergency contacts, the PHQ-9 and the GAD-7. They're filled in online, and the answers wait with the session. TranqBay doesn't score them: you add up the total, or use the scoring pages, and read a teen's total against the adolescent cut-offs above.
  • Video sessions that are end-to-end encrypted and HIPAA-ready. TranqBay's Business Associate Agreement applies when you accept the Terms.
  • Session notes in BIRP, DAP, SOAP or GIRP format, or a blank note, so the extra lines above have a home. The structured formats are part of the advanced note templates, which some plans include.
  • Booking on your terms. You can confirm each booking yourself, which gives you a moment to check who has consented before a teen's first session. Each service has its own length and fee, and you can add your own, such as a parent consultation, or ask new clients to start with a short consultation first.

practice.tranqbay.health shows the practice website designs, including a child and family therapist example, and the booking page your clients would use.

Frequently asked questions

What are good therapy questions for teens?

Open questions about the teen's own life that don't have a right answer: "Walk me through a normal day," "What do you wish your parents understood about you?" or "What helps, even a little, when things are bad?" Good questions also have a purpose: rapport, assessment, risk, goals or ending a session. Mix in direct closed questions for safety.

What should I ask a teenager in the first therapy session?

Start with how privacy works, with the parent and teen together. Then, with the teen alone, ask what they heard about why they're coming, whose idea it was, what they think the problem is, and what would make coming worth it. Ask everyone the basic risk questions. Save deeper history for later sessions.

How do I get a teen to open up in therapy?

Explain confidentiality clearly, start with their interests, ask open questions without "why," reflect what you hear before asking more, let them pass on questions, and give them something to do with their hands. Many teens talk more side by side than face to face.

What do I do when a teen won't talk?

Name it without pressure ("You didn't pick this, and that's fair"), offer choices instead of open questions, use an activity, or talk about other teens first. Ask what would make the hour worth their time. Silence in the first sessions is common and usually eases once a teen trusts that what they say stays private.

Do parents have a right to know what their teen says in therapy?

It depends on state law and your agreement. Under HIPAA, a parent is usually the minor's personal representative, with exceptions such as when state law lets the teen consent to their own care, or when the parent agrees to a confidential relationship. HIPAA defers to state law on parental access. Most therapists agree at the start that parents hear general progress and safety concerns, not session content.

Should I ask a teen directly about suicide?

Yes, in plain words, and every teen, not only the ones who seem at risk. Research in high school students and reviews of adolescent and adult studies have found that asking doesn't increase suicidal thoughts. The ASQ's four questions are a good model of direct wording.

What is the PHQ-A cut-off for adolescents?

A score of 11 or more was the optimal cut point for major depression in 13 to 17 year olds, with a sensitivity of 89.5% and a specificity of 77.5%. The severity bands are the same as the PHQ-9's. Any answer above 0 on item 9 needs a risk assessment, whatever the total.

Can the GAD-7 be used with teenagers?

Yes. It has held up well in large adolescent samples, and one small study of teens with generalized anxiety disorder found 11 and 17 the best thresholds for moderate and severe anxiety. Use 10 as a flag for further assessment and confirm with an interview.

Do I have to tell parents if a teen is using drugs?

Not automatically. It depends on your state's law, your agreement with the family and how serious the risk is. Use that could put the teen in danger, such as riding with impaired drivers, overdose risk or use alongside suicidal thoughts, is a safety concern your agreement should already cover. When you can, tell the teen before you tell a parent, and decide together how.

Can I see a teen by video if they're in another state?

Only if you're licensed or legally permitted to practice in the state where the teen is during the session. Ask where they are at every session, because teens travel between homes, camps and relatives more than adults expect.

Do these questions work with adults?

Many do, once you drop the parent and school layers. For adults who aren't sure they want to change, our motivational interviewing questions are organized by task, and for testing a belief, our Socratic questioning examples are organized by purpose.

Before your next session

Copy the card, decide how you'll explain confidentiality to the next teen and their parent, and check two things in your state: the age at which a minor can consent to their own therapy, and what you must report. Then ask the risk questions of every teen, in the same calm voice as the questions about music.

If you're setting up a practice that sees teens, see how TranqBay works for private practice: you can look at the child and family therapist website example and the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.

Sources

22 sources

Associations 4HHS 3Regulations 2Research 8crafft.org 1uspreventiveservicestaskforce.org 2Federal 1988 Lifeline 1

Updated October 25, 2026. Found it useful? Send it to a colleague.

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