What you want from therapy

The first session of any case has more material to cover than time allows. Presenting concerns, history, current symptoms, current life situation, treatment goals, expectations of therapy. Trying to do all of this verbally produces a session that runs over and a treatment plan built on partial information. A structured intake assigned before session one solves both problems.

This worksheet runs the intake as a pre-session document the client fills in on their own time. Symptoms, the life areas they want to work on, and the main goal for treatment in their own words. By the time you sit down for session one, you have a picture of the case in writing. The session can focus on the clinical material and the alliance rather than on basic data gathering.

Use it for any new case, especially when the client has named one presenting concern but you suspect there’s more they aren’t surfacing yet. The breadth of the worksheet often surfaces material that wouldn’t have come up in session one.

The clinical move at submission review. Look first at the mismatch between the symptom list and the stated main goal. A client who lists six physical symptoms and one social complaint but writes their main goal as “feel less anxious” is reporting a gap between what’s actually bothering them and how they’re framing it. The conversation in session one starts there.

The most clinically informative item in the form is the how-will-you-know question. “What will be different in your life when you know therapy has worked.” Vague answers there (“I’ll feel better”, “I’ll be happier”) predict slow progress on outcome measures across treatment, because the client doesn’t have a concrete target. Specific answers (“I’ll be sleeping through the night”, “I’ll have started dating again”, “I’ll be able to drive on the motorway”) give you and the client a measurable goal. The first session can spend time tightening the answer to this question if it came back vague.

A second pattern: clients who write extensively about symptoms and almost nothing about life areas. That sometimes points at clients who’ve over-medicalised their experience. The conversation in session widens the focus to include what they want their life to look like, not just what symptoms they want gone.

In my-cbt, the worksheet is one of the bundled system templates. Assign it as the first homework after the booking is confirmed, with a personal message asking the client to fill it in before session one. The submission saves in the case file as the intake record, ready when you sit down to prepare for the first session.