It’s the first session with a new client.
They walk into your office carrying the weight of their struggles, looking for relief, and you’re sitting there with a blank slate. You have a million pieces of information you need to collect—diagnosis, presenting problems, symptoms, history—but there’s more to it than just data collection. Your client is battling anxiety and depression, feeling overwhelmed and vulnerable. In this moment, you need to ensure they feel heard, safe, and validated. You need to establish a connection strong enough to bring them back for the next session. The goal of this initial meeting isn’t just to gather facts; it’s to lay the groundwork for everything that’s to come.
No pressure, right?
Balancing these priorities can be a clinical dilemma for even the most experienced clinicians. Here are the top three competing priorities therapists must navigate during an intake session:
- Gathering data needed (diagnosis, presenting problem, symptoms, etc.)
- Making sure the client feels good about returning for “real” sessions
- Attending to any present day safety concerns
- Laying the groundwork for successful work together (rapport, goal setting, etc.)
How do you collect essential information without feeling like you are continually cutting off your new client as they bravely share their story? How do you build rapport while also ensuring you have enough data to formulate an effective treatment plan? These are questions most therapists grapple with.
Granted, every therapist is different, and the way that works best for you might not work for another clinician. But there are a few things you can consider doing to make intake sessions more seamless for you and more enjoyable for your clients.
Set Expectations and Check In Regularly
Your client doesn’t know you yet, so err on the side of more communication to put them at ease. Let them know upfront that you’ll need to collect a lot of information, and that this session will look different than others as a result. Setting expectations can help clients feel more comfortable and prepared for the sometimes rapid pace of information gathering. Consider using a disclaimer like:
“At times, I might need to ask you a lot of questions pretty rapidly—I need to make sure I really understand what’s going on so I can get a full and accurate picture of what you’re experiencing. Please bear with me and let me know if I’m moving too fast.”
Research shows that clients have different preferences—some might want to be asked questions, while others might want to talk uninterrupted. Tell them in advance that you’ll need to gather specific information during the session so they don’t feel rushed or misunderstood.
This is also the best time to share disclosures, such as limits of confidentiality, and gather verbal consent for telehealth services, if applicable. This includes making sure the client knows the risks of telehealth services, making sure the client is in a private location, and developing a plan of action if the connection goes out.
Lead with Spontaneity
Kick off the intake session with open-ended questions like, “What brings you in?” or “Tell me about yourself.” Eventually, you may need to move to more structured data-gathering methods, but you want to start out more like a conversation and less like an interview. Letting the client steer the dialogue can naturally reveal a lot of the details you need.
As one research article points out, “Starting open-ended and simply following the client’s lead can often fill in the majority of the intake details without ever needing to refer back to a cheat sheet.” With some clients, a spontaneous, client-led dialogue can enhance both rapport building and data collection.
Integrate Assessment with Conversation
Weaving data collection into your conversation can make the process feel more natural and comfortable for your client. While the best way to gather information is through an organic chat, sometimes you might hit a snag—like when a client focuses intensely on one topic and avoids others.
If it looks like you might run out of time before getting all the information you need, try a gentle nudge. You could say, “I hate that we’re running out of time, but I have just a few more questions I need to ask so I can come prepared for the next session with some ideas of what might work best for you. Do you mind if I just ask one after another for a few minutes?” This keeps the session on track without making the client feel rushed, helping you gather all the necessary details while keeping the conversation smooth and supportive.
Use Paperwork to Streamline the Process
If your client has already filled out paperwork, use it to streamline the session. This paperwork is a great jumping off point to conduct a more thorough assessment. You might say, “Luckily, it looks like you already answered a lot of my questions in the paperwork. Let’s just read through this so I can double-check I understand it.” This not only saves time but also shows that you value the effort they put into completing the forms. As a result, it makes the session more efficient and comfortable for the client because you can focus on building rapport instead of repetitive questions.
Having paperwork created ahead of time can make a big difference in ensuring that a lot of the key data has already been captured. Make sure the forms include sections for basic info, presenting issues, and medical history. Reviewing these forms before the session helps you walk in with a good understanding of the client’s background. This lets you target your questions better and make better use of your time, so it’s more relaxed and productive.
Be Direct but Apologetic When You Have to Redirect for Data Collection
Sometimes, you’ll need to steer the conversation back to essential data collection. When this happens, be direct, but also sensitive to the client’s experience. For example, your client might be deep into a story they want to share, but you glance at the clock and see that you only have 15 minutes left. When this happens, it’s important to redirect gently. You might say, “I’m so sorry, I just realized time is flying by! I have a few more questions I need to ask you before we’re done – Is it okay if I just ask them now?” Another approach might be something like, “I may need to be more directive during the rest of this session to make sure I get the information I need. Future sessions will be more laid-back, and you’ll be able to share more freely at your own pace.”
Another way to manage this is by using a “parking lot” strategy. You can explain to your client that certain topics will be noted and set aside for future sessions. For example, “I’m writing this down in our ‘parking lot’ so we can come back to it next time – I have questions about what happened with _____! But for right now, I need to ask a few more questions to make sure we cover everything we need today.” This makes clients feel heard, keeps important issues from being missed, and enables you to gather all the information you need.
Explain the Process and Set Goals
Intake sessions are about more than just collecting data — they’re the beginning of you and the client co-creating a therapeutic relationship you’ll take on their journey ahead. Helping your client visualize what working with you will be like can improve retention and build rapport. You might say, “I’ll check in with you every week about x, y, and z. I want you to feel like you can be honest with me – I’ll never judge. We’ll process what you’re going through, and we’ll also figure out how to make changes so that you can get closer to the life you want!”
When setting goals, encourage your client to dream big. Ask questions like, “What do you wish your life would look like in a year? What are some things you’ve always wanted to do but felt were out of reach?” This helps them see therapy as a pathway to achieving their broader aspirations, not just addressing current issues. However, it’s important to remember that therapy goals are meant to address specific symptoms and presenting problems that have caused the client to seek out mental health treatment. Another question you could ask would be, “How will you know when you are done with therapy?” This creates normalcy around therapy being short-term and gets people thinking about what they hope to accomplish in therapy.
Be Mindful to Address Any Cultural Differences
Addressing cultural differences and/or sensitivities – and approaching them with cultural humility – is crucial during the first intake session. This is especially important for therapists who experience privilege working with BIPOC and/or LGBTQ+ clients. Acknowledging cultural differences can go a long way in creating a sense of trust and strong rapport with your client.
Make Sure They Leave with a Takeaway
If you want to build rapport, don’t put off all the therapeutic work until the next session—make sure your client leaves with at least one thing they can use. Sure, it’s “just” an intake session, but your client is struggling right now and might need some hope to hang on until the following week. Try to give them something tangible they can reflect on or work on before your next meeting. This could be a small coping strategy, a piece of advice, or even just an encouraging thought.
For example, you might say, “Before we wrap up, I want to give you something to try out until we meet again. How about practicing this simple breathing exercise whenever you feel stressed? It’s a quick way to center yourself and manage anxiety.”
Giving your new client something to work on right off the bat will boost their confidence and commitment to therapy. You’ll also start the relationship on the right foot by not making them wait a whole week to get help.
A lot hinges on intake sessions – for you, and for your client. Building rapport while collecting data can be tricky, but it’s the best way to help your clients and keep your caseload full.
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