When we look to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) for clarification on a traumatic event, we find their definition of a Trauma as “exposure to threatened death, serious injury, or sexual violence”. Trauma can occur directly to the individual, or indirectly by learning of the event from a loved one, witnessing the event, or having repeated exposure to adverse details of trauma. Keep reading to learn 55 questions for trauma therapy sessions with your clients.

There are still unknowns when it comes to trauma and the development of related Mental Health concerns, including post-traumatic stress disorder (PTSD). Individual differences including age, previous life experiences, and previous traumas are factors that can impact the development of mental health concerns after a trauma. Two people can experience, or witness, the same traumatic event, and have different emotional reactions and responses to the traumatic event.

So, how prevalent are traumatic experiences? One global study from 2015 indicated that  70.4% of participants endorsed experiencing at least one traumatic event during their lifetime. It is important to note that the prevalence of traumatic experiences did vary among the different countries that were included in the study, with the lowest rate in Bulgaria (28.6%) and the highest rate in Ukraine (84.6%).

This study indicated that the rates for exposure to at least one traumatic event among U.S. residents was 82.7%, surpassed only by Ukraine and Peru in this study. Countries that showed lower rates of traumatic event exposure included Colombia, Brazil, France, South Africa, Australia, and Mexico.

As mentioned above, responses to traumatic events are individualistic, and can vary in severity. Individuals who experience trauma can experience psychological distress including anxiety, depression, post-traumatic stress disorder (PTSD), and other trauma-related concerns. They may find themselves experiencing flashbacks, nightmares, emotional numbness, and intrusive thoughts.

Trauma can also manifest as physical symptoms including headaches, fatigue, sleep disturbances, compromised immune system, and gastrointestinal issues. Irritability, aggression, hypervigilance, and increased substance use are common behavioral responses to traumatic events.  Individuals may find themselves avoiding people, places, and things that remind them of their trauma, which can have a significant impact on their daily life. Individuals may find that their concentration is impaired, their memory is suffering, and that they struggle to make decisions. 

Getting Ready for Your First Therapy 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:

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

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:

• Nature of Your Trauma Intake Questionnaire
• Facing Your Trauma Worksheet
• Dealing with Nightmares After Trauma Worksheet
• Trusting After Trauma Worksheet
• Trauma Worksheet Bundle
• Cognitive Processing Therapy (CPT) Worksheet Bundle

Questions for Trauma Therapy Sessions to Ask Clients

Trauma informed questions can be used to cultivate a safe and supportive environment that focuses on promoting healing while validating and respecting clients’ experiences. When used properly, trauma discussion questions can be used to explore the clients’ thoughts, emotions, and experiences without causing further harm. Examples of trauma therapy questions include:

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

Final Thoughts on Trauma Discussion Questions to Ask Clients

Thank you for taking time to read about questions for trauma therapy sessions! While a component of trauma counseling is focusing on helping our clients heal, another important aspect is supporting them as they reclaim their lives by utilizing their strength and resilience. Working with clients who have experienced trauma can be an impactful journey as clinicians where we provide support, validation, and guidance in their journey.

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!

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health forms, worksheet, and assessments here.

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.

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