Mastering the 45-Minute EAP Therapy Intake

The intake session is the foundation of the therapeutic journey, setting the tone for the client’s experience and providing essential information for treatment planning. While some therapists may believe completing an intake in 45 minutes is impossible, with the right tools and strategy, it can be done. The goal of a 45-minute intake is not to complete a comprehensive assessment in one session, but to gather enough information to begin treatment and to build the foundation of rapport with your client. So, how can you efficiently conduct an intake while ensuring the client feels heard, supported, and hopeful? Here are practical strategies:

1. Set the Stage Before the Session

Being prepared and intentional can go along way in setting you and your client up for success:

• Pre-Session Prep: Review any available information about the client’s presenting problem beforehand so you have a sense of their reason for seeking care. This can also guide your assessment questions.
  
  
• Communicate Expectations: At the start of the session, introduce yourself, gather informed consent, and provide a brief overview of what the intake will include. Reassure the client that there will be more time in future appointments dedicated to additional exploration of their presenting problem and history, if needed.  Example: “Hi, I’m Dr. McFakename. Today I’ll review some important information about consent and confidentiality. From there, I’ll ask you some questions to better understand what’s bringing you in, but we likely won’t cover everything today- and that’s okay! Assessment is an ongoing process, and we’ll continue to build on this together in future sessions. We will also briefly discuss your goals of care and a plan of action, but again, nothing needs to be set in stone by the end of our meeting. I know that this may feel quick and like our conversation might feel disjointed, but do know this is atypical for a normal therapy session with me- this is just how I’ll have to facilitate our intake to ensure we get through everything.”

2. Build Rapport Quickly

• Start with Warmth and Curiosity: First impressions matter. A smile, a welcoming tone, and a brief personal connection can set the stage for a comfortable conversation.
• Nonverbal Cues Matter: Warmth and validation can come through in your tone, facial expressions, and body language-even as you keep the conversation moving.
• Find Common Ground: If appropriate, a small acknowledgment of their background (e.g. a cool houseplant) or something they mentioned on intake forms can build connection.
• Normalize the Intake Process: Clients may feel pressure to "get it right" or worry about being judged. Reassure them that this is a collaborative process.
  • Example: “There’s a lot we could cover today, but to make the most of our time, I’d like to focus on what’s most pressing for you right now. Over the next few sessions, we’ll continue to deepen our understanding of your experiences. I know that first sessions can sometimes feel a little overwhelming, but this is just the beginning. You don’t have to have all the answers today. We’ll figure things out together, step by step. ”

3. Use a Structured Yet Flexible Approach

• Prioritize Key Areas: While you won’t cover everything in detail, focus on immediate concerns, history of presenting issues, symptoms, functional impairment, risk assessment, and their EAP treatment plan.
  
  
• Use a Flow That Feels Natural: Many therapists find success with a three-part approach:
  
  
  1. Opening (5 min) – Build rapport, acknowledge concerns, review confidentiality and consents, and set an agenda.
     
     
  2. Core Assessment (30 min) – Cover presenting issues, symptom history, risk assessment, and client strengths.
     
     
  3. Closing (10 min) – Summarize, provide initial impressions, and discuss next steps.

4. Streamline Your Questions

• Open with Broad Questions, Then Narrow Down: Start with “What brings you in today?” and let the client share naturally before guiding them into specifics.
  
  
• Use Scaling Questions: Asking “On a scale from 1 to 10, how much is this affecting your daily life?” quickly provides insight into distress levels.
  
  
• Ask High-Yield Questions: Focus on questions that provide the most meaningful information in the shortest amount of time. Instead of prompting one-word answers or gathering information that may not be immediately relevant to care, ask open-ended questions that invite clients to share their perspectives on their challenges, strengths, and internal and external resourcing.
  • ❌: “Do you feel anxious often?” (Likely to get a yes/no response.)
  • ✅: “Can you describe a recent situation where you felt anxious? What was happening, and how did you respond?” (Encourages storytelling and reveals patterns.)
    
    
• Normalize and Redirect as Needed: If a client starts to share a lengthy backstory, gently validate and refocus.
  
  
• Gently Guide the Clock: If time is running short, acknowledge it.
  • Example:  “We’re coming up on the end of our time, and I want to make sure we touch on what’s most important for you today. What feels like the biggest takeaway so far?”

5. Conduct a Quick Risk Assessment

• Use MIC Screening Tools: Incorporate C-SSRS and CAGE-AID scores into guiding your assessment. If a client has positive score on either of these screeners, focusing on assessing risk (and safety planning) should be a priority.
  
  
• Ask Directly, but Gently: Use clear, open-ended questions to assess risk, especially around harm to self or others. Clients may feel uncomfortable discussing these issues, so normalize the conversation to help them feel safe in sharing. This is critical to ensure immediate safety.
  • Example: “Many people experience thoughts of suicide at some point with varying degrees of intensity, especially during difficult times. Have you had any thoughts like that recently?”

6. Create a Quick Treatment Plan

• Assigning a Diagnosis: Prior to creating a treatment plan and signing your intake note, you’ll need to add an F-code diagnosis in the Rula portal. If your client does not meet full criteria for any DSM-5 diagnosis while receiving EAP sessions, you can assign a diagnosis of F43.20 Adjustment Disorder, Unspecified. 
• Focus on Immediately Impactful Goals: In a 45-minute intake, it's important to set some clear, short-term goals. These should be focused on addressing the client’s most urgent needs while leaving room for deeper work in future sessions.
• Collaboratively Set Goals: Involve the client in the process of setting these goals. A quick, collaborative goal-setting approach can help establish trust and ensure the client feels part of the treatment process.
  • Example: “Based on what we’ve discussed in this session, it sounds like managing anxiety in the moment is a priority. Would you be open to practicing a simple grounding technique once a day and seeing how it feels? We can do some more planning in the next session, but for now, I want to focus on some quick wins to get you feeling better.”

5. Wrap Up with Clarity and Confidence

• Summarize Key Points: Offer a concise summary of what you’ve learned and what the next steps will be.
  • Example:  “Today, we got a great start on understanding your concerns, and we’ll continue building on this in future sessions. For next time, I’d love to explore [specific area] more deeply. How does that sound to you?”
    
    
• Leave Time for Questions: If time permits, offer to answer any questions the client may have. If not, be sure to utilize the Messaging function of the Portal to communicate with the client. 

6. Leverage Efficient Documentation Practices

• Take Brief Notes During the Session: Jot down key phrases rather than full sentences to stay present with the client. Alternatively, type these notes directly in the intake note in the Portal, but be sure to let the client know that you are typing in order to take accurate notes about their experience.
  
  

With a thoughtful, structured approach, a 45-minute intake can be both effective for the therapist and meaningful for EAP clients. Assessment is an ongoing process, and each session builds upon the last. By preparing ahead, using streamlined questioning, and staying present while managing time, you can set your clients up for success from the very first session.

Updated April 17, 2025 19:53