Questions to Ask Client in First Therapy Session
Intake questions for therapists and counselors running a first session with an adult client, covering the presenting problem, risk, substances and medication, support, history and what the client wants from the work.
The questions
Open any question for the note
What brings you here today?
Why ask it
Left open so the client frames the problem before you do. Note whether they name a symptom, an event, or somebody else's complaint about them, because that distinction shapes how engaged they will be.
Why now, rather than six months ago?
Why ask it
Locates the precipitant, which is often not the presenting problem. A court requirement, a partner's ultimatum or an employer referral changes what the client is willing to work on with you.
Have you been in therapy or counseling before, and how did it end?
Why ask it
How it ended matters more than the modality. An abrupt ending, a therapist who left, or a sense of not having been believed will affect this alliance whether or not the client names it.
Are you having thoughts of hurting yourself or anyone else?
Why ask it
Ask plainly, in these words, and early. Leaving it to the last five minutes means assessing risk with no time left to act on the answer or to make a plan with the client.
Have you ever acted on thoughts like that, and what stopped you?
Why ask it
A history of acting changes the risk picture, and what stopped them names a protective factor you can work with. Ask even after a no, since first answers to this are often partial.
Who could you call at eleven at night?
Why ask it
Turns support from a category into a name and a number, which is what a safety plan needs. Hesitation here tells you more than a list of people they see every week.
Who knows you are here today?
Why ask it
More revealing than asking about support in the abstract. A client who has told nobody is carrying the appointment alone, and that concealment is usually part of the picture rather than incidental.
What does a typical day look like, from waking up to going to bed?
Why ask it
A functional assessment that clients find easy to give. Listen for the hours that are unaccounted for, and for whether anything in the day is done with another person.
How have you been sleeping and eating?
Why ask it
Both are measurable, both move early in treatment, and both give you something to track that the client will notice. Ask for times and quantities rather than accepting badly or fine.
Are you drinking or using anything, and how much on a heavier day?
Why ask it
Asking about a heavier day rather than an average one produces a more usable figure. Take the first number as a floor, and revisit it once the alliance is established.
What medication are you taking, and who prescribes it?
Why ask it
You need the prescriber's name for coordination, plus doses missed, recent changes, and whether the client believes it is helping. Include anything bought without a prescription.
Is there any history of mental illness or suicide in your family?
Why ask it
Relevant to risk and to formulation, and it usually produces the client's own theory about themselves: that they are turning into a parent, or that this is simply what their family is like.
What is happening in your closest relationships at the moment?
Why ask it
Ask about the current state rather than the history. Whether the people nearest to them are a source of pressure or of steadiness determines what any plan you make together can realistically rely on.
Is there anyone you are afraid of?
Why ask it
A direct screen for intimate partner violence and coercive control that does not require the client to accept a label. Ask only when you are certain you are alone with them.
What have you been doing to get through this?
Why ask it
Elicits coping without the moral framing of healthy and unhealthy. Clients name avoidance, overwork, food, gaming and alcohol far more readily when the question stays neutral.
What has helped before, even a little?
Why ask it
Identifies something they already have a history of doing, which is easier to restart than a new skill is to install. Include things they have dismissed as not really counting.
What are you good at, and what do people rely on you for?
Why ask it
Gives you strengths to build on, and it often reveals the load they are carrying for other people, which may be the part of the situation nobody has questioned.
Is there anything about your background, culture, faith or identity I should understand to be useful to you?
Why ask it
Signals that difference is discussable rather than something to be inferred, and it invites correction of an assumption the client may already have noticed you making.
What would be different in your life if this work went well?
Why ask it
Push for observable changes rather than feelings. A concrete answer becomes your outcome measure; an answer only about feeling better leaves neither of you able to tell whether anything is happening.
Is there anything you would rather not talk about yet?
Why ask it
Naming the parked topic gives you a map without opening it, and it establishes that the client sets the pace. Most clients return to it themselves, often within a few sessions.
Is there anything about coming here that worries you?
Why ask it
Surfaces the practical and the relational together: cost, notes, being judged, being hospitalized, being told to leave a relationship. Fears left unspoken tend to reappear as cancellations.
What questions do you have for me?
Why ask it
Clients rarely ask unless invited. What they do ask, about your training, your beliefs, or whether you have children, tells you what they need in order to feel safe here.
Running the First Session
Practical guidance for the conversation itself
Structuring the Hour
Cover confidentiality and its limits before the risk questions
Explain in plain language what you would have to disclose, to whom, and what would trigger it, before you ask about self-harm or fear of another person. A client who learns the limits after disclosing may not return, and consent given at minute two does not carry itself to minute forty.
Ask about risk in the first half
Risk questions placed near the end leave no time to make a safety plan, contact a prescriber or arrange follow-up. Ask early, then return to it briefly before the session closes so nothing is left hanging.
Say how the session will run
Tell the client you will ask a number of set questions, that some will be blunt, and that they can decline any of them. Naming the structure removes the sense of being assessed without knowing the criteria.
Leave the last ten minutes empty
You need time for their questions, for practicalities, and for the thing that gets said once the formal part is over. Intake forms expand to fill the hour if you allow it.
Follow the client when it matters more than the list
If a question opens something significant, stay with it and complete the rest of the intake next week. Twenty answered questions and no alliance is the worse outcome; the paperwork can wait a session.
Asking These Particular Questions
- Use the client's own words back to them. Reflecting their phrase rather than the clinical term is what makes the next answer longer than the last.
- Ask one question at a time. Stacked questions get the easiest one answered and the difficult one dropped.
- For the substance question, ask about quantity on a heavy day, then ask about frequency. Reversing the order tends to produce a lower estimate.
- Do not soften the risk question with qualifiers such as you are not the sort of person who, since that tells the client which answer you would prefer.
- If a client declines a question, note the decline and move on. It is information, and pressing it in a first session costs more than the answer is worth.
- Write quotes verbatim in your notes where wording matters, particularly for risk, disclosures and anything that may be read by another clinician later.
Common Pitfalls
Running intake as a form rather than a conversation
A client who is asked twenty questions in sequence learns that this is a place where short answers are expected. The information you lose in the following six sessions outweighs anything gained by completing the form today.
Accepting the referrer's account of the problem
Employers, courts, doctors and family members refer for the behavior they can see. If your goals reflect only the referrer's version, the client remains a spectator in their own treatment.
Treating a single denial of risk as the assessment
Ambivalence is common and one no early in a first meeting with a stranger is weak evidence. Ask again later in the session, in different words, and document both answers.
Setting goals that cannot be observed
Being happier and having better self-esteem give you no way to tell whether the work is helping. Convert them into something countable or visible before the second session, with the client's agreement.
Skipping the practicalities
Fees, cancellation policy, session length, how to reach you between sessions and what to do in a crisis all need saying out loud in the first meeting. Unclear arrangements become ruptures later.