How to do an intake session as a psychologist: engagement before information

Today I want to talk about intake sessions: how to do them well, and more importantly how to stop doing them badly.

The clipboard model

Most junior psychologists think the main goal of an intake is to collect as much information as possible. They walk in with a list: history of the presenting problem, personal history, family history, a genogram, relationships, and a stack of risk checks for suicide, alcohol, drugs, violence and so on.

The problem with that model is that it is fundamentally opposed to what the client needs from the session.

So instead of an intake model, I want to suggest an engagement model.

Put yourself in their shoes

Use some empathy and imagination. You’ve been thinking about this session for weeks, maybe months. Before that, a partner, a brother, a mum or dad has been telling you they care about you and want you to see someone. You’re ready. You’ve got your story, and you know what you want from the session. You walk in and the therapist is sitting there with a clipboard, ready to gather information.

Don’t get me wrong. Some information is non-negotiable (risk screening still happens in the first session; it just isn’t the whole session). But what does the client need to get out of this session?

I’d argue the most important thing is a decision about whether to come back. Somewhere between 20 and 40% of clients vote with their feet and never return for a second session. So let’s make sure our intake doesn’t crowd out engagement.

Three things that matter more

1. Understand their goals, and show them you do. More important than knowing their family history is knowing why they are there and what they want from all this. Then tell them, so they know you are on the same page.

2. Understand how they see their problem and their recovery. Some people expect therapy to mean talking about their childhood, their dreams and everything in their past that made them who they are. Others want some tips and tricks to get through what’s happening right now. These people have very different preferences. Know where your client wants to go, and also how they want to get there.

3. Check for strong preferences about the therapist or the therapy. The research is fairly clear that matching clients to therapists on demographic characteristics doesn’t lead to better outcomes, unless the client tells you it matters to them. That qualifier is both what the evidence shows and what being client-centred means. Male clients don’t need male therapists. Irish clients don’t need an Irish therapist, and people with strong religious affiliations don’t necessarily need a therapist of the same faith. But when a client says “I need a Christian counsellor”, “I need a male therapist” or “I need an Irish therapist”, it matters. Finding out about any preference that could become a barrier is far more important than the genogram.

Further reading

This is only a quick taste. If you want more, look at the work of my friend and colleague Daryl Chow. His book The First Kiss changed my thinking about how we run first sessions.

We also cover the engagement model in more depth in PREP’s on-demand module on first sessions and goal setting.