Clearing Up the Process: The Intake Session

You’ve done it! You’ve signed up for therapy and are awaiting the next chapter of your story to begin. You may have been to therapy before (or maybe you haven’t), but either way, it can be nerve wracking. Finding someone you fit with and (generally) it being someone you have never met can be daunting.

What should you wear? What should you say? Should you cry at the first session? How much do you really want to tell your therapist? What if you don’t like your therapist?

These questions are ones that people may ask themselves before their first session. The first session is unlike the following sessions, and therefore it can feel like a strange encounter. The first session is known in the “counseling world” as the intake session. The purpose of the intake session is for the therapist and you to create the most whole and accurate picture of you as possible. In other words, this is a time where your therapist goes over all there is to know (as if that’s possible in one session) about you to help gather a picture to help you both out. One way in which your therapist gets to know you is through the use of forms. There are probably going to be a lot of forms you must fill out. These could include informed consent, intake forms, release of information, questionnaires, and so on.

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Informed Consent

This is the most important document that you want to read with a careful eye. We aren’t trying to slide anything past you, but we really want you to know what it says. An informed consent is super important to not only the therapist, but for you as well.

Essentially, the document lays out the framework for the legal and logistical parts of therapy. The informed consent will likely be packed with information such as social media policies, mandated reporting laws, what will happen to your file if your therapist expires, payment arrangements, cancellation policies, confidentiality statements, and anything else that your therapist may think is important.

Intake Forms

This is likely to be the form that takes you and your therapist the most time to digest. The purpose of the intake form is to get as much information as possible about you that could inform the therapeutic process. For our team, the intake is online so you can take your time thinking of the answers! Then, we go over it together.

So many different domains are associated with mental health therefore your intake form is probably going to be longer than any other form you must fill out. Most of the time the form will begin with questions to gather basic information; What’s your name? Where do you live? What is your birthday? How do you identify your gender? Race or ethnicity? Therapists know that age, gender, and ethnicity can influence certain disorders differently than persons of differing age, gender, and ethnicity. Also, in the first part of the intake, you will find questions that inquire about work, living arrangements, and education. Our mental health can negatively influence these areas of our lives and it is good to know if these areas are ones that can be positively influenced by therapy. The next sections are not necessarily in this particular order; however, they are all generally included in the intake forms.

Relationships are invaluable as social supports during times when you may feel like you are not feeling like you. Your intake form will want to know about all the types of relationships you have had since you were a child. Did you have supportive parents or siblings? If not, who were your role models? Do you have friends that you can talk to when you are feeling down? Do you have a significant other? If so, do you feel happy with that relationship? Do you have a relationship with spiritual or religious beliefs? All these various relationships can be important when discussing what supports you when you are not in the therapy office.

Being honest with your therapist is crucial. Therapists know how difficult it can be to talk about hard things you may have experienced (i.e., neglect, childhood abuse, family or parent substance abuse, couples conflict), but they also know how much of a need it is and relief it feels to get it off your chest. Although that doesn’t all (i.e. getting it out) come within the first session, we are prepping for the opportunity ahead of you!

There will be questions about previous therapy. Your therapist will want to know if you have been in therapy before. Did someone refer you to therapy? Were you ever hospitalized for psychiatric purposes? Do you take any psychotropic medications? If so, what are they? Most likely, your therapist will inquire what you liked and disliked about previous therapists and what previous goals were. Your therapist may also want to know what you expect from your new therapy. How long should it last? What do you want to see change from the beginning to the conclusion of therapy? Last, your therapist will want to know in your own words why you are coming in. What exactly is happening so that you sought out therapy? Knowing what you have accomplished in previous work and what you expect from current therapy will inform your therapists approach.

Typically, towards the end of the intake form, your therapist will want to know if there is anything else that you want them to know about you. This is a great opportunity for you to expound on any of the answers your previously provided. Also, towards the end of the form, your counselor will ask you to write your strengths. You are so strong and have come so far in life! Your therapist will want to know how you have made life work and then help you find even more strengths within yourself.

Release of information

Although release of information may not be discussed in every intake session, it is good to know about.

A release of information is a form that allows your therapist to speak with other professionals you may visit. In the therapy world when many professionals come together to help the health and well-being of an individual it is called collaborative care. Your therapist may ask you if you would like your other health-care professionals to be able to communicate with them. Collaborating with other professionals can enhance the effectiveness of therapy in many ways. Therapists often spend more time with clients than other health professionals. Because of this inequal amount of time, therapists can act as an advocate for their client if there are any concerns.

If you agree to a collaborative care approach, you will be signing a release of information. On a release of information form there should be specific information; who can the therapist speak with, when the form will expire, and what you can do if you decide to retract the form. As mentioned previously though, it might not be discussed in session because it might not be of interest to you. This is not required.

Questionnaires

Not as if you have had enough papers to fill out, your therapist may ask you to fill out some questionnaires. These questionnaires may be completed at different time intervals such as weekly, monthly, or every three months. Questionnaires serve a purpose, but the purpose may vary.

First, to get a baseline. For therapists, they cannot know where to go if they don’t know where you are. A baseline is an understanding of where you currently are so that your therapist can help you move to where you want to be.

Second, questionnaires can potentially help identify what it is that you are experiencing. Sometimes it is hard to tell whether or not it’s anxiety, depression, obsessions, and so forth. Tentatively identifying what you are experiencing helps inform treatment.

Last, questionnaires can identify when you may need immediate help. It can be very uncomfortable to talk about thoughts of suicide or homicide, but it’s important to talk about it. Research has consistently backed up that directly questioning is the best way to help an individual who is at an extreme end of harming self or others. When you indicate that those thoughts are present, it’s important that your therapist can help you right away.

So now… Let’s talk about it!

So, you have filled out the mountains of forms. You are ready to go in and spill your guts to your therapist. Before you do, it is important to know that the first session will mostly be information gathering. This will not be a normal therapy session. I repeat: this will not be a normal therapy session. This session is to gather more information from you, really a sense of who you are (and for you to meet and get a sense of your therapist), provide you an opportunity to elaborate on any of your answers on your intake form. During this session you may often feel the need to focus on the critical aspects that drew you to therapy; but, as urgent as those feel, you probably won’t get the chance to talk about them in depth. Not that your therapist doesn’t want to hear about the things you’re coming in for! They totally do (or should if they are a good fit).

They are also tasked with getting the biggest view of you as possible, that way they can pinpoint how to move forward and help you find what works for you. If you come in and talk about your problem before your therapist can fully understand you as a person, they may not be able to provide you the most individualized help. The intake session can feel like a weird encounter. You may hear your therapist say, “That sounds really important, and I want to come back to that, but for now, I need to know…” You are also welcome to say, “I know that we have to get through all this stuff, but I want to make sure we talk about…” That way your therapist knows that a specific topic is very important to you.

In summary, there are a lot of forms. These forms give your therapist a clear understanding of who you are so that both of you can make the most informed decisions as possible. You need to carefully read through the informed consent document and decide if there are any release of information forms you would like to fill out. Also, be prepared for more questions as your therapist may want to use a questionnaire. Finally, be prepared to talk about all the forms. The intake session can be quite nerve wracking, but hopefully, you will have a positive experience and you are able to begin your journey towards health!

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About The Author

Molly Lyons- Counseling Intern

Molly is currently in her final year of the Master of Science in Clinical Counseling at Central Methodist University (CMU) and is a student intern at The Counseling Hub and Boone County Mental Health Coalition, where she will assess and provide mental health interventions and resources for individuals and groups in Boone County schools. She obtained her Bachelor of Science in General Psychology with a minor in Child Development from Central Methodist University directly before enrolling in the counseling program. Prior to pursuing her counseling degree, Molly received an Associates of Science in Early Childhood Education from Moberly Area Community College. 

Molly has experience in the Counseling Center at MACC's Columbia campus, providing counseling services for students around the topics of identity crises, school-related stressors, depression issues, and coping with anxiety. Molly has co-facilitated Safe Zone trainings which introduce its members to the LGBTQ+ community terminology and basic information. Molly has also completed on online course in LGBTQ+ Counseling Competencies (College and Career Readiness) through the American Counseling Association (ACA). Molly is an active member of both the ACA and the Association for Multicultural Counseling and Development (AMCD).

Molly enjoys working with diverse populations and seeks to always be open to new learning experiences. She works best with individuals who are trying to discover who they are and how they relate to their world, as well as others in their world. Molly believes that a person’s external factors can provide both barriers and resources towards growth and that one must discover these in order to thrive.

Anxiety is the Devil

Anxiety Sucks

Period. 

People describe it as being stuck inside their own personal hell. And there's a lot of truth to that. It's an endless stream of thoughts about worst-case scenarios, what-ifs, past events where you may have said that one thing wrong, and 10 years in the future when xyz might happen. It's incessant.

And exhausting.

We've written before about anxiety (and will likely write again about it). It's important to talk about the experience of having it, as well as ways of coping with it. 

A couple of caveats - finding ways of coping with anxiety doesn't necessarily mean that it's going to go away. Having anxiety or being prone to anxiety might mean an ongoing "struggle." Except for people who have had it a long time and have learned ways of coping, it's less of a struggle and more of a nuisance. For others, it's a perpetual struggle. 

One of the hardest pieces is that it requires a getting-to-know-you experience before anything else. For example, if you wanted to pull a weed, would you just pull the top of it? Probably not. You'd go for the root. You'd dig into the soil around it and make sure you got all the little tendrils out - because you know as well as we do that one root can grow into multiple roots that dig deeper into the soil, and that can grow into multiple weeds that keep spreading in the yard. And then you're out there digging out weeds all the time instead of tending to the garden and the vegetables or plants that you want to grow.

Understanding Your Anxiety

This is the hardest part - often the scariest, too. Because it requires doing the complete opposite of what anybody with anxiety wants to do. It requires turning towards the anxiety, exposing it, questioning it, allowing space for it, and really trying to fully understand what it's about. 

HEAR US OUT, PLEASE!!

We know it sounds ridiculous, but if we don't fully understand what it's about, then how can we be sure to effectively cope with it?! That'd be like a doctor telling you to put your arm in a sling without ever doing an x-ray. Sounds silly, doesn't it? 

it's the same thing. Okay, not the exact same, but very similar. 

There are different kinds of anxiety and they show up in different ways. Not only are there different diagnoses (i.e. generalized, panic disorder, health anxiety), but each diagnosis (depending on the person, although there's some consistency) can be exacerbated by different things, including sleep, life stressors, food, drugs (yes, including alcohol and caffeine), and exercise. That's probably not even all, but it's the start. 

So, before even moving on to coping (which we're going to do, anyway), the first step is really diving into what kind of anxiety you deal with and what exacerbates your anxiety.

Coping with Anxiety

Again, understanding is the most important part, but we're softies and want to share four tried and true methods for coping with anxiety.

1. Exercise. 3-4x/week for 30 minutes at a time. Especially cardio/aerobic exercise. Weights are also good, but aerobic is better. And don't act like you don't already know this is a thing! Everybody knows the need to exercise, but most people don't find the time or don't have the inclination. For anxiety warriors, it's a must.
2. Sleep. I'm pretty sure I read that the majority of the U.S. are sleep deprived. Yes, majority. For people coping with anxiety, that's a no-no. It wreaks havoc on your circadian rhythm (sleep-wake cycle that you body naturally falls into). And good sleep also means good sleep hygiene (i.e. screen time, caffeine consumption). We'll write more about that later.
3. Thoughts. What do you spend your time thinking about? Do you ever take time to be present, or are you stuck in your thoughts more often than not? If the latter (like most folks with anxiety), then this is a great place to start. Pay attention to what you're thinking, how it impacts you emotionally, and how thinking a different thing can make you feel better. 
4. Meditation. Another one that everybody knows is good, but most people don't do. I'll tell you a little secret. Meditation, literally, changes your brain. As in, for real, changes the activity (i.e. slows it down) and structure of your brain. It's unbelievable what it can do for you (most of these things on the list, actually). And if you think that it's "not thinking" for 10 minutes, you're mistaken. It's simply about paying attention to one thing - a mantra, your breathing, the present, an image, or something else. 

There you have it! Four simple (and highly effective) ways of ocping with anxiety. Doing them all on one day won't make everything better, though. Just something to keep in mind. They require consistent practice and you end up seeing profound effects (especially the longer you stick with them).

Good luck, friends! And if you want help along this journey (it can be trying going at it alone), reach out to us. We're happy to support you in any way possible!

Signs You Could Benefit from Counseling

if you’ve been thinking about individual counseling or marriage counseling, but aren’t really sure if you need it, then this is the post for you. And I’m in the mood for short and sweet, so here we go!

1.  You've been thinking about counseling on and off for longer than six months. I say this with love and affection, but do it already!! Sometimes, we can figure life out on our own (enough that we don’t feel completely off), but sometimes we need to sit and talk with an objective  listener. If you’ve been grappling with something and thinking about counseling for longer than six months, it’s probably time to get in the door. 
    
2. You've tried to “fix” the problem every way you know how and it’s not working . This ties in with the objective listener piece. You've talked to friends, your pastor, your family, strangers, Reddit feeds, and everybody else you can think of. You still can't seem to figure out how to process through/work through/"fix" the problem you're having.
    
3. You keep distracting yourself from feeling unhappy. After you've spent an inordinate amount of time trying to figure out what's wrong and how to fix it, you've decided to stay, "screw it" and have just started spending time trying to avoid thinking about it. It's worked for a little while, but isn't a long-term solution.

And there you have it, folks. There are just a handful of reasons that it might be time to get off your couch at home and on the couch in our comfy office! Start the process by contacting us here!

As a little fun factoid, it's interesting to note that it takes couples (not sure about individuals) an average of six years (SIX YEEEEEEARS) to get into the door from the time they start thinking/talking about getting into counseling. That's six years of time that we can't get back, as well as six years we could be getting out of poor communication habits and into ones that contribute to relationship health and longevity. Super interesting, isn't it?!

What's Wrong With Me?! Five Question to Ask Yourself...

Have you ever had a day (or two or 10 or even more) where you ask yourself, "What is wrong with me?!" Where you feel like you're in a funk and that nothing is really satisfying in life?

Not Depression, Though...

This isn't a blog post about depression, as a caveat, although the questions to ask yourself could also help alleviate some depressive symptoms! And please note that we taken depression and its impact very seriously. We know the havoc it can wreak and that so many people deal with it. This isn't a blog post about depression.

This is a blog post about those days or times where you feel way off from your normal self. Maybe you're slightly more irritable, or maybe you're just less satisfied overall, or maybe you find yourself wishing it was 8 pm so you could have that beer, or maybe you start to question all of your life choices that ever got you to this place you're in (not least of which includes work, relationship, kids, and location).

Ultimately, you just feel off.

What I want you to do when/if you get in that place is to ask yourself these five questions. They're simple, really, but that doesn't mean they don't have a ridiculously impact on our mental health and overall well-being.

Okay, here goes. (That's me mentally prepping.)

The Five Questions

1. What have I eaten or have I eaten lately?
   You know that old saying, "you are what you eat." Well, truth be told, the more we learn about the microbiome (i.e. our gut), the more we realize that there is way too much truth to this statement. We're not asking you to go on a diet (there's a whole different post coming about that word and its implications); we're simply asking you to notice what you eat and how you feel afterwards.
   
   Here's a random example. I was at an outdoor market and had some delicious fudge. From someone who doesn't eat a lot of straight sugar (basically - the first ingredient was sugar, followed closely by marshmallow), I was exhausted right after eating it.
   

2. How much sleep have I been getting?
   This is another obvious one, but it's worth putting it out there. I'm stopping myself from going on a tirade about how lack of sleep is, literally, critical to your physical and mental health. I mean that with SO MUCH SERIOUSNESS.
   
   This post is getting long enough and I don't want to add three paragraphs just for one question. In the spirit of keeping things brief, just ask yourself how much sleep you've gotten, as well as how much is an optimal amount for you. Then pay attention to how you function with that optimal level versus when it's lacking.
   

3. Have I spent any time outdoors lately?
   Oh, I hear you already with the excuses - "it's too cold" or, "it's too hot" or, "it's too sunny" or, "it's too rainy" or something else entirely.
   
   Tell yourself enough!!
   
   Tomorrow (or right after you read this, if it's not nighttime) - go outside and walk. Leave your phone inside (you don't need it for those five minutes). Look at the world around you and stare in awe at how magnificent it really is. If you can get somewhere green, that's even better. Tell me you don't feel more peaceful afterwards. And humble (the world is big and we're just part of the puzzle).
   

4. Have I connected (really connected) with friends lately?
   I'm not talking about via social media. I'm talking about sitting down with a good friend and having a deep conversation where you lose yourself in the experience and completely forget the world exists around you. Where you laugh and connect, or where you cry and grieve, or where you bemoan the state of the world and question how it even got this way. Real conversations.
   

5. Have I given back lately?
   Altruism is underrated. If you can, give back in some way today. I don't mean financially (unless you have that to give and you want to - that's entirely up to you). What I mean is giving your time or help to others.
   
   You could stop and help somebody carry their groceries, or you could pick up some trash on the side of the road, or you could hold up a sign at a busy intersection that says "you're beautiful and I love you for being you," or you could even offer a hug to a stranger (super rare, but it's a possibility). The purpose of this one is to get out of your head and into an empathic state.
   
   I'll tell you a secret about being a counselor. One of the best things is that no matter what kind of day I'm having when I come into the office, the moment I sit down and see a client (or clients), my world shrinks away into nothingness and I'm knee-deep in someone else's experience. My point in saying this is that when we give back, the experience is the same. For that moment in time, we're not thinking about ourselves; we're thinking about others. And that can be enough to shift us out of our problems and thoughts and into the world in front of us.

That's all, folks. Thanks for getting through the rambles above. Even though I sometimes write with what could be perceived as a "flip" tone, my message is for real. These questions can (and often do) impact our mental health. They're good to keep in mind when things are starting to feel a little funky in life.

"That'll do, pig." (<-Please, somebody tell me they know what this is from.)