Leah I. Johnson, M.A.

CNS 736: Appraisal Procedures for Counselors

Assignment 2.1: Intake Form Analysis
01.23.19

My site is a private practice. There is only one clinician and myself the clinical intern.
Either she or I complete these assessments with potential clients. It is a great hands on
experience with an almost instant identification of client/counselor fit. The client gets to have an
in-depth discussion about their past, present, and immediate future with this clinician. They
should know by the end of this assessment if they are comfortable enough to choose them as
their provider and vice versa with the clinician. They should know if they would be able to work
with a client within the scope of their practice based on the information presented.

I think this was a thorough intake assessment that covered all the major points to paint a
whole picture of a person. I honestly found it very difficult to identify ten things that were
ineffective about this document.

EFFECTIVE
• This assessment sets the tone for the initial session. It is conducted as an informal, free flowing
interview, it is an effective tool in a relaxing atmosphere that encourages the client to elaborate
on their troubles and concerns through general conversation. Ultimately it reduces the
possibility for test anxiety.
• This assessment is initially completed by the client prior to their first session and the qualified
mental health professional reviews it. Then together they discuss it and develop a case
conceptualization.
• The assessment begins with a comprehensive health section that allows the client to describe
any physical health concerns that possibly contribute to their mental health. It also requires the
name of their PCP for coordination of care as well.
• The health portion of the assessment also includes a substance use/abuse section. This opens
the opportunity for the clinician to conduct an additional substance use assessment if
necessary.
• This assessment does a good job of covering both demographics and family history.
• This assessment asks if the client has previously been in counseling and if so, what that it was
like for them. This is helpful for the clinician to gauge client expectations of a new
counselor/counseling experience. (Microtraining Associates, 2010)
• This assessment includes a spirituality section. The owner advertises as a Christian based
practice, but accepts all religious/spiritual persons. This allows the client to express their ideals
and morals to the clinician and scale how important it is to them to incorporate that into their
counseling.
• The assessment flows in an organized manner (Hayes, 2017).
• The intake assessment includes a personal agreement in the end which encourages the client to
be honest and willing to do the work with an understanding that they aren’t being coerced and
 are exercising free will in their decision making. I think this is an interesting addition to the
assessment and a gentle reminder that the clinician is just in place to assist and guide.
• Finally, this comprehensive assessment will be used to develop a client centered treatment plan
and help the client and counselor decide an appropriate length of therapy.

Ineffective
• In the initial document the client is not asked to identify their gender preferences or sexual
orientation. I feel this may be helpful if a presenting concern happens to surround this topic.
• There is not a place for revocation of consent as an additional attachment.
• This assessment form is not geared toward the treatment of children (and to my knowledge
there is not an additional form on file that is child specific).
• This assessment does not ask about history or of current issues with eating/sleeping patterns.
• If the practice was to expand beyond one clinician, may want to incorporate language
preferences
• This assessment could also include a career section to indicate job satisfaction or gather
information for the need of career counseling (as it does for substance abuse and
suicide/homicide assessment)

References

American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA.

Hays, D.G. (2017). Assessment in counseling (6th ed.). Alexandria, VA: American Counseling
Association.

Microtraining Associates (Producer). (2010). The Counseling Intake Process: Culturally

Competent Demonstrations and Debriefings [Video file]. Retrieved from Counseling and
Therapy in Video: Volume II database.