When you enter the therapeutic space as a new client, it can be very overwhelming.  Regulations of the field require therapists to engage in informed consent (“what am I getting into?”) and ensure completion of intake documentation. Then, often immediately following the completion of this paperwork, you’ll be asked to provide information on what brings you into therapy, as well as providing overall background information and health history. 

 

For many clients, this is an uncomfortable and vulnerable process, as our intake process can ask some questions that may feel invasive or irrelevant. If you are new to therapy, or if you simply haven’t been comfortable with voicing these concerns, read on to discover answers to why therapists ask some of the questions that we do. 

 

Demographics

 

To start with the very basics, we will ask our clients to answer demographic questions such as age, gender, sexual orientation, ethnicity/race, and religion/spirituality. In my experience, younger clients often appreciate the recognition that their expression may differ from their internal experience (eg, cis-presenting individuals who identify as transgender or nonbinary), while many of my older clients feel uncomfortable being asked. In particular, I have had one client who stated that it is none of my business who she is sexually attracted to or intimate with and that she does not feel she should be asked this question. 

 

While I absolutely see her point of view, there are some really important reasons we ask about demographics. First, we believe that mental health should be accessible to everyone, and it is the clinician’s responsibility to provide culturally-informed care. When a client identifies as transgender, using the wrong pronouns or a dead name is going to destroy rapport and make them feel unwelcome in the therapeutic environment. They may believe that a therapist does not care about their experience and is not willing to help them, and it can be even harder to access help in the future. Likewise, a client may feel like the therapist is not interested in providing care if they fail to even ask questions related to how this client builds their identity.

 

Focusing back on the client who raised concern, while there were some demographics that were not relevant to her reason for coming to therapy, there were other cultural contexts that would come into the room and be actively engaged in the process. She was a highly religious and spiritual person, and her faith was a large part of her coping toolbox. Thus, another reason we ask for demographic information: we want to be able to access coping strengths and resources.

 

While some demographics can be experienced as a resource to a client, there are also other aspects of culture or identity that can be a source of pain, and may even be part or all of the reason that a client chooses to come into counseling. Consider a person from a conservative household who identifies as LGBTQIA+, or a member of an ethnic minority: these experiences often lead to significant experiences of trauma that may directly or indirectly impact the problem bringing them to therapy. Without understanding the client’s worldview, it would be very difficult to help them. 

 

So what if I don’t want to disclose my demographics? While there are sometimes questionnaires that will not let you skip this, you likely will be able to select “decline to respond,” “N/A,” or “other.” You can also directly tell your therapist that you are uncomfortable answering, do not feel that it is relevant to the reason you are seeking help, or whatever other reason you may have for choosing not to provide this information. 

 

Medical History

 

In my experience, there are a lot of people who are also uncomfortable providing a medical background, for a wide variety of reasons. The goal for addressing medical history is to ensure that you are receiving the appropriate treatment for the problem at hand. Many mental health diagnoses share similar symptoms and expressions to physical diseases, so ensuring that you are up-to-date with your medical care can prevent misdiagnosis as merely a mental health issue.

 

 For example, the World Health Organization (2024), shares that symptoms of hypertension (high blood pressure) include: difficulty breathing, anxiety, chest pain, and confusion, and nearly 50% of adults with the condition are unaware that they have it. To the unsuspecting person of average health, it may feel like generalized anxiety that would be treated by psychotherapy. There are also many conditions that are diagnosable by medical standards but are largely related to the way that a person’s stress impacts their nervous system. People with these conditions may need coordinated care between medical and mental health professionals. Doctors are more able to treat the manifestations of stress in physical symptoms, while therapists can provide tools for managing stress and internally regulating the nervous system. 

 

Again, if you are uncomfortable with providing a thorough medical history you can decline, though I would caution that you do so at your own risk. You can simply inform the therapist that you are up-to-date on routine care or have medical care managed by your doctor. 

 

Substance Use 

 

I want to start out by letting you know that we do not ask about substance use with the intention of getting anyone in trouble. There are a few specific instances where we may be required to report information connected with substance use (a topic for a later article, maybe), but generally this question is asked to understand if any symptoms bringing you into therapy may be directly related to substance use. 

 

Much like medical illnesses, substance use can have symptoms that mimic mental health issues. What comes to mind immediately is the impact of methamphetamine use on developing symptoms of psychosis. Scientists and psychologists have observed that repeated or high-dose usages of methamphetamines lead to psychotic symptoms including hallucinations, delusions, and odd/eccentric behavior or speech (Hsieh, Stein, and Howells, 2014). All substances interfere with the brain’s natural processes and have a large impact on how the entire system functions; without knowing what a client is using and how often, therapists may be missing a large piece of the problem. 

 

Since substance use can cause significant challenges when someone is already struggling, therapists who gain an understanding of their client’s use of substances will also be able to examine how the substance is used for coping and provide alternative coping strategies that have a more positive impact.

 

Legal History

 

This is another one that people are often understandably reluctant to answer, however, the disclosure of any legal involvement during intake can prevent a lot of headaches in the future. First, it is important to know that not all therapists have experience working with court-ordered (mandated) treatment and may not be able to accept these individuals as clients. Second, when treatment has been mandated, there will be a case worker or supervising officer who needs to be provided with treatment updates to verify that the client is fulfilling their obligation. The therapist will need a Release of Information filled out in order to provide these updates and without following the proper steps, the client can face severe consequences in their legal situation. 

 

Trauma History

 

When a person enters therapy reporting a combination of anxiety and depression, it is frequently the case that they have underlying trauma that will need to be addressed in order to  successfully resolve their symptoms. While treating depression or anxiety can improve wellbeing to a degree, trauma is stored in our bodies in implicit memories. When these memories are triggered, it is difficult to stay present and available for learning new coping tools, and treatment often stops progressing. (Implicit memories can also be triggered by anything: the environment, an emotion, a sensation, a person, a place, a word or phrase….)

 

While therapists do not necessarily need to know the nitty gritty details of what happened, being informed that there is a history of trauma helps to ensure that a trauma-informed approach is used in treatment. Being trauma-informed means that your therapist will be able to focus on tools that help you stay regulated and grounded in the here-and-now rather than getting stuck in unhelpful loops that are detrimental to treatment and just don’t feel good. 

 

Conclusion

 

It can be a very vulnerable and scary thing to share so many parts of yourself, especially in that first appointment. As therapists, we want to make sure that we are setting up for success by understanding your unique story and creating a plan that will help you accomplish whatever goals that brought you to see us. The information you provide helps us learn more about what brought you to your current situation so that we can focus our attention on the best path forward into healing. 

Sources:

 

Hsieh, J. H., Stein, D. J., & Howells, F. M. (2014). The neurobiology of methamphetamine induced psychosis. Frontiers in human neuroscience, 8, 537. https://doi.org/10.3389/fnhum.2014.00537

World Health Organization. (2024). Hypertension. (retrieved: January 2, 2025).
https://www.who.int/news-room/fact-sheets/detail/hypertension