Assessment

How to conduct a therapy intake session (90-minute structure)

From the first hello to a signed treatment plan — a paced structure that gathers what you need without overwhelming the client.

8 min read·7 steps· Updated June 10, 2026

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The intake session sets the tone for everything that follows. Done well, it gives you a working formulation, a sense of fit, an initial risk picture, and a plan the client can agree to — all in 60 to 90 minutes. This guide gives you a structure you can adapt the first time you sit down with a new client.

Quick answer

An effective intake session covers presenting problem, relevant history (medical, psychiatric, substance, trauma, family), mental status, risk assessment, working diagnosis, and a draft treatment plan — while also building enough alliance that the client returns. Most intakes run 60–90 minutes; the alliance work is half of why the second session happens.

Key takeaways

Spend the first 5 minutes on logistics, confidentiality, and rapport — not data gathering.
Lead with the presenting concern in the client's own words before any structured questions.
Always include risk assessment and basic MSE, even when the presentation seems mild.
Close with a shared formulation in plain language and the next session booked.

When to use this

The first therapy session with any new client.
Re-intake when an established client returns after 12+ months away.
Inheriting a case from another clinician and needing your own baseline.

Steps

1
Minutes 0–10: Frame the session
Welcome, review confidentiality and its limits (harm to self/others, mandated reporting), informed consent, fees, telehealth caveats. Invite questions before you start.
2
Minutes 10–25: Presenting concern
Open with 'What brings you in today?' Let the client narrate for several minutes before you ask structured questions. Track onset, duration, intensity, and impact on functioning.
3
Minutes 25–45: Biopsychosocial domains
Move through medical, psychiatric, substance, family, relational, work/school, trauma, and identity/cultural domains. Use a checklist; don't trust memory.
4
Minutes 45–55: Risk assessment & MSE
Suicide and homicide screen (e.g. C-SSRS), self-harm, abuse, IPV. Observe and document mental status throughout — formalize it now.
5
Minutes 55–70: Strengths, goals, and shared formulation
Ask what's worked before. Offer a brief plain-language formulation: 'Here's what I'm hearing…' and check fit.
6
Minutes 70–85: Initial treatment plan
Propose modality, frequency, expected duration, and 1–2 initial goals. Discuss medication referral if indicated. Confirm fit and ask the client what they'd like to focus on first.
7
Minutes 85–90: Close & next steps
Book next session. Provide between-session resources or a small homework assignment. End with a clear 'see you next week' — not on a heavy disclosure.

Example

Sample shared formulation (end of intake)

'Here's what I'm hearing. You came in because the anxiety has gotten loud enough that it's affecting sleep and how present you are at work. It started about six months ago when the promotion happened, but the pattern of worry has been with you much longer — it sounds like it ran in the family, and the move three years ago took away some of the support that used to buffer it. The good news: you've used CBT successfully before, you have a partner you trust, and you came in early — not after a year of trying to white-knuckle through it. My recommendation would be weekly CBT for anxiety, starting with sleep stabilization and worry exposure, and we'd track progress with the GAD-7 every four weeks. Does that fit what you were hoping for?'

Quick checklist

Confidentiality and limits stated explicitly.
Presenting concern documented in the client's own words.
Risk assessment completed and documented.
MSE captured (even brief).
Initial formulation shared and checked for fit.
Next session booked before client leaves.

Common variations

60-minute intake

Trim the BPS to the highest-yield domains for the presenting concern; complete remaining domains in session 2.

Telehealth intake

Spend extra time on tech check, private-space confirmation, and an explicit address/location for emergency response.

Crisis intake

Skip ahead to risk and safety planning if the client discloses active ideation; defer non-essential history to session 2.

Evidence base

The structured intake model has roots in Sullivan's psychiatric interview and is reinforced by APA, NASW, and AAMFT clinical practice guidelines. Measurement-based intake (using validated screens during the first session) is associated with stronger therapeutic alliance and faster symptom remission (Fortney et al., 2017).

Deep dive

Alliance and assessment are the same task in the intake

Clinicians who treat the intake as a structured interview lose 20–30% of clients to no-show before session 2. Clinicians who treat it as alliance-building only end up with sparse data and a directionless treatment plan. The integration is to ask assessment questions inside an alliance frame: 'I want to make sure I really understand what's been going on — can you walk me through what brought you in today, from the beginning?' is both an alliance move and an assessment opener. Follow the client's narrative for the first 15–20 minutes; structured probing comes after the relationship has begun.

Risk assessment in the intake — non-negotiables

Every intake assesses suicidal ideation, homicidal ideation, self-harm history, current substance use, and intimate-partner-violence exposure. Ask directly, in plain language, in roughly this order — direct questions about suicide do not increase risk and reliably uncover information that softer phrasing misses (the AAS and SAMHSA both endorse direct asking). Document the assessment in the intake note even when all answers are negative ('denied current SI, no prior attempts, no access to firearms, no recent self-harm; collaborative and engaged throughout assessment').

What to send home after the intake

The post-intake window is when motivation is highest and when the client decides whether to invest. Send: a clear next-session time, a one-paragraph collaborative summary of what you heard and what you propose ('Here's my early read; we'll refine it together'), one small between-session task (often a self-monitoring sheet or a measure to complete), and the practical paperwork (consents, portal access). What you do not send: a finalized diagnosis-only letter, homework that requires you to have explained the model in detail, or anything that feels transactional. The first impression is the start of the alliance, not the end of the assessment.

Glossary

Limits of confidentiality: The legal and ethical exceptions to confidentiality, including imminent harm, child/elder abuse, and court orders.
Shared formulation: A brief, plain-language summary of how the clinician understands the client's situation, checked for fit.
Therapeutic alliance: The collaborative, trust-based working relationship between client and clinician — the strongest common predictor of outcome.

Tips

Use a one-page intake checklist on screen or paper so you don't lose domains while listening.
When a heavy disclosure comes near the end, name it ('I want to come back to what you just said next week') and reground before closing.
End on a stabilizing question: 'What's one thing that will help you between now and next week?'

Common pitfalls

Spending so much time on history that there's no time for formulation or planning.
Skipping risk because the presentation seems mild — the disclosure often comes later.
Closing the session in the middle of an activating topic without grounding.

Related tools

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High-Risk Situation Planner

Frequently asked questions

How long should an intake be?

Most outpatient intakes are 60 or 90 minutes. Complex presentations, custody cases, and assessments for higher levels of care often need 120 minutes or two sessions.

Can I bill an intake session?

Yes — 90791 (psychiatric diagnostic evaluation) is the standard CPT code for non-prescribers. 90792 includes medical services and requires prescriber credentials.

What if the client doesn't want to answer something?

Note it ('client declined to elaborate at this time') and move on. The relationship is more important than completing every line of the intake form.