Questions to Ask Children in Therapy: A Clinician's Session Guide
For child therapists, school counselors and play therapists: 20 session-ready questions that build rapport, externalize the problem, screen for safety, and turn what a child tells you into a workable treatment plan.
The questions
Open any question for the note
What did your grown-ups tell you about coming here today?
Why ask it
Children arrive with wildly different explanations, from "you need help" to "this is because I got in trouble." Hearing their version lets you correct a punishment framing in the first two minutes.
What should I know about you that has nothing to do with why you are here?
Why ask it
Signals that you see a whole kid rather than a referral problem, and hands you the Minecraft server, the dog, or the gymnastics meet you will use as a bridge for the rest of treatment.
If this room had one rule that you got to make, what would it be?
Why ask it
Gives a child who has no control over being here one real decision, and the rule they pick often names their core need: no yelling, you cannot tell my mom, we get to stop when I say.
Who lives in your house, and who sleeps where?
Why ask it
Far more concrete than "tell me about your family," and it surfaces step-siblings, a grandparent on the couch, shared beds, and week-on week-off custody without asking about family structure directly.
If today were a number from one to ten, with ten being the best day you can imagine, what number is it and what would make it one number higher?
Why ask it
Sets a baseline you can re-ask every session, and the "one number higher" half produces a step small enough to actually happen before next week.
If your worry were a creature, what would it look like and what would you call it?
Why ask it
Externalizing turns "I am an anxious kid" into "Fuzzball shows up at bedtime," which gives you and the child a shared target to outsmart instead of a trait to fix.
Where in your body do you notice it first when you start to get upset?
Why ask it
Young children often cannot label emotions but can point to a hot face or a tight stomach. That sensation becomes the early warning cue every regulation skill you teach will hang on.
What usually happens right before you get in trouble at school?
Why ask it
Pulls antecedents rather than consequences, so you learn whether the trouble clusters around transitions, unstructured time, reading aloud, or one specific classmate.
What is the part of the day you dread the most?
Why ask it
Locates distress in a real moment such as the bus, the cafeteria, drop-off, or lights out, which is much easier to build an intervention around than a general report of unhappiness.
When the worry shows up, is there anything you do that makes it even a little bit smaller?
Why ask it
Finds the coping the child already owns, so you can amplify something that works instead of installing a brand new skill they have no history of using.
Who notices when you are having a hard day, and what do they do?
Why ask it
Maps the real support network and, just as usefully, reveals whether any adult is currently attuned enough to spot distress before it becomes a behavior report.
What happens at your house at night when you cannot sleep?
Why ask it
Opens up nightmares, bedtime fears, hypervigilance, and whether anyone comes when they call. Sleep is often the first thing to improve and the easiest progress marker for parents to see.
Lots of kids secretly think it is their fault when grown-ups fight. Do you ever think that?
Why ask it
The normalizing preface makes it safe to say yes, and it surfaces self-blame in divorce, conflict, and parental illness cases where children rarely volunteer the thought.
Is there anything you are not supposed to talk about outside your house?
Why ask it
Names family secrecy rules directly and tells you what loyalty bind the child is carrying. Follow up gently and be ready to explain your reporting limits again before they answer.
If I could say one thing to your parents so they would finally understand, what would you want me to say?
Why ask it
Gives the child a voice in a system that mostly talks about them, and it writes your agenda for the next parent or family session in their own words.
Is there a person or a place that makes your stomach feel tight?
Why ask it
A non-leading way to screen for bullying, an unsafe adult, or an avoided setting, since children will point to a body feeling long before they will accuse someone.
If you had a magic remote that could pause, rewind, or fast forward your life, what would you use it on?
Why ask it
The rewind answer often points at an unprocessed event, the fast forward answer at what they are dreading, and the pause answer at what is actually good and worth protecting.
Have you ever wished you could go to sleep and not wake up?
Why ask it
A developmentally appropriate way to open suicide and self-harm screening with children who do not yet think in adult language. Ask it calmly, and have your risk protocol and parent conversation ready.
How will we know when you do not need to come see me anymore?
Why ask it
Makes the child a partner in defining the goal and produces observable, child-sized endpoints such as sleeping in my own bed or going to birthday parties again.
Is there something you almost told me today but decided not to?
Why ask it
A closing invitation that recovers withheld material while still leaving the choice with them, which teaches that disclosure in this room is always voluntary.
Working These Questions Into a Session
Practical guidance for the conversation itself
In-Session Practice
Ask while hands are busy
Most children answer better sideways than face to face. Deliver these questions over a sand tray, a drawing, Jenga, or a walk down the hallway. Eye contact plus a direct question reads as an interrogation to a nine year old.
Route hard questions through a third thing
If a question lands flat, hand it to a puppet, a character, or a hypothetical kid: "If a kid your age felt that way, what would help?" The child answers honestly without having to own the answer yet.
Give pass permission out loud
Say at the start that any question can get a pass, a shrug, or a made-up answer. Children who know they can decline answer more, and a pass on one specific question is itself clinical information.
Re-ask the scaling question every week
The one to ten question is the cheapest outcome measure you have. Track the number, the reason given, and the one-step-higher answer, and you have session-by-session data parents and payers both understand.
Restate confidentiality before the risky ones
Before the secrecy, safety, and self-harm questions, repeat in kid language what you will and will not tell parents. Consent that was given in session one does not carry itself into a disclosure moment.
Adjust for Developmental Stage
- Ages 4 to 6: swap words for pictures. Use feeling faces, have them draw the worry creature, and keep to one clause per question. Expect answers through play rather than speech.
- Ages 7 to 9: concrete and literal works best. Anchor questions to specific times and places, use scaling with a visual thermometer, and avoid asking why, which usually produces "I don't know."
- Ages 10 to 12: they can handle cause and effect and will tolerate the antecedent and self-blame questions, but they are newly self-conscious. Drop the puppets and treat them as a collaborator on the plan.
- Teens: keep the scaling, goal, and almost-told-me questions and cut anything that sounds like it was written for a little kid. Lead with the confidentiality conversation instead of following it.
- Neurodivergent or language-delayed children: allow long silences, offer forced-choice options ("more like angry or more like scared?"), and accept written, typed, or pointed answers.
- Any age: if a child gives a rehearsed-sounding answer, note it and move on. Rehearsed answers usually mean an adult has coached the topic, and pushing hardens it.
Common Pitfalls
Asking suggestive questions about possible abuse
Do not add names, details, or bodies to a child's answer. Stick to open prompts and body-feeling questions, document quotes verbatim, and refer forensic interviewing to a trained interviewer so testimony stays clean.
Running the list like an intake form
Twenty questions is a menu, not a sequence. Three questions that open something real beat all twenty answered in order, and rapid-fire questioning trains children to give you the shortest possible answer.
Relaying answers to parents without a plan
A child's honest answer about a parent can cost them at home. Decide with the child what gets shared and how it will be framed, and coach the parent before the content reaches them.
Treating the referral complaint as the child's complaint
Parents and schools refer for behavior. Children rarely name that as the problem. If your goals only match the adult's version, the child will stay a spectator in their own therapy.