55 Questions for Trauma Counseling Sessions with Your Clients

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), we find their definition of a trauma as “exposure to threatened death, serious injury, or sexual violence”.

Trauma can stem from direct experiences or indirect exposure, such as learning about an event from a loved one or witnessing it firsthand. This can lead to various mental health issues, including PTSD. Individual factors like age and past traumas influence how people respond to trauma. Despite similar events, reactions can differ widely among individuals.

The prevalence of traumatic experiences is significant, with a global study showing that 70.4% of participants had encountered at least one trauma in their lifetime. This rate varied by country, with the highest in Ukraine (84.6%) and the lowest in Bulgaria (28.6%). In the U.S., 82.7% reported exposure to at least one traumatic event, placing it among the highest rates along with Ukraine and Peru.

Responses to trauma are diverse, with individuals experiencing psychological distress like anxiety, depression, and PTSD. Symptoms may include flashbacks, nightmares, emotional numbness, and intrusive thoughts, highlighting the complex and individualized nature of trauma responses.

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Trauma can also surface through physical symptoms like headaches, fatigue, sleep disruptions, a weakened immune system, and gastrointestinal problems. Behavioral responses may include irritability, aggression, heightened alertness, and increased substance use. Avoidance of triggers related to the trauma is common and can greatly disrupt daily life. Individuals may also experience difficulties with concentration, memory, and decision-making abilities.

Getting Ready for Your First Counseling Session with a New Client with Trauma

Traumatic events can have a profound impact on various aspects of an individual’s life that could contribute to their interest in counseling and therapy services. As a clinician, you may or may not know that your client has a history of trauma before meeting with them. One thing you can do to prepare for your session is to review paperwork you have, including self-assessments, questionnaires, and referral forms, before your session. This can give you some insight into the challenges that this individual is experiencing in their life. 

If you know that your client has a history of trauma, it may be helpful to pull out various assessments and screeners that may be relevant to your client’s experience. This allows you to seamlessly utilize them to enhance your initial session. Examples of assessments that you could use include:

  • Beck Depression Inventory (BDI-II)
  • Childhood Trauma Questionnaire (CTQ)
  • Clinician- Administered PTSD Scale (CAPS)
  • Impact of Event Scale-Revised (IES-R)
  • Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5)
  • Trauma History Questionnaire (THQ)
  • Trauma Symptom Inventory (TSI)

As your therapeutic relationship continues, you will have the opportunity to prepare materials for each session you have with your client. Many clinicians sand their clients benefit from the use of handouts and worksheets. Worksheets can be an effective way to transition in session, and provide clients with a take-home reminder of what was discussed in session. TherapyByPro provides mental health professionals with access to worksheets that utilize various therapeutic approaches for a wide array of presenting concerns and mental health disorders. Examples of worksheets that may be helpful with clients who have experienced trauma include:

Questions for Trauma Counseling Sessions to Ask Clients

Trauma-informed questions aim to create a secure and empathetic space, prioritizing healing while acknowledging and honoring clients’ experiences. When employed effectively, these questions facilitate exploration of clients’ thoughts, emotions, and experiences without exacerbating distress. Here are some examples of trauma therapy questions:

  1. How do you feel about discussing your trauma with me in sessions?
  2. Can you tell me about your experiences with trauma?
  3. What are your goals for therapy regarding your trauma and overall emotional well-being?
  4. What strengths or coping skills have helped you navigate your trauma and its effect on your life?
  5. Can you share with me any physical symptoms, or changes you have noticed, related to your trauma?
  6. How has your trauma affected your sense of self-worth or self-esteem?
  7. Can you think of ways that your trauma influenced your beliefs about yourself, others, and the world?
  8. How do you typically express or manage your emotions, including those related to your trauma?
  9. How do you typically cope with difficult emotions?
  10. Have you noticed any changes in your relationships since the traumatic event?
  11. What triggers or reminders of the trauma do you experience? How often would you say this comes up for you?
  12. Can you share how you typically respond to, or manage when, triggers that remind of the trauma?
  13. Have you noticed any patterns or themes in the triggers you experience, or within your reaction to them?
  14. Are there any aspects of your trauma that you feel particularly uncomfortable talking about?
  15. How do you feel about coming to therapy to address your trauma?
  16. What coping strategies have you used to manage the distress caused by your trauma?
  17. How do you feel about exploring how your body responds to trauma in therapy?
  18. What emotions come up for you when you think about the trauma you’ve experienced?
  19. How has your trauma affected your daily life?
  20. What do you need from me as your therapist to feel safe and supported while discussing your trauma and related experiences?
  21. How do you feel about exploring how trauma has impacted your ability to connect with others in therapy?
  22. How do you typically cope with feelings of sadness or grief that are tied to the trauma?
  23. Have you experienced any changes in your libido since your traumatic experience?
  24. How do you typically cope with feelings of anger or resentment related to the trauma?
  25. Can you tell me about any changes in your energy levels or motivation since experiencing trauma?
  26. Is there anything I can do to help you feel comfortable exploring these feelings in future sessions?
  27. How do you typically cope with feelings of guilt or shame when they come up for you?
  28. Have you noticed any changes in your appetite or eating habits since experiencing trauma?
  29. How do you feel about exploring how trauma has affected your thought processes with me in therapy sessions?
  30. Have you experienced any difficulties concentrating or making decisions recently? How does this differ from your experiences before the trauma occurred?
  31. Can you tell me about how you typically respond to nightmares or intrusive thoughts when they come up for you?
  32. Have you noticed any changes in your sleep since experiencing trauma?
  33. How do you feel about exploring these memories or images together during sessions?
  34. Are there any specific memories or images related to the trauma that stand out to you?
  35. How do you think your trauma experiences have influenced your thoughts about trust and safety?
  36. How do you feel about setting boundaries or limits around discussing trauma in therapy?
  37. How have experiences with therapy and other healthcare providers influenced your feelings about getting help for your current mental health challenges?
  38. How do you feel about using mindfulness or relaxation techniques into our sessions to help manage symptoms that come up for you?
  39. Are there any cultural or social factors that influence how your thoughts and emotions regarding your trauma?
  40. How do you feel that spirituality or faith influences your healing process?
  41. Are there any changes or modifications I can make to our current environment to make you feel more comfortable?
  42. What changes will you notice when our work together is having a positive impact on your life?
  43. Can you tell me about the supportive people in your life?
  44. How do you feel about exploring how trauma has influenced your beliefs about safety or danger in therapy?
  45. Have you experienced any changes in your ability to feel grounded or present in the moment since experiencing trauma?
  46. Are there any changes in your ability to feel empathy or compassion towards others?
  47. How do you typically cope with feelings of fear or anxiety related to the trauma?
  48. Can you tell me how you cope with, or manage, feelings of vulnerability?
  49. How do you feel that your sense of humor or ability to find joy in everyday life has changed since experiencing trauma?
  50. Have there been any noticeable changes in your ability to feel connected to yourself or your surroundings?
  51. How do you typically cope with feelings of loneliness or isolation? How often would you say these come up for you?
  52. Can you tell me about how you typically cope with feelings of hopelessness or despair? Are these common experiences for you?
  53. Have you found ways to cope with feelings of frustration or irritability that come up for you?
  54. How do you typically cope with feelings of numbness or dissociation connected to the trauma?
  55. Can you tell me about any changes in your ability to experience pleasure or enjoyment since experiencing trauma?

Final Thoughts on Trauma Discussion Questions to Ask Clients in Counseling

Thank you for investing your time in exploring trauma therapy questions! In trauma counseling, we not only facilitate healing but also empower clients to reclaim their lives by tapping into their resilience and inner strength. Guiding clients through their trauma journey is a profound experience for us as clinicians, as we offer support, validation, and guidance along the way.

If you would like to learn about trauma informed care, or the therapeutic approaches that can be effective in treating PTSD and trauma-related mental health concerns, we encourage you to look for continuing education and other training opportunities within your professional niche!

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and help your clients be their best selves.

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Resources:

  • Benjet, C et al. “The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium.” Psychological medicine vol. 46,2 (2016): 327-43. doi:10.1017/S0033291715001981
  • “DSM.” Psychiatry.org – DSM. Accessed March 7, 2024. https://www.psychiatry.org/psychiatrists/practice/dsm.
Kayla VanGuilder, MA, LCMHC
Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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