Empowering your patients and guiding them to realize their inner strengths to deal with life’s difficulties are some of the central goals of counseling.
Knowing which questions to ask patients at different points of the counseling process is vital, as your patients will be more inclined to reflect on their difficulties. Ultimately, this will ease distress and promote long-lasting change (Prout & Wadkins, 2014).
This article will provide specific outlines of how you can structure your counseling interview, with questions you can use in different stages of the process.
The aim of these resources is to help you develop a meaningful connection with your patients as they embark on a counseling journey toward self-understanding and meaningful change.
Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.
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What Is the Counseling Interview? 2 Types
Counseling interviews are multifaceted and can be structured or more fluid, depending on the therapeutic relationship stage at which it is conducted. The conversation should be characterized by respect, empathy, and active listening. The counselor should also be mindful of their affect and tone throughout the discussion (Prout & Wadkins, 2014).
In clinical practice, there are two types of interviews that a clinician uses to help understand the difficulties that bring patients to their practice (Kelly, 2020). Each interview serves a different purpose, but interviewing in general aims to give the clinician more information about their patients so that they can provide relevant treatment and guidance.
A structured clinical interview is a semi-structured guide outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Each disorder classified in the DSM-V has a semi-structured guide of questions that clinical psychologists or clinicians trained in recognizing these disorders can ask to determine if a patient meets the diagnostic criteria for a particular disorder (Kelly, 2020).
Since these DSM-V questions are specific to a particular disorder, this interview style should only be used in a counseling interview if the patient wants to explore their predisposition to a particular disorder. Confirmation and further analysis from a clinical psychologist or doctor will be needed to diagnose the patient formally.
A clinical interview is more focused on facilitating conversation between the patient and the counselor. Even though there is still a focus on building a rapport with the patient, the purpose of this interview is to understand their life and what aspects of it are being affected. This type of interview is usually done during the first counseling session and is used to help determine the trajectory for the conversations in subsequent sessions.
5 Good questions for your first session
The first session is focused on understanding the presenting problem, which is the patient’s current level of functioning. In addition, the counselor may ask questions surrounding the history of difficulties that have brought them to counseling (Prout & Wadkins, 2014).
Since the first session with a client should be centered on what prompted them to seek counseling, the questions might be more focused and narrow so you can provide them with the support that best fits their needs (Prout & Wadkins, 2014).
The first question should always be, ‘What brings you here today?’ This gives you an opportunity to set the stage for further sessions and understand what is troubling the patient. A question like this will create a positive, supportive atmosphere where they are more likely to open up and be receptive to change.
To further explore the reasoning behind the presenting problem, it is important to understand the internal and external factors that are present in their lives. Questions that delve more into a patient’s past and present experiences include:
- What was your childhood like? Can you tell me about your family growing up?
- Are there any relationships (romantic or non-romantic) that have impacted your personal outlook or daily functioning?
- When you encounter difficulties, what are your current coping mechanisms?
- What do you think your strengths are? Describe an instance where you’ve used them.
Although there is no prescriptive order in which to ask these background questions, at some point in your first session, you should ask your patient what they would ideally like to get out of counseling.
Even if your patient does not have an answer right away, it is important that you work together to understand this, as it will allow both of you to have an optimal level of functioning to work toward in the sessions following.
9 Useful Assessment Questions
Alongside determining your patient’s intent for seeking counseling and how they want their life to improve as a result, it is also important to collect information that addresses the patient’s concerns and serves as a starting point for planning (Balkin & Juhnke, 2014).
Assessment is a process, not a means to an end in counseling, as it allows for counselors to decide what issues need to be addressed first and what kind of treatment and interventions should be implemented (Balkin & Juhnke, 2014).
Therefore, it is natural for the assessment portion of your session to be more formal and focused on assessing your patient’s mental and physical health, and could include topics such as:
- History of hospitalizations – ‘How many times have you been hospitalized? What for?’
- Medications – ‘Are you currently on any medication? If so, for what and what is the dosage?’
- Previous therapeutic experience – ‘Have you ever had therapy before? If so, what kind of therapeutic interventions/practitioners have you seen?’
- Suicidal ideation – ‘Have you ever had thoughts of killing yourself or attempted to kill yourself? What motivated or triggered these thoughts?’
- Symptomatology – ‘What kind of symptoms have affected your daily functioning? Rate the severity and frequency of each symptom.’
After you get a complete history of your patient’s mental and physical health, you can then narrow down the resources and formal assessment tools that can assist them in your sessions together.
Process of the Interview: Step-by-Step Guide
After conducting the initial clinical assessments, each subsequent session with patients is viewed as an informal interview. Even though the interview may not be as structured as the initial assessments, each session is aligned with a staged counseling approach that is oriented toward guiding the patient toward workable action that will improve their quality of life.
Each stage of the interview process will help to build this connection between you and your patients. Depending on the time you have with your patients, these stages can be divided or executed based on time constraints. Below is an outline of the stages you should follow when trying to build a meaningful rapport with your patients (adapted from Cameron, 2008):
- Step one – Making a connection
The first portion of the interview should be focused on building rapport with your patients, such as demographics, history, and the reasons counseling is sought (Ivey & Ivey, 2003). Questions should be open ended and aim to give each session a specific purpose. What brings you to counseling? What would you like to focus on in today’s session? What can we do today that will help you move forward?
- Step two – Identifying individual strengths and goals
During this step, the focus is on getting a patient to recognize their strengths and acknowledge them through self-affirmation. To set the stage, counselors can ask patients questions that help draw out their inner strengths, such as, ‘Where do you think your strengths are?’ or ‘Tell me about a time when you felt good about something you did.’
After drawing out these scenarios, counselors can then move on to helping patients learn how to use positive self-affirmations to help increase their confidence and improve their perception of themselves.
Positive self-affirmations should be relevant to the patient’s struggle and help them achieve the goals they set out to achieve in their sessions. For example, if a patient has body image issues, they should focus the affirmations on praising their body (“I am beautiful”) and their strength (“I am strong and I can overcome”).
- Step three – Actionable strategies for change
The last step is for you and the patient to make an actionable plan to help them change their behavior. In this final part of the session, you and the patient will work together to come up with a plan of action.
The goals should be clear, and there should be a plan set up to ensure accountability. Asking questions such as ‘How do you plan to apply what you’ve learned in today’s session in your everyday activities?’ and ‘How can we work together to make a plan so you continue to feel empowered?’ will help give patients workable strategies to help adjust their behavior.
How to Use Open Questions: 9 Examples
There are two broad approaches to questioning in counseling: open-ended and closed questions.
Closed-ended questions are less broad and are used to get very specific information from your patients, for example, medical information or living arrangements (Balkin & Juhnke, 2014).
Open-ended questions are more unstructured and are meant to give you more information about unique events and, when used strategically, can be formatted to gain specific insight about various parts of the patient’s life (Australian Institute of Professional Counsellors, 2009).
Specific ways that open-ended questions can be used in counseling sessions depend on what information you want from your patients. This section provides a general overview of how you can convert simple questions into open-ended questions to help get your patients to open up (Australian Institute of Professional Counsellors, 2009):
- “How” questions enable patients to talk about their feelings – ‘How does this particular situation make you feel? How did this experience shape your current perspective?’
- “What” questions help you get specific facts surrounding a situation that has shaped your patient’s perspective – ‘What happened here? What role did (person) play in this situation?’
- “When” questions are centered around the timing when a situation or event occurred – ‘When did this happen?’
- “Where” questions give specific information about the environment or place the event took place – ‘Where did this situation occur? Where did most of these difficult events happen?’
- “Why” questions focus on the reasons leading up to the event or any information related to it – ‘Why did (person) react that way? Why did X happen at this particular time?’
Questions during the counseling session are meant to provide new areas for discussion and provide clarity for you when learning about the reason your patients sought counseling.
Summarizing and asking open-ended questions – John Malouff
17 Best Questions for Your Sessions
A large part of knowing what and how to speak to your patients involves building a strong emotional bond. Emotional bonding between counselors and therapists could include compassionate and empathetic listening or humor. It could also involve just sitting with the patient while they are experiencing strong emotions (e.g., sadness or anger) and giving supportive, positive feedback (Meyers, 2014).
Giving your patients opportunities for evaluation and reflection on what techniques are working for them in your sessions together will allow you and your patients to understand how they are feeling throughout treatment and ensure that the questions being asked are relevant to their experience (Meyers, 2014).
This approach can also help develop the emotional bond between patient and counselor, as it allows for open communication and dialogue between the two parties.
Questions that can help facilitate reflection during your sessions include:
- How are we doing?
- Are these sessions helpful?
- What do you want to work on?
- What would you like to get out of today’s session?
- Where would you eventually like to be?
- Where do you think you can go?
Making emotional bonding a central part of the counseling process means that instead of only relying on formal counseling techniques and interventions, you are also making an effort as a practitioner to ensure your patient is heard and that the sessions are moving at a pace they are comfortable with.
5 Questions for marriage and couples counseling
According to Gottman and Silver (1999), the central reason couples choose to seek marriage or couples counseling is because of difficulties in communication. When working with couples, it is important to develop an understanding of why they are seeking counseling and what they hope to get out of their sessions.
Start by asking questions such as:
- How long have you and your partner been together?
- What are you hoping to achieve in these sessions?
- Can you tell me what has prompted you to seek couples/marriage counseling?
- Tell me about how you met.
- Do you have any issues outside your relationship with each other that cause difficulties in your partnership (e.g., in-laws, co-parenting with high-conflict exes, stepchildren, differing work schedules)?
After developing a baseline, it is important to help couples develop effective communication strategies. Counselors often emphasize active listening strategies, where couples learn to resolve their conflicts by using “I statements” to communicate how they are feeling.
However, therapy that is centered on conflict resolution has been shown to have a 35%-success rate, as couples who engage in these strategies can sometimes feel that their true concerns are not heard by their spouse (Gottman & Silver, 1999). It is important that you help couples develop a safe environment where they can communicate honestly and openly with each other.
Our Marriage Counseling Toolkit has a section entitled ‘key questions’ that allow couples to think about what is bringing them to therapy and consider the goals they have for their marriage.
Giving both individuals a copy of these questions to answer prior to the first session will allow couples to compare their perspectives in a neutral environment and give you a starting point to determine what techniques and interventions are necessary.
Best career and school counseling questions
Career and school counselors aim to help students and older individuals explore, understand, and execute career-related decisions.
While school counselors focus more on the steps that students need to take when pursuing specific career paths, career counseling gives both trained professionals and people just starting out in their careers guidance on how to explore, understand, and execute career-related decisions (Lent & Brown, 2012).
Open-ended discussion is an effective strategy for getting the most out of individuals who are seeking career counseling. Determining an individual’s goals and what they intend to get from the sessions, similar to other types of counseling, will allow you and your clients to get the most out of your sessions.
Some open-ended questions counselors can ask to help guide their clients include:
- How long have you been in your chosen career?
- Where do you see yourself in 10 years? Do you still see yourself in this field, or do you think you want to move into another area?
- Are you happy with your chosen career path? What could be better?
- Think of a goal you have achieved. What are the steps you took to get there?
In school counseling, it is important to adopt a similar open-ended discussion format when talking to students about what they plan to do. Instead of focusing on their career, you want to focus on what they plan to achieve. Questions such as ‘What can you see yourself doing in the future?’ or ‘Where are your strengths/passions?’ can help students to think about what direction they want to go in.
Our career counseling article has a large selection of questions you can ask students just starting out on their career journey, as well as questions you can ask seasoned professionals who are further on in their careers. Speaking of career, here is an excellent resource on How to Become a School Counselor.
Helpful Resources From PositivePsychology.com
Our site has many tools and resources that can help enhance your counseling practice. Whether you are a clinical counselor, marriage and relationship counselor, or career counselor, our activities and worksheets are highly variable and can apply to a variety of different contexts in the counseling profession.
Assessing a patient’s mental status is an important aspect when moving forward in ongoing counseling sessions. These Brief Mental Status Exam and Mental Status Exam – Exploring Strengths worksheets can help counselors get a baseline before they start working with their patients.
If you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.
A Take-Home Message
Building positive connections with your patients is a key part of the therapeutic process. How you respond to your patients’ feelings, needs, and goals will determine the strength of the clinician–patient relationship and, ultimately, determine how much your patients choose to open up to you about their difficulties in their sessions.
We hope this article provided you with several questions you can ask your patients, no matter what type of therapy your practice specializes in. In addition to the resources you are providing, make sure you are using the time with your patients to develop a strong relationship so that the sessions can be meaningful for both of you.
We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.
- Australian Institute of Professional Counsellors. (2009). Counselling microskills: Questioning. Retrieved on October 8, 2021, from https://www.counsellingconnection.com/index.php/2009/07/10/counselling-microskills-questioning/
- Balkin, R. S., & Juhnke, G. A. (2014). The theory and practice of assessment in counseling. Pearson.
- Cameron, H. (2008). The counseling interview: A guide for the helping professionals. Palgrave-MacMillan.
- Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. Seven Dials.
- Ivey, A. E., & Ivey, M. B. (2003). Intentional interviewing and counseling: Facilitating client development in a multi-cultural society. Thompson, Brooks & Cole.
- Lent, R. W., & Brown, S. D. (2012). Career development and counseling: Putting theory and research to work (2nd ed.). Wiley.
- Meyers, L. (2014). Connecting with clients. Retrieved on October 9, 2021 from https://ct.counseling.org/2014/08/connecting-with-clients/
- Kelly, O. (2020). How clinical interviews help diagnose mental illness. Retrieved on October 9, 2021 from https://www.verywellmind.com/structured-clinical-interview-2510532
- Prout, T. A., & Wadkins, M. J. (2014). Essential interviewing and counseling skills: An integrated approach to practice. Springer.