Intakes and First Sessions: Information Gathering & Treatment Planning

We open the door, say “come in.” One or two strangers come in, sit down, say hello, and we look at each other. They don’t know what to expect from us. We have no idea who we’re facing, what they need, or where we’re going. A new relationship has begun.

What are our goals for this first hour? How do we accomplish them? And how does this session relate to subsequent ones?

Early sessions are about gathering information to understand what a given client needs and to generate a treatment plan. This plan is developed on the run, designed to provide the experiences, information, perspective, and relationship we decide the client needs. As we provide these things, the client reacts, both consciously and unconsciously. These reactions are themselves information that we process, refining our ideas of the client’s internal resources, current life, and clinical needs. This shapes our responses, helping us further develop our plan.

And so it goes: we ask, they tell. They tell, we learn. We learn, we ask. We ask, they learn. Each of these early moments dictates the next. This is the dialectic of all therapy, most particularly in the intake and early sessions.

There’s an inherent tension in first and early sessions: on the one hand, we want to collect information from patients that they may not want to discuss, and may not have thought about for years (or ever). On the other hand, we want to demonstrate our sensitivity, caring, and understanding that this is a difficult process for clients. We want to establish the cooperative therapeutic relationship so indispensable to clinical success. How do we pursue these hard-to-reconcile goals—simultaneously?

Using plenty of case material, this seminar covers issues including:

  • When new patients don’t believe in therapy, or challenge your expertise
  • When one partner in a couple doesn’t want to be there
  • Couples therapy or individual therapy? Handling this by phone and in person
  • Assessing who you don’t want to see again
  • How much self-disclosure is helpful? How much is too much?
  • How to get people to come back for a second session
  • Setting boundaries and rules—before patients are usually ready
  • How much therapy to do in the first or second session—and why too much can be as problematic as not enough

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