Effective therapy intake questions establish treatment foundations, build therapeutic rapport, and gather essential client information while ensuring ethical assessment and appropriate care planning from the first session.

A comprehensive intake interview marks the beginning of every therapeutic relationship. The questions therapists ask during this initial session shape treatment direction, identify immediate safety concerns, and help clients feel heard and understood from the first interaction.

Quality intake assessments require balancing thoroughness with sensitivity, gathering clinical information while building trust, and identifying both presenting problems and underlying patterns that inform treatment planning. The intake process sets the tone for the entire therapeutic journey.

The Therapy Intake Process

Purpose of Intake Questions:

• Assess client needs and presenting concerns

• Identify safety risks requiring immediate attention

• Gather relevant history and background information

• Establish treatment goals and expectations

• Determine appropriateness of services and level of care

The therapy intake serves multiple critical functions beyond simple information gathering. This initial assessment creates the foundation for the therapeutic relationship while ensuring clients receive appropriate care matched to their needs.

Unlike follow-up sessions focused on specific therapeutic work, intake interviews cast a wide net to understand the whole person—their history, current circumstances, support systems, and reasons for seeking help now.

Essential Categories of Intake Questions

Core Assessment Areas:

• Presenting problem and current concerns

• Mental health history and previous treatment

• Safety assessment (suicide, homicide, abuse)

• Medical history and current medications

• Substance use patterns

• Family and social support systems

• Cultural and spiritual considerations

Presenting Problem and Chief Complaint

Key Questions to Ask:

• What brings you to therapy at this time?

• How long have you been experiencing these concerns?

• What specifically prompted you to seek help now?

• How are these issues affecting your daily life?

• What have you tried on your own to address these concerns?

Understanding why clients seek therapy now—rather than last month or next year—provides crucial context about symptom severity, recent stressors, or changes in coping ability.

Example questions: "You mentioned feeling depressed for several years. What made you decide to reach out for help this week specifically?" or "Describe a typical day for me. How do these anxiety symptoms show up in your daily routine?"

The presenting problem section should capture both the client's description in their own words and the therapist's clinical observations. Direct quotes help document the client's perspective and language around their difficulties.

Mental Health History

Areas to Explore:

• Previous therapy experiences (what worked, what didn't)

• Past psychiatric hospitalizations or intensive treatment

• History of mental health diagnoses

• Family mental health history

• Previous medications tried and responses

Mental health history questions provide context for current symptoms and inform treatment planning by revealing patterns, previous treatment responses, and potential genetic or familial factors.

Example questions: "Have you worked with a therapist before? What was that experience like for you?" or "Has anyone in your family struggled with similar concerns? What do you know about their experiences?"

When clients report previous therapy that "didn't work," explore what specifically felt unhelpful. This information helps therapists avoid repeating ineffective approaches and understand client preferences.

Safety Assessment Questions

Critical Safety Areas:

• Current suicidal thoughts, plans, or intentions

• History of suicide attempts and circumstances

• Homicidal thoughts or violent impulses

• Current or past abuse (physical, sexual, emotional)

• Access to means of self-harm

Safety assessment represents the highest priority during intake interviews. These questions must be asked directly and thoroughly, using clear language rather than euphemisms.

Example questions: "Are you having thoughts of harming yourself or ending your life?" not "You're not thinking of doing anything to hurt yourself, are you?" The latter suggests the expected answer and may discourage honest disclosure.

For clients endorsing suicidal ideation: "Do you have a specific plan for how you would end your life? Have you taken any steps toward carrying out this plan? What has kept you safe so far?"

When abuse is disclosed or suspected: "Are you currently safe in your living situation? Is anyone hurting you, threatening you, or forcing you to do things you don't want to do?"

Medical History and Medications

Medical Information to Gather:

• Current medical conditions and diagnoses

• Medications (psychiatric and general medical)

• Recent medical changes or hospitalizations

• Primary care physician and last visit

• Sleep patterns and appetite changes

Physical health significantly impacts mental health, making medical history essential for comprehensive assessment. Many medical conditions mimic psychiatric symptoms, and medications can affect mood and behavior.

Example questions: "What medications are you currently taking, including over-the-counter supplements?" or "When was your last physical exam? Are there any medical concerns your doctor is monitoring?"

Recent medication changes deserve particular attention, as starting, stopping, or adjusting medications can precipitate mental health symptoms.

Substance Use Assessment

Substance Use Questions:

• Current alcohol use (frequency, quantity, circumstances)

• Drug use (prescription and recreational)

• History of substance abuse or dependence

• Impact on functioning and relationships

• Previous treatment for substance issues

Substance use questions should be asked matter-of-factly, normalizing disclosure while gathering specific information about patterns and consequences.

Example questions: "Tell me about your alcohol use. How many days per week do you drink, and how much on a typical drinking day?" or "Have you ever felt you needed to cut down on your drinking or drug use?"

Using standardized screening tools like the AUDIT (for alcohol) or DAST (for drugs) alongside conversational questions provides both quantitative data and clinical context.

Family and Social History

Relationships to Explore:

• Current living situation and household members

• Relationship status and quality

• Children and parenting concerns

• Extended family relationships and support

• Friendships and social connections

• Employment or school situation

Social support and relationships profoundly influence mental health and treatment outcomes. Understanding the client's social world helps identify both stressors and resources.

Example questions: "Who are the important people in your life? Tell me about those relationships," or "When you're going through a difficult time, who do you turn to for support?"

Explore both the presence of relationships and their quality. A client may have family nearby but feel unsupported or misunderstood by them.

Cultural and Spiritual Considerations

Cultural Factors to Address:

• Cultural background and identity

• Language preferences and proficiency

• Religious or spiritual beliefs and practices

• Cultural perspectives on mental health and treatment

• Immigration history and acculturation stress

Cultural competence requires understanding how clients' backgrounds shape their experiences, beliefs about mental health, and treatment expectations.

Example questions: "What role does spirituality or religion play in your life? Are there spiritual practices that help you cope with stress?" or "How does your cultural background influence how you think about mental health concerns?"

Asking about potential barriers to care demonstrates cultural sensitivity: "Are there aspects of therapy or treatment that concern you based on your cultural or religious beliefs?"

Specialized Intake Questions for Different Populations

Population-Specific Considerations:

• Children and adolescents

• Couples and families

• Older adults

• LGBTQ+ clients

• Trauma survivors

Questions for Child and Adolescent Intake

When working with minors, intake questions should address both the child's perspective and the parent or guardian's observations, recognizing that each provides valuable but different information.

Example questions for parents: "What changes have you noticed in your child's behavior, mood, or school performance? What does a difficult day look like at home?"

Example questions for youth: "What do you think brings you here today? Is this something you wanted help with, or did your parents decide you should come?" Acknowledging the child's agency respects their perspective.

Developmental history becomes more prominent in child intakes: "Tell me about pregnancy and delivery. Were there any complications? When did your child reach major milestones like walking and talking?"

School functioning deserves detailed attention: "How is school going academically and socially? Any concerns from teachers? Have there been any disciplinary issues?"

Questions for Couples Therapy Intake

Couples therapy intake requires understanding both individual and relationship dynamics while maintaining neutrality and avoiding premature alliance with one partner.

Example questions: "What brings you both to couples therapy at this time? How would each of you describe the main concerns in your relationship?" Ask each partner to respond individually.

Relationship history provides context: "Tell me the story of your relationship. How did you meet? What attracted you to each other? When did you notice things becoming difficult?"

Assess commitment to the relationship and therapy: "On a scale of 1-10, how committed are you to working on this relationship? What would need to change for you to feel hopeful about your future together?"

Questions for Older Adult Clients

Older adult intakes should address age-specific concerns while avoiding ageist assumptions about cognitive decline or limited potential for change.

Example questions: "How is your memory functioning? Have you or others noticed any changes in your ability to remember things or complete familiar tasks?" Cognitive screening becomes more important with older clients.

Loss and grief often feature prominently: "Tell me about losses you've experienced in recent years—deaths of loved ones, retirement, changes in health or independence."

Social isolation deserves attention: "How often do you see or talk with friends and family? Are you able to get out and do activities you enjoy?"

Questions for LGBTQ+ Clients

LGBTQ+ affirming intake questions demonstrate competence, create safety, and avoid heteronormative assumptions.

Example questions: "What pronouns do you use? Is the name in your chart the name you prefer to be called?" rather than assuming chart information matches current identity.

"Tell me about your identity—how do you describe your sexual orientation and gender identity? What has that journey been like for you?" Invite but don't pressure disclosure.

"Have you experienced discrimination, rejection, or violence related to your identity? How has that affected you?" Acknowledge minority stress while focusing on resilience.

Questions for Trauma Survivors

Trauma-informed intake questions balance gathering necessary information with avoiding retraumatization through overly detailed questioning about traumatic events.

Example questions: "Have you experienced events that felt traumatic or overwhelming? You don't need to share details right now, but can you tell me generally what type of experiences?" This acknowledges trauma without demanding a detailed narrative.

"How do you typically respond to reminders of these difficult experiences? What helps you feel safe when you're feeling triggered or overwhelmed?"

Assess current safety: "Are you currently in contact with the person or people who harmed you? Do you feel safe in your current living situation?"

Effective Intake Interview Techniques

Best Practices:

• Use open-ended questions initially, then narrow with specific questions

• Allow silence for clients to process and respond

• Reflect and validate client emotions throughout

• Normalize difficult topics before asking sensitive questions

• Notice and address client discomfort or hesitation

Building Rapport During Information Gathering

The intake interview must accomplish two sometimes competing goals: gathering comprehensive information and building therapeutic alliance. Skillful therapists weave these together rather than treating them as separate tasks.

Begin with easier, less threatening topics before moving to more sensitive areas. Starting with presenting concerns and current life situation feels less intrusive than immediately diving into trauma history or substance use.

Use transition statements before shifting to sensitive topics: "I need to ask some questions about your safety that I ask all clients. These might feel uncomfortable, but they help me understand how to best support you."

Validate emotional responses to difficult questions: "I notice you became tearful when discussing your family. That seems like it brings up painful feelings." This demonstrates attentiveness and empathy.

Documentation During the Intake Session

Therapists must balance note-taking with maintaining eye contact and engagement. Explain the documentation process: "I'll be taking some notes as we talk so I can remember the important things you share. Please let me know if that feels distracting."

Some therapists take minimal notes during the session and complete detailed documentation immediately afterward, while others document throughout. Find an approach that works for your style while ensuring accurate records.

Note verbatim client statements about key issues, particularly safety concerns and presenting problems. Direct quotes provide valuable information and documentation.

Intake Forms and Screening Tools

Common Standardized Assessments:

• PHQ-9 (depression screening)

• GAD-7 (anxiety screening)

• PCL-5 (PTSD screening)

• AUDIT (alcohol use)

• ACEs questionnaire (adverse childhood experiences)

Standardized screening tools complement conversational intake questions by providing quantitative data, tracking symptom severity over time, and ensuring consistent assessment across clients.

Introduce screening tools as collaborative: "I'm going to have you complete a brief questionnaire about depression symptoms. This gives us a baseline to measure progress and helps me understand what you're experiencing."

Review questionnaire responses together rather than simply scoring them independently. This creates opportunity for discussion: "I see you marked 'nearly every day' for feeling hopeless. Tell me more about what that's like for you."

Screening tools should enhance rather than replace clinical interviewing. Scores provide useful information but don't substitute for therapeutic conversation and clinical judgment.

Documentation and Treatment Planning

Post-Intake Documentation:

• Presenting problem and symptom description

• Relevant history (mental health, medical, social, family)

• Mental status examination findings

• Risk assessment and safety planning

• Diagnostic impressions

• Treatment recommendations and goals

• Referrals or adjunctive services needed

The intake interview provides raw material for comprehensive treatment planning. Documentation should synthesize information gathered, formulate clinical impressions, and outline initial treatment direction.

Treatment goals should emerge from collaborative discussion: "Based on what we've discussed, what would you most like to work on in therapy? What would be different in your life if therapy is successful?"

Initial treatment recommendations might include therapy frequency, treatment modality (individual, group, family), potential medication evaluation, or referrals to other services like psychiatric evaluation, substance treatment, or social services.

Bottom Line

Comprehensive therapy intake questions establish the foundation for effective treatment by gathering essential information, assessing safety, and building therapeutic rapport. Through thoughtful questioning across clinical, social, and cultural domains, therapists create understanding of each client's unique experiences and needs.

Mastering intake interview skills requires balancing thorough assessment with empathic engagement, knowing what to ask while remaining attuned to how clients experience the questioning process. The investment in conducting quality intake assessments yields better treatment planning, stronger therapeutic alliances, and improved client outcomes.

Quality intake interviews demonstrate professional competence while communicating care and respect for clients' experiences. By approaching each intake with curiosity, cultural humility, and clinical judgment, therapists set the stage for meaningful therapeutic work that addresses what clients truly need from treatment.