Set yourself and your clients up for success from day one.
The initial intake assessment is often the most important interaction you’ll have with your clients. It’s not only an important step in the event of an insurance audit, but provides an opportunity for you to learn more about why your client is seeking support, develop rapport, form a case conceptualization and foundation for treatment, and get an idea of their goals for therapy. Realistically, you may not have time to discuss the full scope of each client’s needs during that first meeting. Consider the intake as a jumping off point for future sessions. From preparing for the intake to wrapping it up, we’ve gathered a few helpful tips and resources below.
Ethical and legal obligations to consider prior to the first appointment
Establishing a new client relationship starts with some paperwork. Before treatment starts, you’ll need to prepare an informed consent document for the client to sign, either in advance or upon meeting in-person (see ‘What disclosures do I need to provide?’). Once the session begins, have a discussion around confidentiality–an important piece of the therapy puzzle. It’s important that your client understands there are limitations to confidentiality right away, even though your conversations in therapy are private. For example, if a client indicates they are a risk to themselves or others, certain states require you to inform the appropriate authorities. Stay up to date on your state's duty to warn requirements.
Structuring your intake
Whether you are a seasoned clinician or just starting your private practice, you understand that the art of intake is refined over time. “Experienced therapists, like tango aficionados, find their flow and gather information, maintain rapport, and begin dealing with closure at the same time, without specifically thinking about it...but they didn’t begin their careers with this ability (Skovholt & Jennings, 2004). While each providers’ approach to the clinical intake may differ, they typically follow a similar outline in an hour-long session:
Helpful information to gather
The intake should feel like a guided conversation; natural, yet goal-directed and allowing for you to maintain control. As you get to know more about your client, it’s important to understand their motivation for seeking support in the first place. Some clinicians find it helpful to gather the client’s current symptoms and concerns, as well as any pertinent psychiatric, developmental, medical, career, school, social, romantic, and familial histories to develop their case conceptualizations. Others prefer to let the client speak about their most pressing concerns using a free-form structure and dive into topics as they arise. As you develop your preferred model, the following templates offer suggestions for a streamlined intake process.
Using additional assessments
While the intake interview is ripe with qualitative information about your client and their needs, clinical questionnaires and other various assessment tools score client feedback in a quantitative way that can further support therapy and your discussions. For example, if a client endorses suicidal ideation on the PHQ-9 (a score >0 on question #9), you should administer a follow-up suicide risk assessment to ensure the client is safe and not a risk to themselves or others. It’s typical to administer these assessments prior to the first session so that you can gather a baseline on the client’s state and have an idea of which topics to discuss during their first visit.
Ending your time and setting up for future sessions
After you’ve gathered initial background on your client and discussed potential therapy goals, it’s time to wrap up the conversation. Spend the last 5-15 minutes discussing your initial case conceptualization thoughts, reiterating goals, positively reinforcing their decision to seek therapy and next steps, such as scheduling another appointment and homework for the client. Remember, you likely won’t get to discuss every pressing issue in the first hour. It’s important to gently inform the client that therapy takes place over a few sessions, and that you will continue to address their needs in the next meeting.
No matter what your therapeutic approach is, the intake interview is an important part of the process. It allows you to get a snapshot of your clients needs and begin to steer them towards success. And, like snowflakes, no two intake sessions are alike. While you may want to check off every box on your intake template, flexibility on what topics to explore and when will make the conversation more natural for your client. If you have more questions on intake structure and style, check out the additional readings below:
**Disclaimer: This document is intended for educational purposes only. Please check with your legal counsel or state licensing board for specific requirements.
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