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Help with Intake Interview Questions
 
 

1.         When did the symptom first occur? (In some cases, the symptom will be one that the client has experienced before. If so, you should explore its. origin and more recent development and maintenance.)

 


 2.    Where were you and what exactly was happening when you first noticed this symptom (what was the setting, who was there, etc.) ?

 


 3.         How have you tried to cope with or eliminate this symptom?

 


 4.    Of all the efforts you've made to cope with or eliminate this problem, which has been most effective?

 


 5.    Can you identify any situations, people, or events that it seems usually precede your experience of this symptom?


 6.    What exactly happens when the symptom begins


 7.    What thoughts or images go through your mind when the symptom is occurring?

 


 8.         Do you have any physical sensations before, during, or after the symptom oc­ curs?

 


 9.    Where and what do you feel in your body? Describe it as precisely as possible.


 10.         How frequently do you experience this symptom?

 


 11.         How long does the symptom usually last?


 12.         Does the symptom affect or interfere with your usual ability to function at work, at home, or at play?


 13.         In what ways does the symptom interfere with your work, relationships, school, or recreational pursuits?

 


 14.   Describe the worst experience you have had with this particular symptom. When the symptom is at its worst, what are your thoughts, images, and feelings then?


 15.         Have you ever expected the symptom to occur and it did not occur, or it oc­curred only for a few moments and then disappeared?


 16.         If you were to rate the severity of your problem, with 1 indicating it is not dis­tressful at all and 100 indicating it is so distressful that it is going to cause you to kill yourself or die, how would you rate it today?


 17.        What rating would you have given your symptom on its worst day ever?


 18.         What is the lowest rating you would ever have given it? In other words, has the symptom ever been completely absent?

 


 19.   As we have discussed your symptom during this interview, have you noticed any changes (i.e., has it gotten any worse or better as we have focused on it)?


 20.   If you were to give this symptom and its effects on you a title, like the title of a book or play, what title would you give?

 

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7. First employment and work experience

What was your first job or the first way you ever earned money?

How did you get along with your coworkers?

What kinds of positive and negative job memories do you have?

Have you ever been fired from a job?

What is your ultimate career goal?

How much money would you like to make annually?


 8. Military history and experiences

Were you ever in the military?

Did you volunteer, or were you drafted?

Tell me about your most positive (or most negative) experiences in the military. What was your final rank?

Were you ever disciplined? What was you offense?


 9. Romantic relationship history

Have you ever had romantic feelings for someone? Do you remember your first date? What do you think makes a good romantic or loving relationship? What do you look for in a romantic (or marital) partner? What first attracted you to your spouse (or significant other)? Describe your first sexual or sensual experience.


10. Sexual history (including first sexual experience)

Describe your first sexual or sensual experience.

What did you learn about sex from your parents (or school, siblings, peers, television, or movies)? What do you think is most important in a sexual relationship? Have you had any traumatic sexual experiences (e.g., rape or incest)?

 


11. Aggressive history

What is the most angry you have ever been? Have you ever been in a fight? Have you ever been hit or punched by someone else? What did you leam about anger and how to deal with if from your parents (or siblings, friends, or television)? What do you usually do when you get angry? Tell me about a time when you got too angry and regretted it later. When was your last fight? Have you ever used a weapon (or had one used against you) in a fight? What is the worst you have ever hurt someone physically?


12. Medical and health history Did you have any childhood diseases? Any medical hospitalizations? Any surgeries?

Do you have any current medical concerns or problems? Are you taking any prescription medications? When was your last physical examination? Do you have any problems with eating or sleeping or weight loss or gain? Have you ever been unconscious? Are there any major diseases that seem to run in your family (e.g.,heart disease or cancer)? Tell me about yeur usual diet. What kinds of foods do you eat most often?

Do you have any allergies to foods, medicines, or anything else?

What are your exercise patterns? How often do you engage in aerobic exercise?

 

13. Psychiatric or counseling history

Have you ever been in counseling before?

If so, with whom and for what problems, and how long did the coun­selinglast?

Do you remember anything your previous counselor did that was particularly helpful (or particularly unhelpful)? Did counseling help with the problem? If not, what did help? Why did you end counseling?

Have you ever been hospitalized for psychological reasons? What was the problem then?

Have you ever taken medication for psychiatric problems? Has anyone in your family been hospitalized for psychological reasons?

Has anyone in your family had significant mental disturbances? Can you remember that person's problem or diagnosis?\


14. Alcohol and drug history

When did you have your first drink of alcohol (or pot, etc.)?

About how much alcohol do you consume each day (or week or month)?

What is your "drinking/drug of choice"?

Have you ever had any medical, legal, familial, or work problems

related to alcohol?

Under what circumstances are you most likely to drink?

What benefits do you believe you get from drinking?

 


15. Legal history

Have you ever been arrested or ticketed for an illegal activity?

Have you been issued any tickets for driving under the influence?

Have you been given any tickets for speeding?

How many or how often?

Have you ever declared bankruptcy?

 


16. Recreational history

What is your favorite recreational activity?

What recreational activities do you hate or avoid?

What sport, hobby, or leisure time pursuit are you best at?

How often do you engage in your favorite (or best) activity?

What prevents you from engaging in this activity more often?

Whom do you do this activity with?

Are there any recreational activities that you'd like to do, but you've

never had the time or opportunity to try?

 


17. Developmental history

Do you know the circumstance surrounding your conception?

Was your mother's pregnancy normal?

What was your birth weight?

Do you know whether your were nursed or bottle-fed?

When did you sit, stand, and walk?

When did your menses begin? (for females)


18. Spiritual or religious history

      What is your religious background? What are your current religious or spiritual beliefs? De you jiave_a religious affiliation?

     Do you attend church, pray, meditate, or otherwise participate in re­ligious activities? What other spiritual activities have you been involved in prevoiusly?


1. First memories

What is your first memory?

How old were you then?

Do you have any very positive (or negative) early memories?


2. Descriptions and memories of parents

Give me three words to describe your mother (or father).

Who did you spend more time with, Mom or Dad?

What methods of discipline did your parents use with you?

What recreational of home activities did you do with your parents?


3. Descriptions and memories of siblings

      Did you have any brothers or sisters? (If so, how many?) What memories do you have of time spent with your siblings? Who was your closest sibling and why? Who were you most similar to in your family? Who were you most dissimilar to in your family?


4. Elementary school experiences

      Do you remember your first day of school? How was school for you? (Did you like school?) What was your favorite (or best) subject in school? What subject did you like least (or were you worst at)? Do you have any vivid school memories? Who was your favorite (or least favorite) teacher? What made you like (or dislike) this teacher so much? Were you ever suspended or expelled from school? Describe the worst trouble you were ever in when in school. Were you in any special or remedial classes in school?


5. Peer relationships (in and out of school)

Do you remember having many friends in school?

What kinds of things did you do for fun with your friends?

Did you get along better with boys or girls?

What positive (or negative) memories do you have from relationships

you had with your friends in elementary school?


6. Middle school, high school, and college experiences

Do you remember having many friends in high school?

What kinds of things did you do for fun with your friends?

Did you get along better with boys or girls?

What positive (or negative) memories do you have from high school?

So you remember your first day of high school?

How was high school for you? (Did you like high school?)

What was your favorite (or best) subject in high school?

What subject did you like least (or were you worst at)?

Do you have any vivid high school memories?

Who was your favorite (or least favorite) high school teacher?

What made you like (or dislike) this teacher so much?

Were you ever suspended or expelled from high school?

Describe the worst trouble you were ever in when in high school.

What was your greatest high school achievement (or award)?

Did you go to college?

What were your reasons for going (or not going) to college?

What was your major field of study in college?

What is the highest degree you obtained?