Meeting with a client for a first-time appointment or an intake assessment can be quite overwhelming – especially as a trainee! Only having 60 minutes to obtain all of the information you need is often challenging and sometimes even feels impossible.
However, I encourage you to think of the intake assessment as both a skill and an art; a skill and an art that can be honed through practice and by implementing the tips offered below. Rest assured that by the time you begin your career as a psychologist, intakes will flow fairly routinely and may not even take a full hour to complete.
1. Orient the Client (and Yourself) to the Intake Process.
Seeking behavioral health services can be an intimidating and anxiety-provoking process for many clients. Similarly, it is normal for trainees to feel intimated by clinical work, especially early in their training, and it is not uncommon for a parallel process to occur in which some of the client’s discomfort is transferred to the therapist.
Thus, by orienting the client to the intake process, you can help reduce their anxiety in terms of what to expect throughout the appointment. This can also aid in reminding you of your agenda and reducing the discomfort you may be experiencing. Providing orientation to the intake process can also assist in developing rapport by making the client feel more comfortable and relaxed. (For example, it is okay to laugh when clients comment on the presence, or lack thereof, of a couch in your office!)
2. Remind Yourself of the Purpose of the Intake.
When we meet a client for the first time, we may feel compelled to learn everything we possibly can about them in the first appointment. However, it is important to shift your conceptualization of an intake early on by focusing on its function, which then defines the “job” you need to accomplish in that first appointment.
Specifically, an intake is designed to obtain information regarding a client’s presenting concerns and symptoms, as well as foundational background information (described next), to arrive at an accurate diagnosis.
Accurately diagnosing your client is important for a variety of reasons, but especially important in terms of billing insurance and informing your treatment plan. Thus, if you focus the intake on obtaining the information necessary to arrive at an accurate diagnosis, not only are you able to set a clear goal for the appointment, but you also begin to inform your treatment approach.
3. Set Your Priorities.
As indicated above, it is necessary to obtain some background information about a client during the intake appointment. However, sometimes it can be difficult to decipher which background information is necessary and which information can be collected at a later time – especially when clients are exceptionally talkative, or the information they want to share is very important to them.
For example, while it is relevant to know whether a client has a conflictual relationship with a parent which may contribute to their symptoms, it is probably much less important to know where they attended elementary school. Striking the balance between obtaining too much or too little background information in the first appointment is something you will grow more comfortable with as you hone your therapy practice.
Generally, it is helpful to focus on the following main content areas when conducting an intake: presenting concern, symptoms, suicide/safety assessment, trauma history, treatment history and medical history. It has been my experience that these content areas also overlap with insurance requirements for documentation.
Of all these content areas, an assessment of the client’s safety – potential to harm self or others – may be one of the most important pieces of information you, your employer, or training site may need. Be sure to ask about this in the very first meeting.
When it comes to gathering information about symptoms, it can be particularly helpful to focus on symptoms consistent with DSM-5 diagnostic criteria. For example, if a patient is depressed, it is useful to ask about feelings of isolation, hopelessness, and inability to experience joy. This helps organize your assessment and justify your diagnosis
Further, although informative, obtaining a client’s social history, such as work and educational background, can generally occur at a later date. Most of the time, this is not crucial for making an accurate diagnosis.
4. Develop Your Own Flow.
Each employer or training site will have its own intake documents and accompanying paperwork. When I first began conducting intakes, I remember feeling a lot of pressure to review the intake documents and ask questions in a specific order – for example, the order in which the paperwork or questions were organized.
However, as I became more comfortable with the intake process, I found it helpful to develop my own flow. I realized that as long as I obtained all of the necessary information, and as long as all the paperwork was reviewed and signed, the order of doing so did not seem to matter so much. (One caveat to this is informed consent and reviewing limits of confidentiality, which should always be done at the start of the appointment.)
Developing my flow helped me feel more confident in my approach and more in control of the process, which in turn can help clients feel more at ease during the appointment. Keep in mind you are the expert in the room, and most clients are not aware or concerned about there being a specific order of questions for the intake.
5. Be Realistic and Kind to Yourself.
There is a lot of information to collect during an intake. That being said, be realistic in recognizing that you will make mistakes and you will forget to obtain some pieces of information. But guess what? That is okay! We may be therapists, but we are also human, and our clients do not expect us to be perfect. So, accept you will make mistakes, forgive yourself when it happens, and remember: you can always collect information you may have missed at a later appointment.
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