Compliance and documentation

Your guide to couples therapy intake assessments

Use a couples therapy intake assessment to quickly capture history, risks, and goals so relationship therapists can plan focused, evidence-based treatment.

January 16, 2026

By Savanah Harvey, AMFT

12 min read

By Savanah Harvey, AMFT

A strong, collaborative, and inviting intake assessment can make the difference between a focused course of therapy and one that feels a little bit hectic from the start. Many clinicians feel extra pressure when working with more than one client at a time, as this means more perspectives, complex dynamics, and sometimes immediate conflict. Handling this while documenting thoroughly and staying clinically attuned (and neutral) can be difficult.

This guide is designed to help you simplify that process. With the tools and techniques below, you'll learn how to prepare for the intake before meeting the couple or individuals in the relationship, the essential information to gather and document, and what to prioritize in early sessions.

How should an initial psychiatric evaluation run?

The goal of couples (or “relationship”) therapy is to create a foundation for the relationship to move forward with clarified goals, relational patterns, and expectations for each partner.
Conducting a fluid couples therapy session starts with slowing down the pace, remaining a neutral third party, and approaching the individual and relational histories from a place of curiosity.
When we focus on those goals while prioritizing safety, context, and connection, we begin to form a clear, collaborative treatment plan.

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The goal of couples therapy intake sessions

Intakes with couples help you understand the relationship as a dynamic relational system while learning each partner’s values, needs, history, and concerns. The focus of the intake is not about resolving conflict in real time — which is a common misconception — but instead it’s about gathering necessary context to shape a clear treatment plan to move forward with. There are many different approaches and interventions when working with individuals in a relationship. It’s highly recommended to seek training and clinical supervision when starting couples or relational counseling.

Information needed from the couple in intake sessions

As a therapist, a well-structured intake is your first impression of the relationship. It’s also a first impression of your work, which gives the couple a glimpse into what working with you will be like.

While deeper emotional work will naturally unfold over time, the intake highlights the strengths, stressors, and stories each partner brings to the relationship. To write a clear intake note, clinicians should focus on the following (this list is not exhaustive):

Presenting concerns

Why has the couple decided to come to therapy, and why now?
The severity, frequency, and length of the issues, and how they impact daily and relational functioning
Each partner’s individual and subjective experience and understanding of the relational problem

Relationship history

How did the couple meet? What were their early impressions of each other?
Any major milestones they have shared (living together, marriage, careers, children)
Recognizable patterns, high points, and moments of tension
Any previous therapy experience (individually or relationally) or prior attempts to resolve conflict

Individual histories

Learn about their family of origin and early relationships, attachment-shaping experiences, significant life events, and any traumatic experiences
Mental health history, diagnoses, or prior treatments
Cultural, religious, or societal factors that may influence roles and expectations within the relationship
Individual experiences or circumstances the client has encountered that may indicate additional history to gather

Relationship dynamics

What does conflict look like? How is it communicated and resolved?
Is there intimacy in the relationship? If so, how often? If not, how long has there been a lack of sexual connection? Explore closeness and withdrawal cycles within the relationship
What coping strategies does each partner use in stressful moments?

Strengths and protective factors

What are their shared values and commitments?
Ask about recent moments of resilience or repair
What are individual or relational strengths that support change?

Safety risks

Assess for emotional, financial, or physical abuse
Assess for suicidality or self-harm
Assess for substance abuse concerns
Assess for weapons in the home
Assess for intimate partner violence

If IPV is indicated, the priority is safety over relational work. You pause and do not proceed with couples therapy when there is ongoing, coercive, or fear-based violence, because conjoint work can increase risk and inhibit honest disclosure. You shift to individual assessment, complete a safety and lethal means evaluation, provide resources and referrals (e.g., domestic violence supports), and clarify that couples therapy may be reconsidered only after safety is established and violence has ceased, with clear boundaries and accountability in place.

Intake note requirements

A complete intake note should include:

Presenting concerns from the Identified Patient, or IP
Other people present in the session
Individual and relationship history
Current mental status of the IP
Past mental history
Risk and safety evaluation
Strengths
Clinical summary
Diagnosis of the IP (if applicable)
Proposed treatment plan
Medical necessity justification relating to the IP

Using this structure will help you ensure your documentation is clinically appropriate, legally protective, and approved by insurance, while setting the foundation for a treatment plan rooted in evidence-based practices.

Effective couples therapy intake questions

Thoughtful couples therapy intake questions help uncover attachment needs, emotional cycles, and any long-term relational patterns within the couple. How the questions are asked — and answered — can set the tone for the dialogue of treatment. Some key questions to consider asking are:

“What made you seek (or re-seek) therapy now?”
“How do you each experience conflict?”
“Where do you feel connected in your relationship?”
“If therapy was successful, how would you know?”
“How do you reconnect after an argument?”
“Who modeled love, conflict, or repair for you? How were they handled?”
“When you are in a moment of stress or disconnection, what do you each need?”
“What has been the strength that has kept you together?”
“Are there any triggers or symptoms that you'd like your partner to better understand?”

Before your first session with the couple

Intentional preparation helps you stay organized, grounded, and fully present once the session begins. Before meeting the new couple, send intake paperwork and informed consent forms. Require each partner to fill them out individually to protect confidentiality and ensure both partners feel equally engaged, protected, and valued. If you’ve received any referral information, previous therapy notes, or any other context that may help you understand the relationship in a broader context, be sure to review this before meeting with the couple.

Regardless of meeting in person or online, create a welcoming environment that invites safety, balance, and a place of connection. With this in mind, consider how you will create space for each partner as you map out a simple timeline of the session.

During your first session with the couple

Presenting therapy as a collaborative space where no one is “right” or “wrong,” is the most important way to invite clients in the relationship into the therapeutic space. From this foundation, set clear expectations of your work together, explain the session flow, and describe your commitment to neutrality — as well as how confidentiality works with two clients in the room.

Begin by inviting each partner to share why they're in therapy so both receive equal speaking time. As each partner speaks, track recurring themes, emotional cycles, and any signs of escalation without intervening. If tension rises, use this as an opportunity to slow the pace while using regulated communication to come back to a space where each partner feels heard and supported. As you continue learning about the couple, continue to approach their shared and individual stories with empathy, patience, and most importantly, curiosity.

A few tips:

Think of your role during the intake session as part investigator, part stabilizer, and part narrator.
Set the tone from the beginning, reinforcing neutrality and shared responsibility from the start.
When escalations arise, use grounding questions to bring everyone back to a neutral place.
As you notice strengths, point them out. This will help balance the heaviness of the presenting problems and give the couple a sense of encouragement.

Explore more couples counseling techniques from Headway.

After couples therapy intake sessions

Once you have completed the intake, it’s time to transfer everything you learned into an organized treatment plan in a timely manner. A cohesive treatment plan will include:

A clear description of the couple’s cycle
Goals that reflect both partner’s hopes, values, needs, and readiness for change
A shared hypothesis that relates to each partner’s attachment patterns
Any immediate risks or protective factors
When clinically appropriate, diagnosis for one or both partners

Sharing your treatment plan with the couple as a roadmap gives them a groundwork to build from, especially when arriving at therapy in an emotionally heightened place of uncertainty, skepticism, or distrust that therapy can help.

Guidance for individuals seeking couples therapy

Sometimes a client may arrive at therapy alone, only for you to discover that couples therapy may also benefit them. When this happens, it's important to clarify whether they are seeking individual therapy, couples therapy, or a mix of both. Be mindful of forming opinions or conclusions about the relationship without the second partner present, and instead focus on helping the initiating partner re-define their goals, boundaries, and why their reasoning for showing up to therapy. You can offer gentle psychoeducation about what successful couples therapy looks like, giving them the opportunity to then make an informed decision about their next steps.

More couples therapy resources

Headway offers additional guides and resources to help you build confidence and strengthen your work with couples:

Expand your practice with Headway

A strong couples therapy intake is the foundation of a successful treatment. When clinicians stay neutral and create a collaborative space to gather the right information early, they reduce miscommunication and are able to create a clear path that focuses on the couple. Headway helps providers streamline their paperwork, billing, and insurance reimbursement so they can spend more time doing what matters most: helping couples heal, connect, and rebuild their relationships with intention.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

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