clinical intake interview questions

As you and your cohort settle into practicum, you will hear at some point about the intake process, specifically how different sites may have different ways of approaching an intake. Department of Mental Health sites in your county may have an intake form with questions that go on for several pages. For example, the Los Angeles County Department of Mental Health Adult Intake form has nine sections, with subsection questions for each one!

Your site may have an intake form the client has to fill out before seeing a therapist; that information may already be included. Asking about sexual or gender identity can seem imposing for a first session. The key is to get a feel for the client and establish a comfortable working relationship during your conversation about informed consent, emphasizing the extent of confidentiality at your site. Asking if clients are comfortable disclosing their sexual orientation after that conversation usually typically yields an answer. If not, it is important to affirm their decision and move on without drawing attention to their decision not to provide that information.

Beginning this section by asking, “so what brought you in to see me?” or “what can I help you with today?” establishes friendly atmosphere. Clients will usually be able to articulate some form of symptomology or another; you’ll want to get information on how often symptoms occur, their severity, a history of their symptoms (how long they’ve been experiencing them), and how it impacts their functioning. Does it get in the way of work, school, or sleep? How so? Clients will most likely disclose more than just these things, and it doesn’t hurt to ask if there’s something else you’d like for them to elaborate on!

Take note of your client’s alertness and orientation. Outside of doing a Mini Mental Status Exam, you can gather orientation through asking four questions: their name, their location, the day of the week, and what they were doing right before they arrived or as they were arriving (in the world of emergency medicine, this is typically used to assess a client’s mental orientation when arriving on scene, where the last question is replaced with asking if they know what happened to them just now).

When explicitly asking those questions, I’ve yet to find a client who felt negatively about them. However, if you should feel the need to make it feel more organic, you can simply ask them to state their whole name to help you learn the pronunciation, ask what day of the week it is because you’re trying to fill out a form and it’s slipping your mind, ask them to clarify if they know where they are (following it up with the qualifier that you just wanted to make sure they’re here for mental health services and not something else), as well as a friendly question on how they felt and what they were doing as they were getting ready for session.

That seems like a mouthful, but as you grow more comfortable, you’ll find this process to be quite brief, assuming they do not have difficulty with any of the questions. Next, you can assess their memory simply by how they describe other sections of the intake. Their long-term memory can be intact if they’re able to recall events from their childhood or from years ago, and their recent memory can be assessed by listening to them describe events from earlier that day, or days/weeks ago. Also note their movements; are their gestures within normal, conversational bounds? Or are there a lot of animated movements, or even a noticeable lack of body movement? Body movement outside normal conversational bounds is often described as psychomotor agitation.

Thought process can be described as linear and organized on one end, and disorganized and tangential on the other. Tangential speech starts at one point and never returns to the original prompt, and in charts and notes is often understood as a proxy for psychosis, so use “tangential” and “disorganized” with caution. Circumstantial speech may be a good descriptor for clients who answer to a question by telling stories, narratives, or hitting different, unrelated points before coming to an answer that is relevant to your queries.

Do include other noteworthy clinical observations; this is not an exhaustive list. You may include whether clients make unusual amounts of eye contact or none at all, if their speech changes when talking about certain topics, etc. As you conduct more intakes, you will undoubtedly gain proficiency in noticing behaviors that are out of the norm or not found in most of your clients.

Ask clients where they were born and raised, and who they lived with growing up. It may be helpful to ask them how they got along with their family/friends when they were younger, and how they do so currently (if they’re older, feel free to ask them to elaborate on how they got along with family and friends in different periods of their life).

Ask what school was like if applicable, as well as if they took any special needs or gifted courses growing up. Discuss their efforts in making friends and socializing when they were younger as well as currently, noting if there are any changes (for example, a client may have made friends easily as a child, and found it more difficult in high school onward).

If clients have seen a therapist before, discuss if they found it helpful or not, and why. Ask how long they were in treatment, as well as what type of setting it was (a community mental health site, hospital, school counseling, private practice, etc.). If they have no history of mental health treatment, ask if there was anything that kept them from seeking services.

You can follow up by asking them to elaborate; how many times a month do they socially smoke, drink, or use other substances? If they do not currently use any substances but have in the past, ask how long ago, how often they used to, and when they started and stopped.

Inquire about any current chronic/recurring/significant medical issues, and check if they are being managed by a healthcare professional. See if they can remember their last physical or physician’s appointment. Ask if they know if any medical issues run in their family, and if anyone in their family has also experienced mental health issues.

Think of this section as the part where you generate your treatment plan based on what you know, and things to consider in therapy. Based on the client’s reported symptoms, what do you think they may benefit from? For example, a client’s self-report might have you see a mix of generalized anxiety and panic, suggesting a need to cultivate calming coping skills.

Does the client have present or past suicidal ideation? Trying to ask clients this question can seem daunting and encroaching on their privacy, but research suggests that asking about suicidal ideation doesn’t increase the risk of suicidal behavior; on the contrary, for suicidal clients, it can lead to improvements in treatment [1]. In addition, you’ll have clients who do not present with a history of suicidal thoughts/behaviors, and they’ll answer the question candidly. I’ve found that clients are forthcoming with their past experiences with suicidal thoughts and behaviors, and the key is being able to listen to them with empathy. Asking them what was going on in their life at the time can foster dialogue that can build a more positive working relationship. Other risk factors include a history of abuse, social isolation, lack of peer/family support (real, perceived, or otherwise), drug use, and no positive coping skills. Ask them how they’ve been managing their symptoms, and what they do when they experience them. Make sure to also note positive protective factors in their life as well, such as family/peer support, pride in their job/goals/aspirations, and anything else they may perceive to be a protective factor.

Make sure to write out what the client wants to accomplish, using their own words, and elaborating on those goals as necessary. If a client reports wanting to get their anxiety under control, try to get a clearer picture of what they think that looks like; how would they function at work or with family? How often would they experience anxiety after seeing you for a month? Are they invested in a reduction of frequency and severity of symptoms, or do they want to try to obtain total symptom removal? This conversation leaves room for both therapist and client to collaborate on a concrete, obtainable goal.

This is the section that illustrates what you and the client agreed on for treatment. This doesn’t have to be a section to describe the technical names of an intervention you decided on, but rather how those interventions were explained and may play out in therapy. A client with anxiety may collaborate with a therapist and agree on practicing body-oriented calming techniques to address panic symptoms as they occur, as well as thought logging to reframe automatic thoughts about the client’s self.

Depending on your time constraints, you may find it helpful to ask for a client’s presenting concerns near the end of the intake, before moving on to treatment goals and the collaborative action plan. Presenting concerns can lead to very thorough conversations about clinical issues. This may also organically lead into a therapy session, leaving you with little to no time to collect other information.

By saving presenting concerns for near the end, you can allow clients to discuss their presenting problems while having a natural segue into treatment goals and an action plan. However, keep in mind that this template is for a semi-structured interview. By its very nature, it’s intended to be utilized by the therapist in a way that works best for their own practice. Early in your training, you may sound very structured any time you use any form of a template or questionnaire.

It’s more important to ask for feedback from a supervisor on what your site believes is more relevant for an intake and adjust accordingly. Before you know it, you’ll be able to complete a semi-structured intake with time to spare. Remember to ask the client their feelings about how the intake was for them and to assess their motivation to continue treatment.

Take those final minutes to establish some comfort and build your client’s confidence in treatment. Just as important is your confidence in your actual treatment plan. Completing a thorough intake and having enough information to inform treatment is always a great way to start therapy for the client and the therapist.

11 example client intake interview questions
  • What is your reason for coming in today? …
  • Can you tell me more about your case? …
  • Have you ever worked with an attorney before? …
  • Have you seen an attorney about this matter already? …
  • What are your goals? …
  • Do you have additional documents or information for me?

Intake and Assessment Role-Play Part 1 – Referral and Presenting Problems

Ask clients where they were born and raised, and who they lived with growing up. It may be helpful to ask them how they got along with their family/friends when they were younger, and how they do so currently (if they’re older, feel free to ask them to elaborate on how they got along with family and friends in different periods of their life).

Beginning this section by asking, “so what brought you in to see me?” or “what can I help you with today?” establishes friendly atmosphere. Clients will usually be able to articulate some form of symptomology or another; you’ll want to get information on how often symptoms occur, their severity, a history of their symptoms (how long they’ve been experiencing them), and how it impacts their functioning. Does it get in the way of work, school, or sleep? How so? Clients will most likely disclose more than just these things, and it doesn’t hurt to ask if there’s something else you’d like for them to elaborate on!

You can follow up by asking them to elaborate; how many times a month do they socially smoke, drink, or use other substances? If they do not currently use any substances but have in the past, ask how long ago, how often they used to, and when they started and stopped.

Take those final minutes to establish some comfort and build your client’s confidence in treatment. Just as important is your confidence in your actual treatment plan. Completing a thorough intake and having enough information to inform treatment is always a great way to start therapy for the client and the therapist.

If clients have seen a therapist before, discuss if they found it helpful or not, and why. Ask how long they were in treatment, as well as what type of setting it was (a community mental health site, hospital, school counseling, private practice, etc.). If they have no history of mental health treatment, ask if there was anything that kept them from seeking services.

How To Conduct The Perfect Intake 101

First, it’s important to remember that the perfect intake session starts way before meeting with your client.

Before you sit down with your client or turn on your webcam for the intake meeting, make sure you:

  • Have all the necessary paperwork ready (e.g., informed consent, social media policy, a release of information form).
  • Review your client’s background so you have a sense of what they’re looking for help with.
  • Jot down the important questions you need to ask in this session; it’s all too easy to forget a question or two in the moment.[1]
  • Once you get face to face with your client (or webcam to webcam), the most important skill you can practice is good listening. You want to show compassion and empathy to build an effective therapeutic relationship with your client.

    According to the professionals at Good Therapy, you can show empathy and compassion by:

  • Greeting your client warmly.
  • Listening actively and asking questions.
  • Facing your client during the session to show engagement.
  • Letting the client know that feeling nervous or anxious about the first session is common.
  • Asking the client what led them to therapy and what they’d like to get out of therapy.
  • Checking in at the end of the first session to see how they feel.[1]
  • Nondirective listening is being an active, good listener for your client without offering interpretation, explanation, or direction on where to go next.

    Here are some ways you can practice nondirective listening:

  • Maintaining eye contact
  • Using body posture to show you’re listening
  • Using an attentive tone
  • Verbal tracking (using your words to show your client you are actively listening)
  • Using silence to encourage the client to keep talking
  • Asking for clarifications (giving verbal prompts)
  • Paraphrasing
  • Reflection of feeling back to the client
  • Summarization[2]
  • However, there may be times when you need to practice directive listening. Directive listening is still active, nonjudgmental listening, but it adds other elements to guide the client towards insight and action.

    Here are some ways to practice directive listening:

  • Feeling validation (validate your client’s feelings)
  • Interpretive reflection of feeling (aka “advanced empathy”)
  • Interpretation (providing inferences to your client)
  • Reframing (offer different ways of looking at things)
  • Confrontation (pointing out discrepancies)[2]
  • The balance in the types of listening you use will depend on your client, what they’re dealing with, and how you plan to move forward with them.

    Aside from practicing good listening—which is vital in any session—therapy pros John and Rita Sommers-Flanagan identified three components of a successful intake session:

  • Identify and explore the “chief complaint
  • Take personal history and information
  • Review current functioning[2]
  • As you work through the initial session with your client, these three components should be at the forefront of your mind.

    You don’t necessarily need to have a plan for exactly how therapy will progress after the first session, but you should understand (1) what the major issue is for your client, (2) who your client is, and the most relevant points in their background, and (3) how they’re doing right now.

    If you’re interested in seeing an example of an intake and assessment in action, there are several good videos on this topic.

    The video below from Dr. Todd Grande is one of the most popular videos showing how an intake session should go.

    This role-play showcases the most vital parts of the client intake: he communicates nonjudgmentally, he asks pertinent questions to gather information about the client, he asks for clarifications when needed, and he uses good listening skills in general.

    Notice how Dr. Grande uses both nondirective listening (e.g., making eye contact, facing the client, using a friendly tone) and directive listening (e.g., feeling validation, interpretation) skills to build a rapport with his client.

    If you want to see more, the role-play continues in further videos from Dr. Grande.

    According to counselor Adam Bagley, several things should make it onto any intake form, including:

  • Name of client
  • Address of client and if the counselor may mail information to this address
  • Phone number(s) of your client and if the counselor may either leave a message or text the numbers(s)
  • Is it an in-office visit, or online counseling?
  • Email address for the client and if the counselor can send a message to the address
  • Insurance information (their insurance, subscriber/group number, and their co-pay)
  • Birthdate of client
  • Referral source
  • Emergency contact information
  • Medical history as well as current medical problems; also medical hospitalizations
  • Current medications and the amount taken each day; also name and phone number of the prescribing doctor
  • Mental health history (includes questions about former mental health providers, any prior medical hospitalizations, and any suicide attempts)
  • Family members with a mental health history and diagnosis
  • Substance abuse history and any former treatment for substance abuse as well as any former or current issues with DUI or drug-related charges; also ask about current substance use
  • History of abuse or trauma (i.e., physical, emotional, mental, or sexual)
  • Any current life transitions/issues the counselor should be aware of
  • Specific behavioral, mental, or physical symptoms related to depression or anxiety experienced in the last 30 days (i.e., upset stomach, feeling restless, feeling guilty, isolating from others, etc.)
  • Current use of social media and time spent on the Internet, Facebook, or other forms of social media, and ask if their use of social media is impacting any of their relationships
  • Client’s preferred mode of communication (texting, phone, or in-person)
  • Reason client is seeking counseling
  • Goals for counseling and what the client would like to accomplish or see change as a result of counseling[3]
  • Here’s a great template for an Adult Psychotherapy Intake Form that checks most of the boxes above.

    Quenza’s Coaching Client Agreement, pictured below, is also freely available as a customizable template for platform members:

    Along with the platform’s Pre-Coaching Questionnaire, Session Rating Scale, and more, this can quickly be personalized using pre-populated fields such as Client Name and Professional Name – all are available with Quenza’s $1 monthly trial.

    It’s also important to have your client fill out an acknowledgment of informed consent. You can bundle this with your intake form, but here’s an Informed Consent Form for Assessment and Treatment from the pros at ICANotes if you decide to keep it separate.

    You might also want a Records Release Authorization form that allows you to release or receive mental information about them from another care provider.

    This is another helpful Records Release Authorization template from ICANotes.

    14 Questions To Ask Your Clients

    There are tons of questions you can ask your client during the intake session, and determining which questions are the “right questions” will depend on what your client is struggling with.

    However, some questions help virtually any intake session, no matter what problem or issue your client is presenting with.

    Dr. Dennis O’Grady identified 10 questions that are commonly asked in first sessions:

  • What brings you here?
  • Have you ever seen a counselor before?
  • What is the problem from your viewpoint?
  • How does this problem typically make you feel?
  • What makes the problem better?
  • If you could wave a magic wand, what positive changes would you make happen in your life?
  • Overall, how would you describe your mood?
  • What do you expect from the counseling process?
  • What would it take to make you feel more content, happier, and more satisfied?
  • Do you consider yourself to have a low, average, or high interpersonal IQ?[4]
  • Building on the basics, therapist Maelisa Hall likes these four questions for an intake session:

  • Describe a typical day for you.
  • What strategies have you already used to try and solve the problem?
  • What would you like to get out of counseling? How will you know you are ready to finish?
  • Have you ever been arrested?[5]
  • Use these 14 questions as the basis of your intake session questions, and you’ll have a great foundation from which to work with your clients.

    FAQ

    What is a clinical intake interview?

    Intake interviews are the most common type of interview in clinical psychology. They occur when a client first comes to seek help from a clinician. The intake interview is important in clinical psychology because it is the first interaction that occurs between the client and the clinician.

    Is an intake interview a clinical interview?

    The intake interview is perhaps the most ubiquitous clinical interview; it may be referred to as the initial interview, the first interview, or the psychiatric interview.

    What kind of questions do they ask at therapy intake?

    Here are some of the questions you may be asked and why:
    • What prompted you to seek therapy now? …
    • How have you been coping with the problem(s) that brought you into therapy? …
    • Have you ever done therapy before? …
    • What was it like growing up in your family? …
    • Have you ever thought of harming yourself or ending your life?

    How do I start an intake interview?

    Make a note of important questions to ask.

    If someone you’re working with doesn’t know where to start, you might ask, “Is there anything you want to make sure we talk about today?” You may also want to ask if they’ve been having thoughts of suicide or self-harm.

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