194 Your Intake Process Might Be Costing You More Than You Think

Your intake process is doing a lot more than collecting signatures. It is shaping the expectations your clients and supervisees will carry into every interaction that follows.

In this episode, I unpack some of the most common intake mistakes I see therapists and supervisors make. The surprising part is that these mistakes rarely become obvious during the first meeting. Instead, they show up weeks or even months later when a client pushes back on a cancellation fee, a supervisee questions a policy, or someone says, "I didn't know that."

We'll talk about why intake is really about building clarity, trust, and protection from the very beginning. Whether you're onboarding a new therapy client or welcoming a supervisee, your systems matter more than you may realize.

In this episode, we cover:

•  Why your intake process begins before the first appointment 
•  How mismatched expectations create avoidable conflict 
•  The difference between having a contract and conducting an orientation 
•  Common documentation gaps that leave therapists vulnerable 
•  The intake mistakes supervisors make most often 
•  Why professionalism during intake becomes your best marketing tool 
•  Simple changes you can make this week to strengthen your systems 

You don't need to overhaul your entire practice overnight. Often, one well-designed improvement can make your intake process smoother, your documentation stronger, and your professional relationships more successful.

Want to learn more? Check out this month's free resource from Kate Walker Training. 

Want deeper support? Inside the Step It Up Membership, we provide updated templates, live coaching, supervision resources, documentation systems, and practical business strategies designed specifically for therapists and supervisors.

Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit. 

Transcript

Why Intake Costs Add Up

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Today is for private practice owners and supervisors. We're talking about what your intake process is costing you in time, money, and protection. I'm going to get practical and specific today. And if you've been meaning to look at your intake process for some time, summertime's the right time. Hey, I'm Dr. Kate Walker, and welcome to this episode. I have talked about intakes in the past. And it was actually a pretty popular podcast episode. You can go check that out. Today I wanted to dovetail off of the how-to into this idea of common mistakes people make in their intake process. And I'm going to add a supervision element to this as well, because you know what, supervisors, you do intakes too. So the problem usually shows up somewhere weeks, maybe months later after you've seen the client for a bit or after supervision's been going along. In supervision, we call it moving into level two. This is where there's a little bit of push-pull with our supervisees. Maybe they're pushing back on, you know, you being hands-on, or they're pushing back on the type of theory that you wanted them to use originally, or their need for direction. And things may come up that you think to yourself, wait a second, I thought we covered this in the contract. Or you start thinking, dang, I wish I'd had a contract. Same thing with clients. You know, it could be such an amazing first four, five, six, seven, eight sessions, but then something happens and they no-show you, or something happens and they show up late or they late cancel. And you're thinking, oh my gosh, we have this excellent rapport. We've done such good work together. What do I do? And if you stock the internet threads, as we do, social media, Facebook, Instagram, all the things. This is really the most common complaint. We see everything's fine till it's not. So what's the answer? Well, maybe we don't have the answer, but avoiding these mistakes in your intake session, it's gonna help a lot. Okay, first and foremost, you know that commercial back in the day, you never get a second chance to make a first impression. That's your intake. I mean, even if you've done a consultation, like a 10-minute consultation, we talk about a Kate Walker training for your client, or you've done a pre-interview with your supervisee. I mean, think about the way you present yourself, how you dress, or what your office looks like. If you're virtual, same thing. Like what kind of background are you using? How good is your camera and your sound? Um, to things like, are you showing up on time? I'm assuming that would be an expectation you're gonna have for your client and for your supervisee. And certainly for your supervisee, it's gonna be the expectation for them to have for their clients in their work setting. So you taking that very first meeting as an opportunity to set the expectation of who you are, that starts with how you present yourself, how you show up, when you show up. Can you end the session on time? If you're calling this a 30-minute meeting, are you showing up late and then going way over time? Um, that shows a lack of respect for their time and your time. Um, so understanding that that very first session is telling them something. All behavior is communication.

When “Everything’s Fine” Breaks

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So think about that very first session as an opportunity to communicate who you are. All right. So let's go back to the 10-minute consultation for clients. I mean, if clients have never had therapy before, a lot of times they're anticipating coming to that first session and deep work. You know, you see, I know on TV shows, it's like, okay, do I lay down on the couch? Do what do I tell you the whole story? You know, clients are wondering, okay, when does this start? And they're not expecting a whole lot of questions. They're not expecting you to have an intake packet in front of you, or maybe spending a lot of times just talking about policy and maybe spending five or 10 minutes on the actual issue. They may not understand that it actually takes two or three sessions in a lot of cases to get through the entire intake before you can even start to set treatment goals. And this is especially confusing if you bill insurance and they're demanding a diagnosis at that very first session. So having a 10-minute consultation beforehand with your potential client does a lot more than just build rapport and establish a show-up rate for that first session that's higher than if you didn't do a 10-minute consultation. It also sets the expectation and that improves their demeanor and their, it reduces disappointment, right? That's what disappointment is usually, right? It's a mismatched expectation. So if you have a 10-minute consultation that says something to the effect of, hey, at this first session, I'm going to ask you a lot of questions. In fact, it may feel like an interview. And at the end of that session, we'll talk about some goals for therapy. I may give you something to read or write or look up. And by the second session, we're going to course correct based on your feedback. So, really, by that third session, you're going to know if working with me is a good fit. I mean, even that spiel right there, it helps them understand that this is a three-session process. They have low expectations for that first and second session. And there are some real specific expectations built in there too, like homework and goal setting. And are we a good fit? I mean, ask your friends how many of them come away from therapy after one session saying, yeah, it just wasn't a good fit. That is a mismatch matched expectation in most cases. Uh, let's talk about supervision. So, with supervision, it could be the same thing. I've talked so much about how associates, when they meet you the first time, they've got their state paperwork in hand and they're maybe saying yes to everything, your rate, your time, your uh location, the modalities. Just please sign my paperwork. So at Kate Walker Training, we talk about the OER triad. I talk about it in my book, The Clinical Supervision Survival Guide. And that O is orientation. That's where you take all the stuff they signed that they said they agreed to, and you go over it item by item. And then you really pay a lot of attention to the things that can cause problems. For instance, let's just talk about scheduling and flexibility. If you said during the initial interview, hey, I'm only available on Tuesdays and Thursdays, and then they get a job where they're working Tuesdays and Thursdays, you've been real clear you're not flexible. Well, that's a met expectation. They know they may have to get another supervisor because you explain that clearly. The

First Impressions Set Expectations

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orientation helps them understand, okay, here are my flexible dates. Okay, Tuesday and Thursday isn't going to work. Well, let's collaborate together and see what we can come up with so we don't have to end this uh this end this relationship based on schedule. Same thing with a no-show policy. If you never mention a no-show policy or the fact that you will charge extra if you have to meet with them on a day that's not in your schedule, or you charge for extra contact outside of supervision if they have questions or emergencies, that's going to cause the relationship to go sideways if you haven't gone over this in the orientation, right? They may have attested to it on the contract and said, oh, yes, I understand, not a problem. And then the situation comes up again, mismatched expectation. And if you've heard other trainings that we do, you are responsible for the relationship. So the contract is just the first conversation. The orientation is still part of your intake. And so not doing an orientation or not having a contract, that's a huge mistake that supervisors make that could really, if they would just do those things, have a contract, whether your state requires it or not, and an orientation where you go over those things, especially the troublesome spots in detail, that can do wonders for the relationship and making sure things are smooth in the future. Okay, so let's get back to therapy. I'm going to put my glasses on because I've made some notes here. Most common intake gaps on the therapy side, vague or missing financial agreement, especially around no-shows and late cancellations, and how you will collect those funds. Are you going to have a credit card on file? Is it something you're going to invoice them for? Is it a huge rate that's outside of the rate maybe their insurance pays for? Maybe you have a generic consent for treatment, like maybe you grabbed it off the uh badass counselors building practices that thrive Facebook page, which is a template. I love it when people grab those resources. Please grab those free

The Consult That Prevents Disappointment

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resources. But a lot of people don't understand that those are templates. You still have to personalize them for your practice in your state. So a generic consent form that doesn't reflect your actual practice can be a huge mistake. HIPAA notice of privacy practice. Do you document that you give your client that HIPAA notice? Super easy to find. You can go to that Health and Human Services website. I believe it's a.gov. They have them in Spanish and English and other languages. You just download that and you can include that in your intake paperwork. Missing or outdated ROIs, making sure, generally, if there's no end date, ROIs are good for 12 months. So make sure that you have an ROI that reflects that. Don't worry if you are in the Step It Up membership, you have an updated ROI template. Intake paperwork that hasn't been reviewed in years. And if you are a listener to this podcast or you're in the Step It Up membership, we review paperwork every year and we keep those templates updated in your profile. The clinicians who struggle to enforce their policies almost always never set them up clearly in the first place. So super important with clients. Now let's talk about your supervisees. As I mentioned before, not having a contract. And I know there are probably some trainings out there that don't teach folks to have a contract because honest to goodness, it's really, it's not a requirement in a lot of states. And I'm not talking about the state paperwork. I'm talking about a contract that sets expectations. So a huge mistake, number one, is not having that contract. Number two, not asking or uh not asking for or not checking references. I actually advocate that uh you get an ROI to speak with former supervisors and professors. I call it an ROI. It's really just an agreement that your supervisee is okay with you contacting the references, not requiring HIPAA training of your supervisee. You don't know if your supervisee ever learned HIPAA. And if you're hiring them to work in your practice, it's on you to make sure they get annual HIPAA. And in Texas, we have something called House Bill 300. You have to get those trainings and document them regularly. Not verifying that they have malpractice insurance. That's a biggie. As a supervisor, keeping track of their expiration date. You might have a supervisee that works for an agency that says they cover your supervisee with their umbrella malpractice insurance. That's never enough. And so one of the mistakes you could make in your intake with this supervisee or your orientation is telling them, oh, yeah, it's fine. You don't need to have malpractice

Supervision Contracts And Orientation

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insurance. Or a mistake would be not writing down their expiration date. That's a huge liability having a supervisee walk around with no liability insurance. Starting supervision with a system to track hours, a system to keep track of notes so both of you have a copy, and a system to track sites and to keep track of site supervisors. If you live in a state like Texas where you can be off-site from your supervisee, a huge mistake would be not tracking those sites, making sure you know how to contact each and every one of those sites, even if you're virtual. Another mistake you can make is missing the opportunity to use your intake as a marketing moment. I know, I know that doesn't sound great, but it really is this opportunity to help people understand how to refer you to their friends and colleagues. Everybody wants to be a helper. Everybody wants to be that person who says, oh yeah, I know a guy, or oh yeah, I know a girl who can, whether it's a plumber or an electrician or a great therapist or a great supervisor. So that intake is a really wonderful opportunity for you to tell people who you are so that they can confidently refer you. If you don't take supervision or the therapy session seriously, if you show up late, if you show up and then you eat a sandwich during the intake, or you've done this so many times, you don't need paperwork, or you know what, it's fine, just sign here, we're good to go. If you're communicating that this process is not serious or important to you, you're also helping them receive the information and decide on their own, you know what, this may not be important to me. And if it's not important to your client or your supervisee, think about the quality of their work, right? Because a client works hard in therapy. They want to be able to trust you with this information. Now, talking about the marketing moment, are they going to refer someone who is disorganized, who eats a sandwich, who starts and ends late, who doesn't uh follow what they're saying, who just appears like they're just not in it. Same thing with supervision. If you're disorganized, if you're late, if you're eating a sandwich, I know I'm really harping on this sandwich thing, but just keep in mind, they want to be helped and they want to help their friends, their family, and their colleagues. Okay, so as we wrap up, I want you to think about things you can tighten up

Paperwork Policies And Referral Clarity

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this week. Is it uh if you're thinking about your therapy clients, is it going in and making sure that you have clearly defined your uh late cancel no-show charge policies? If it's for supervision, is it going back and looking at your contract and then scheduling an orientation? I was just asked this yesterday during one of our Step It Up Member Live weekly coachings. We do it every Tuesday at noon. Somebody said, I change my orientation all the time. How often should I update it? And I said, Well, you know, twice a year, have everybody get together, everybody in your practice, all your supervisees, and go over all of those changes. You can have a Google Doc so everybody sees the changes in real time. So these are all solvable problems. And the idea that you're having this orientation,

Tighten One Thing This Week

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that's a wonderful way to set that expectation. So if you don't have an orientation, start one. If you don't have a contract, build one. We have templates for you in the Step It Up membership. And if you're in Texas and the Texas Supervisor Coalition Facebook page, I'm pretty sure we have some there too. Now remember, all of these license requirements vary by state. So go into your rules, find where they are, go to the section about intakes, paperwork, and get everything ship shape. And if you're overwhelmed by everything I'm saying, at least change one thing this week. I challenge you. All right, guys. Have a great day. If this was useful, hit like and tap subscribe and share it with a colleague who's also been meaning to update their intake process. For more on building a sustainable private practice, grab the guide at KateWalkertraining.comslash free guide. The link is in the description, and I'll see you next week.