Why Our Intake Practices Need to Change
The first session with a new client sets the foundation for the therapeutic relationship. It’s the moment when we gather history, establish goals, and determine treatment fit. But for trauma survivors—especially those with complex PTSD—the standard intake process can be overwhelming, triggering, and even re-traumatizing.
Trauma specialist and instructor, Dr. Nirit Gordon, PhD, experienced this firsthand as the manager of an intake department. She explains: “Most intakes are handled in a way that is good for the organization—collecting info, establishing diagnosis, handling insurance, and understanding client fit—but often not as supportive of survivors of trauma.”
The structure of traditional intake prioritizes efficiency, but it often fails to recognize that there is a danger of retraumatizing the clients with PTSD or CPTSD. As Nirit describes:
“A system that is not trauma informed, which are most systems that serve clients suffering from CPTSD or PTSD conduct intakes that often trigger and flood clients. Instead, intakes should become an opportunity for empowerment, teaching regulation skills, psychoeducation that hold a message of hope about healing from trauma.”
Research supports this concern. Nakash et al. (2009) found that when clients feel unheard or disempowered during intake, they are less likely to return for follow-up sessions. Liang and Shepherd (2020) highlight how intake forms and private practice websites often fail to reflect cultural responsiveness, further alienating marginalized clients.
What if the intake process could be more than a procedural necessity? What if it could be an opportunity to provide emotional regulation, psychoeducation, and a sense of empowerment?
A trauma-sensitive, anti-oppressive approach to intake transforms the first session from a bureaucratic hurdle into a therapeutic intervention. Here’s how.
How Traditional Intake Can Re-Traumatize Survivors
For clients with a history of trauma, recounting their experiences during an initial consultation can be destabilizing. Standard intake procedures often:
Rush into trauma history too soon – Recounting traumatic events before a foundation of safety is built can overwhelm a client’s nervous system (Fisher, n.d.).
Feel interrogative rather than supportive – The structured, checklist-driven nature of traditional intakes can feel impersonal, reinforcing power imbalances (Shaia, 2019).
Lack cultural responsiveness – Intake forms and interview scripts often fail to consider the impact of structural and intergenerational strength and trauma, leaving clients feeling unseen (Brown, 2019; Nickerson, n.d.).
Without thoughtful adjustments, these elements can make clients feel unheard and unsafe.
Reframing Intake as an Intervention
A trauma-sensitive intake shifts the focus from information gathering to co-regulation and empowerment. This doesn’t mean eliminating essential intake components but rather restructuring how they are delivered.
1. Create Immediate Safety
Before diving into history, prioritize grounding techniques. Simple interventions like offering a client choice (e.g., “Where would you like to sit?” “Where would you like to start our conversation?”) can provide an immediate sense of control. This approach aligns with positive psychological assessment frameworks, which emphasize client strengths and autonomy in shaping their care (Owens, Magyar-Moe, & Lopez, 2015).
2. Slow Down the Process
A trauma-informed intake allows space for emotional regulation. Checking in with a client’s nervous system throughout the session ensures that they are not becoming overwhelmed. Parnell (2013) emphasizes that attachment-focused approaches help create a sense of stability for trauma survivors in early therapeutic interactions.
3. Offer Psychoeducation from the Start
Many survivors feel overpowered by their experiences. Providing a brief explanation of trauma’s impact on the brain can normalize their reactions and introduce hope. Janina Fisher’s (n.d.) psychoeducation flip chart is a valuable tool for helping clients understand the neurobiological legacy of trauma in an accessible way.
4. Integrate Anti-Oppression Practices
Clients bring intersecting identities that shape their experiences with trauma. A culturally aware intake acknowledges structural and systemic factors that impact healing, with the intention hope that therapy is making an effort to address power imbalances and equalize them. Brown (2019) and Umana & Timothy (2020) advocate for anti-oppressive psychotherapy as a means to create more inclusive mental health practices.
Adding Cultural Context: The Role of a Culturally Informed Genogram in Intake
Trauma does not exist in isolation; it is deeply shaped by cultural history, intergenerational experiences, and systemic factors. To fully understand a client’s context, we must look beyond individual symptoms. One way to do this is by incorporating a culturally informed genogram—a tool that maps out cultural influences, migration patterns, and intergenerational trauma.
Dr. Nirit Gordon emphasizes the importance of this practice in her training, explaining that creating a cultural genogram allows clients to explore how their identities intersect with structural and personal histories. This approach can highlight strengths, resilience, and the impact of oppression, helping both the clinician and client to see the broader context of their experiences.
“What will make the first session last?”
When intake provides an opportunity for deep self-reflection, clients are more likely to engage meaningfully in therapy. In the training, we will explore how to create a culturally informed genogram, like the example below, to deepen intake conversations.
This tool helps reframe intake as more than just a procedural step—it becomes an intervention in itself, allowing space for empowerment and insight.
5. Use Collaborative Language
Reframing intake questions with more collaborative phrasing can shift the power dynamic. For example:
Instead of “Have you experienced any trauma?” → “Many of my clients have experienced difficult or overwhelming life events. Is there anything that feels important for me to know to better support you?”
Instead of “What symptoms are you experiencing?” → “How has your body and mind been responding to stress lately?”
Solomon et al. (2017) emphasize that culturally competent interviews—especially with LGBTQ+ youth—require nuanced, inclusive language that avoids assumptions and allows clients to self-define their experiences.
Shifting the Role of the Therapist in Intake
Traditional intake models position the therapist as the evaluator, but in a trauma-sensitive model, the therapist becomes a guide. The intake session is an opportunity to model co-regulation, provide tools, and set a foundation for a healing relationship.
By integrating trauma-informed care, emotional regulation, and anti-oppression practices into intake, we can create a first session that doesn’t just assess a client’s needs—it actively supports their healing journey.
Reframing Your Intake Approach
Shifting to a trauma-sensitive intake model takes more than minor tweaks; it requires holding in mind that the intake conversation is a clinical intervention from the very first moment.
Trauma Sensitive Intake in the Perinatal Period: with or without EMDR
🗓️ May 12, 2025
Learn to conduct intakes through a trauma-informed lens, integrating regulation, resourcing, and anti-oppression practices for safer, more effective care.
Led by Dr. Nirit Gordon, this workshop will provide hands-on guidance in conducting trauma-informed, anti-oppressive intakes. You’ll learn how to:
Integrate anti-oppression practices into your intake process
Use emotional regulation strategies from the first session
Create a culturally informed genogram to deepen therapeutic insight
Final Thoughts: Small Changes, Big Impact
A trauma-sensitive intake is more than an ethical consideration—it’s a clinical necessity. When clients leave their first session feeling more regulated, informed, and empowered, they are far more likely to engage in the therapeutic process.
As mental health professionals, we have the power to make intake an intervention, not just an administrative formality. How we begin therapy matters. Let’s make sure we’re starting on the right foundation.
References
Brown, J. D. (2019). Anti-oppressive counseling and psychotherapy: Action for personal and social change. Routledge.
Fisher, J. (n.d.). Working with the neurobiological legacy of trauma: A flip chart for psychoeducation. Retrieved from https://janinafisher.com/flip-chart/
Liang, Y. S., & Shepherd, M. A. (2020). A multicultural content analysis of mental health private practices’ websites and intake forms. Professional Psychology: Research and Practice, 51(4), 325.
Nakash, O., Dargouth, S., Oddo, V., Gao, S., & Alegría, M. (2009). Patient initiation of information: Exploring its role during the mental health intake visit. Patient Education and Counseling, 75 (2), 220-226.
Nickerson, M. (n.d.). Chapter 3: Phase 1 Cultural Assessment. In Cultural Competence and Healing Culturally Based Trauma with EMDR Therapy: Innovative Strategies and Protocols.
Owens, R. L., Magyar-Moe, J. L., & Lopez, S. J. (2015). Finding balance via positive psychological assessment and conceptualization: Recommendations for practice. The Counseling Psychologist, 43 (5), 634-670.
Parnell, L. (2013). Attachment-focused EMDR: Healing relational trauma. W.W. Norton & Company.
Shaia, W. E. (2019). SHARP: A framework for addressing the contexts of poverty and oppression during service provision in the United States. Journal of Social Work Values and Ethics, 16 (2), 42–53.
Solomon, D. T., Heck, N., Reed, O. M., & Smith, D. W. (2017). Conducting culturally competent intake interviews with LGBTQ youth. Psychology of Sexual Orientation and Gender Diversity, 4 (4), 403.
Umana, M., & Timothy, R. (2020). Anti-oppression psychotherapy: An emancipatory integration of intersectionality into psychotherapy. Journal of Social Work Values and Ethics, 17 (2), 52–64.