Therapist Session Starter & Flow Cheat Sheet"
"Therapist Session Starter & Flow Cheat Sheet", designed to help you open and structure sessions with intention, variety, and clinical depth beyond the typical “How was your week?”.
PURPOSE: A guide to open sessions, re-engage clients, and structure meaningful conversation when sessions risk feeling repetitive or unproductive.
1a. Opening & Setting Focus
(Move beyond “How are you feeling?” to anchor the session in purpose.)
Sample Prompts:
“What feels most important for us to focus on today?”
“Would you like to check in on ongoing goals or create a new one for this week?”
“What’s been taking up most of your mental space lately?”
“Looking back since our last session — what moments stood out to you, good or bad?”
“Is there anything you’ve noticed about your patterns or emotions recently that you’d like to unpack?”
What is
Clinician Tip:
If sessions feel aimless → redirect with “goal refresh”:
“Let’s revisit your goals to make sure they still fit where you are right now. What’s still relevant, and what feels outdated?”
1b. Goal Setting & Recalibration
Sample Prompts:
Use when sessions feel stagnant, directionless, or when a goal has been achieved/metastasized.)
Objective: To create, update, or reframe therapeutic goals, ensuring they are relevant and motivating.
For New Goals:
"If we could make one meaningful change in your life in the next few months, what would it be? Let's work backwards from that vision."
"Looking at the challenges you've been facing, what would you like to do differently, feel differently, or believe differently as a result of our work?"
"On a scale of 1-10, how important is [current therapy topic] to you right now? What would make it a 10?"
For Recalibrating/Updating Goals:
"I notice our sessions have been circling [topic]. Does this still feel like the most valuable use of our time, or has the core challenge evolved?"
"Let's revisit the treatment plan goals we set. Which of these feels most alive for you right now? Which feels less relevant?"
"It seems like we're a bit stuck. If we were to completely change our approach today, what new direction would feel most energizing to you?"
Clinician Tip:
If sessions feel aimless → redirect with “goal refresh”:
“Let’s revisit your goals to make sure they still fit where you are right now. What’s still relevant, and what feels outdated?”
2. Reviewing Progress / Wins / Successes
(A structured alternative to "How was your week?")
Objective: To gather data on successes, challenges, and specific focus areas from the past week.
Progress & Wins (No matter how small):
"Tell me about a time this week where you managed a difficult thought, feeling, or situation even slightly differently than you would have before."
"What's one thing you did this week that was in alignment with your values or goals?"
"Did you have any 'aha' moments or observations about yourself between our sessions?"
Recent Challenges:
"Where did you feel the most stuck, triggered, or discouraged since we last met?"
"What specific situation would you like to 'unpack' together today?"
"Did any old patterns or unhelpful thoughts resurface this week?"
Specific Area of Focus for This Session:
"Given what you've just shared about your wins and challenges, what feels most important to focus on in our time today?"
"Is there something specific happening in the coming week that you'd like to prepare for?"
"Of all the things we could talk about, what feels like it would have the biggest impact to discuss right now?"
Clinician Tip:
Reinforce agency:
“You’ve been showing consistency with ___. How does it feel noticing that?”
3. Exploring Challenges or Setbacks
(Normalize struggle and create curiosity, not shame.)
Sample Prompts:
“What’s been getting in the way lately?”
“Were there any moments this week that felt like backslides?”
“When you noticed yourself struggling, what thoughts or emotions were present?”
“What would support have looked like in that moment?”
Clinician Tip:
Explore patterns gently:
“I notice this challenge tends to reappear when ___. What do you make of that?”
4. Session Focus / Agenda Setting
(A formal check-in on the overarching roadmap, best done every 4-8 sessions.)
Objective: To ensure the therapy is on track and aligned with the client's long-term objectives.
"I'd like to take about 10 minutes to formally review our treatment plan. Let's look at the original goals we set."
For each goal:
"On a scale of 0-10, where 0 is no progress and 10 is completely achieved, where would you rate your progress on this goal?"
"What has contributed to that score? What's helped you get this far?"
"What would need to happen to move it just one point higher?"
"Has your understanding of the problem changed since we started? Do these goals still feel accurate?"
Clinician Tip:
Try “micro-goal framing”:
“If we could accomplish one small thing by the end of this session, what would that be?”
5. Reviewing or Updating Treatment Plan
(Reassess alignment with evolving needs.)
Sample Prompts:
“Let’s review our original goals — are they still meaningful to you?”
“Would you like to add or shift focus to something new?”
“How do you feel about your current progress toward these goals?”
“Are there skills, habits, or tools you’d like to spend more time on?”
Clinician Tip:
Use this when sessions stagnate:
“Sometimes therapy goals need a refresh to match where you are now. Let’s revisit what success would look like from today’s lens.”
6. Feedback & Session Effectiveness
(The most critical section for the therapeutic alliance and efficacy.)
Objective: To openly assess the process of therapy itself and make real-time adjustments.
What's Working / What Can Improve:
"What has been the most helpful or impactful part of our work together so far?"
"Is there anything about our sessions or my approach that hasn't been as helpful as it could be?"
"If you were the therapist, what would you do differently in our sessions to make them more effective for you?"
Assessing Perceived Progress & Frequency:
"On a scale of 1-10, how confident are you feeling in your ability to manage your challenges independently?"
"As you think about your progress, how does our current session frequency feel? Is weekly still feeling essential, or are you starting to feel you could space them out more?"
"A sign of progress is often needing therapy less. I'm curious if you've had any thoughts about what it might look like when you're ready to start tapering down our sessions?"
Clinician Tip:
Normalize feedback:
“Therapy works best when it’s a collaboration. Your feedback helps me tailor things for you.”
Empower agency:
“Therapy can evolve as you do — we can adjust frequency or focus to fit where you are in your process.”
7. Closing & Integration
(End with reflection and next steps.)
Sample Prompts:
“What feels like the biggest takeaway from today?”
“What do you want to carry forward or practice before next time?”
“Is there a word or phrase that captures how you’re leaving this session?”
How to Implement This Cheat Sheet:
Don't Use All at Once: This is a menu, not a checklist. Choose one or two questions from a relevant section to open a session.
Be Transparent: You can say, "Instead of asking how your week was, I'd like to try a slightly more structured way of checking in. Is it okay if I ask you about a specific win or challenge from the past week?"
Let it Flow: Use these questions as a launchpad. The client's answer is what you follow, not the next question on the list.
Schedule Reviews: Proactively schedule the "Treatment Plan Review" (Section 3) and "Meta-Conversation" (Section 4) every few months. It signals that you are proactive about their progress and the value of their time and investment.