Intake Forms & Earning Trust

Trust

I went to see a therapist the other day.

It was my first time making an appointment with her.

I arrived early to the old house, renovated to be a clinic where my naturopath is also housed, and was offered some tea while I filled out the intake form.

Some of the questions were straight forward but some of them were incredibly personal, asking about addictions and relationship status. Neither of which, to my knowledge, have anything to do with what I was there for. I left them both blank for the most part and gave only partial answers to other questions. They felt immensely assumptive.

Never assume that your clients should trust you. Trust is earned. 

I realized that, aside from the basics, I only wanted one question on the intake form, “What brings you to see me today?”

“Can you pay before the session? I’ll be on my lunch break when you get out.”

“Sure,” I said and then caught my breath at the $180 price tag for the hour. Shit. I had not realized it was going to be that much. Rule #1 of Pricing: never surprise people unless it’s with a discount. Sighing, I paid and followed the receptionist upstairs.

The therapist came out a few minutes later and invited me into her office. She had a good vibe and I liked her right away.

“So, this first session is mostly to go over the intake form, the policies and to answer any questions you have and then to maybe do a bit of work.”

I hate this.

This happened to me a few months ago when, on a friend’s suggestion, I went to see a therapist who spent the entire session talking about the theory of the treatment and the ethics of the whole thing.

In both cases, I sat there thinking, “What the fuck? Why am I paying $180 to have her go over things she could have emailed me in advance?”

“Did you read up the technique we’ll be using?” she asked.

I shook my head. It would have been a good idea. “I wasn’t given anything on it to read.”

“You didn’t take any of the flyers at the front desk?”

I shook my head.

From a marketing and business standpoint, this is such a gap.

When I booked the appointment, the therapist sent me the following email:

I am sending you an email to welcome you and also to pass along some information prior to our first session. If you have had counseling before, this may be familiar. In general, the first appointment is primarily a paperwork, history-taking and get-to-know-you session.
 
However, if there is something that you want to make sure we address specifically in that first session, please let me know either ahead of time via email or at the start of the session so that we can budget enough time.The first session is also an opportunity to clarify your goals for coming for counseling. Sometimes a good way to frame this is to ask yourself how you will know you’re done with counseling? How will you feel? What will your life be like?
 
It is best to approach counseling as a process and to allow sufficient time for you to work through what you need to work through. This time-frame varies from person to person, depending on issue(s), personality, and history. In general, however, you should notice some positive change in the first 3 sessions and more substantive change in 8-10 sessions.
 
My job is to support you in your process, offering expertise and feedback. If you are finding that my approach is not working for you, I welcome your feedback, as a means to learn and grow myself, and to see if I can better address your needs.
 
I look forward to meeting you.
Warm regards,

 

It was a fine email to get and set the context well and, I would have loved it if she had added a link to a 10-15 minute video about the modality and asked that I make sure I watch it before the session. It would have been wonderful if it was a video of herself explaining it. I might have watched the video and decided that due to her vibe or her description of the modality that it wasn’t a fit. I might also have gotten even more excited to see her. And there could have been another video that would go over all of the ethics and other typical things discussed in a first session.

And then, two days before, if she’d sent me a reminder email with those two links asking me to make sure I set aside thirty minutes to go over these before the session but that, if I didn’t have him, it was alright, we’d just go over the content together in the session – then I would have had the choice.

As a client, I deeply resent paying money to sit through something I could do better at home.

She began to go through my intake form which had me wonder why I bothered writing it down in the first place. Couldn’t she have just had it and written it down as we talked?

Stop being cranky I told myself.

“So it says here your last relationship…” and she begins to ask me about whether I’m dating or if that’s something I’m looking for.

I narrow my eyes.

“I am confused by this line of questioning.” I say. I’m not particularly trying to be nice about this.

I’m paying her $180 for this time and she hasn’t even asked me why I’m there. It’s reminding me of the pulse reader from last week. But it’s also different. These are issues that seem to, in no way, relate to why I’m there. They are immensely personal issues to be divulging to someone I’ve just met. Perhaps most therapists assume that they are trustworthy. Maybe they’ve lost touch with how vulnerable these issues are for people and it’s become rote for them.

I don’t know why.

But I sat there resenting her questions wondering, “Who do you think you are to ask me such questions with no context of why you’re asking them or how they relate to why I’m here? And why haven’t you asked me why I’m here?”

Never assume that your clients should trust you. Trust is earned. 

She is thrown off for a second but seems to collect herself quickly, “Oh, it’s just taking your history for what we’re going to be working on.”

“Why don’t we skip to that?” I say.

“Sure.” And, to her credit, we do.

The good Bill Baren suggests starting off your first session with a client with two questions: “Why me? Why now?”

I wish all sessions would start this way.

If she’d asked, “Why me?” I would have said, “Well, I’ve heard good things about the modality you use and my naturopath recommended you as someone who could help me with some things I’ve been struggling with.”

If she’d said, “Why now?” it would have been a doorway into my symptoms and struggles.

She didn’t ask those questions but I took the opening in her conversation to lay it all out for her. She listened well and I immediately relax to not be sitting there and waiting or regretting having shared something so personal.

If there are other issues related to this that come up, I think to myself, I’ll be happy to share them. But I didn’t walk into this room with an agreement to share every secret I have.

Trust is such a precious thing. And it’s earned. Our unwillingness to go slowly, in the beginning, is so much of what kills trust in both a therapist-client relationship or a customer-business relationship. You are rarely done much harm by going slowly.

By the end of the session, I really liked her and she had earned some portion of my trust.

But it lifts up questions for all of us: where in our business or helping processes are we assuming trust? Where are we asking questions we have not yet earned the right to ask? Where could we give more context into the reasons for our asking the questions we ask. Can we trust the process in that the right information will come up at the right time?

Never assume that your clients should trust you. Trust is earned. 

Additional Reading:

Marketing for Psychotherapists

Slow Marketing

Case Study: Hidden Gems (good thoughts on personalizing intake forms here)

About Tad

  • Hi, Tad – Wow, so many good points here! Both from a client and practitioner perspective. We can’t read each other’s minds and so a “Why me? Why now?” right up front can save a lot of misunderstanding and resentment. I personally, don’t like the assumption that just because I’m coming to see someone (or someone is coming to see me – I’m a holistic health practitioner) that it’s going to evolve into a long-standing process. Maybe one session will be enough and I think it’s important that the client have the opportunity to get what they need out of the appointment (as much as possible). I recently had a phone consultation with a very well known Ayurvedic practitioner. Ayurveda is my passion and I was so excited to hear his perspective on some issues I had. I was immediately thrown by how unfriendly he seemed. He hadn’t even read my (very lengthy) intake that I’d emailed to him well in advance of the call. He didn’t say anything, just read my form and then said that he’d email me back with his recommendations. I was shocked that I didn’t even have the opportunity to have a conversation with him. I tried to ask a few questions but he was generally dismissive and obviously in a hurry. The call lasted about 10 or 15 minutes. Then the email came – all laid out for what would be months of follow-up calls to check on progress. I lasted about two months and decided he wasn’t for me. This comment probably relates more to your other post, which I meant to comment on.

    On another note, I cruised over to your About Me page and got the biggest kick that you’ve learned Scots Gaelic! I’m obsessed with Scotland (very long but cool story…lots of synchronicities), went there last summer on a two week road trip and am going back (also to Ireland) this summer. The unadulterated Nature took my breath away. I was captivated by the Gaelic language up in the Highlands. I love that all of the signage has Gaelic over the English. I may never come back to the US. Moran taing (that’s all the Gaelic I know!).

  • I’ve been thinking about those words “Why me? Why now?” , since I read this post the other day. I’ve decided to use those for any potential romantic interest. What a great question to ask a potential life partner, why me, why now? I decided for business use, I’d like to phrase it something like this, “What about me and my work is calling to you right now, or brings you in today?”

  • Jill

    Thanks Tad, this is so great to hear. I think I do this sometimes… in the fear that I have to prove myself as a practitioner, rather than realizing that it is in the listening that I open myself as a TRUSTWORTHY practitioner.

  • David Jurasek

    Tad,

    I love this blog!

    Having been a client douzens of times and being a therapist, I found myself nodding and wishing every one of my many therapist friends in private practice would read this piece!

    As a client, I have had the same reactions, even recently. And I don’t want to have to teach therapists or helping pro’s I see on what I need, especially when they are seasoned, highly recommended, and charge sooo much! And yet, I see that I need to teach people what I need and how I wish to be treated, as well as to model myself as their client and EVEN MORE SO, to walk the talk as a therapist myself.

    Endless learning here and also some great points above. I cannot wait to pass this along!

  • happy to know it’s not just that I’m cranky :-)

  • It’s interesting that you’re having these ‘issues’ with intake (listening) and trust right now, Tad. (I read your last post last week.) On the one hand it’s… well it’s something to write about, and on the other (more interesting) hand, it’s… I wonder what comes to mind for you?

    That’s what came to mind as I read this (“people make mistakes”) post. Normally, I’d just keep this reflection to myself. Today, I didn’t.

    I appreciate you, Tad, and the work that you do – thank you. :-)

    Steve

  • Hi Tad..This was so difficult to read, because I could feel your own befuddlement and frustration in the process. You’re not being cranky – you’re being honest, transparent and truthful about your experience. I’m sorry you had to go through that, Tad. I love the idea about introductory videos as a pre-appointment experience. I’m going to work with that in my own work. Now, I could go through things piece by piece and be “nice” about it, but I won’t. I think shooting from the hip would be better here. So here goes… You are a person. You are not a problem to be solved. You are not a specimen to be studied. You are not a compilation of data on a form. You are a person who needs to be heard, validated and supported. I think the lesson here is clear, regardless of whether one is a therapist, life coach, advisor, etc.: Be careful about procedures and routine in a practice; they can easily end up creating distance or even barriers to effective connection and a productive helping relationship. I could say more here about eliciting criteria effectively, rather than running the paper-chase approach, but I think that’s up to the individual practitioner. I hope your future experiences are better ones!

  • Andy Hunt

    In my intake process there is always an initial conversation, usually by phone, with the client. Which starts with “how can I help?” and “what are you struggling with?” kinds of questions. The conversation is a chance for the client and I to try each other out to see if we would be a good fit and to develop a rudimentary rapport. If we’re not right for each other I’ll try to point them to someone I think might be better able to help.

    If it seems like we might be a good fit, at end of the conversation there is usually enough trust for me to tell them that the next step is for them to fill in a confidential client questionnaire (which does ask personal questions) and return it to me before we book our 1st session. The return of the questionnaire is a pre-requisite for the booking of the session. Usually people will return the questionnaire and we book the first session. A few people (usually men) have received but not returned the form.

    At the first formal session we discuss their needs in more detail and I frame the session as a chance for them to ‘test-drive’ me as a therapist and for me to decide if I’m the right person to help them with what is troubling them. If they are agreeable and there is time we may start work on what’s going on for them.

    After the first session I ask them to think about how the session (and I) went for them for a few days and then we’ll be in touch by email to see if they want to commit to further session. I do this so that clients don’t feel they have to book more sessions with me because I am an nice guy and they don’t want to disappoint me when I ask them – and then not show up to those sessions if they have had a change of heart. I want to give the clear opportunity to have a change of heart and to make it easy for them to say “this is for me”. If they sign up for further sessions after all this I know they are committed to the process – which they need to be because it can be hard work.

    BTW I like the “Why me?” & “Why now?” questions.