Counselor’s Intake Script

1. Welcome & Confidentiality

“Hi [Student Name], I’m [Counselor Name], and I’m really glad you’re here today. This is a safe, private space for you to share whatever’s on your mind. Everything we talk about stays between us, except if I believe you might harm yourself or someone else, or if I think you’re in danger. In those cases, I’m required to get help to keep you safe. Do you have any questions about that before we begin?”

Pause for any questions and acknowledge them.

“Great. To get started, I’d love to learn a little about how your day is going.”

2. Rapport Building (Ice-Breaker)

“• How’s your day going so far?”
­– If needed: “What’s been the best part of your day?”

“• What’s something you’ve enjoyed this week?”
­– If needed: “What about that stood out to you?”

“• Can you tell me one thing that makes you feel at ease?”
­– If needed: “How does that help you when you’re stressed?”

Use the student’s answers to build connection, mirror their language, and show genuine interest.

3. Transition to Personal History

“Thanks for sharing that with me. Now I’d like to get a bit more background about you, so I can better understand what’s been going on in your life.”

4. Collecting Personal History

“• Who do you live with at home? Can you tell me about your relationships with family members?”
­– Follow-up: “What’s one of your favorite memories with your family?”

“• What’s a typical day like for you when you’re at school?”
­– Follow-up: “Is there a part of the school day you look forward to the most?”

“• What clubs, sports, or hobbies are important to you?”
­– Follow-up: “How did you get started with that activity?”

“• If you had to name one strength or skill you’re proud of, what would it be?”
­– Follow-up: “How has that helped you in challenging times?”

Note positive themes and emerging concerns as the student speaks.

5. Risk Assessment

Transition gently:
“Sometimes we ask a few tougher questions so I can check in on how you’re feeling inside. If at any point you need me to slow down or take a break, just let me know.”

“• Over the past few weeks, how often have you felt down, hopeless, or unusually tired?”
­– Follow-up: “Can you describe a moment when you felt that way?”

“• Have you ever had thoughts about harming yourself or not wanting to be here?”
­– Follow-up: “When those thoughts happen, what do you usually do?”

“• In the past year, have you experienced any major changes or losses—like a move, a breakup, or someone passing away?”
­– Follow-up: “How did you cope with that?”

Validate their courage for sharing.
“Thank you for talking about that. I know these questions can feel tough.”

6. Protective Factors & Strengths

“• Who do you feel you can turn to when you need help or support?”
­– Follow-up: “What makes that person a good support for you?”

“• What activities, hobbies, or routines help you feel better when you’re stressed?”
­– Follow-up: “Can you think of a recent time you used that strategy?”

“• Tell me about a challenge you’ve faced and how you got through it.”
­– Follow-up: “What did you learn about yourself in that situation?”

Highlight and affirm any coping skills and positive relationships mentioned.

7. Summarize & Next Steps

“Here’s what I heard today: you told me that [brief summary of main points, e.g., home situation, school experience, current mood]. You’ve shown strength by [highlight protective factors]. Does that sound right?”
Pause for confirmation.

“Based on what you’ve shared, here’s what we’ll do next:
• I will [e.g., connect you with peer support group / share coping strategy handouts]
• We’ll schedule a follow-up in [timeframe] to check in again.
Does that plan feel okay to you?”

Agree on next steps and write down the follow-up appointment.

8. Closing

“Thank you again for being open and honest today. I really appreciate your trust. Remember, you can reach out to me anytime if you need to talk before our next meeting. You’re not alone, and I’m here to support you.”
Offer any printed resources or contact information.
“Take care, and I’ll see you on [scheduled date].”

Personal History Form

Student Name: _________________________ Date: _______________

Section 1: Demographics

1. Age: ________________________ Grade: ________________________
   
   
   
2. Who lives with you at home? (parents, siblings, guardians):
   
   ______________________________________________________________________
   
   
   

Section 2: Family & Relationships

1. Describe your relationship with family members (parents, siblings, others):
   
   
   
   
   
   
2. Share a positive memory with your family:
   
   
   
   
   
   

Section 3: School Experience

1. What is a typical day like for you at school?
   
   
   
   
   
   
   
   
2. What subjects do you enjoy most and why?
   
   
   
   
   
   
   
3. Which subject do you find challenging and why?
   
   
   
   
   
   
   

Section 4: Activities & Interests

1. List any clubs, sports, or hobbies you participate in and what you enjoy about them:
   
   
   
   
   
   
   
   
   

Section 5: Strengths & Skills

1. What is one strength or skill you’re proud of? How has it helped you?
   
   
   
   
   
   
   
   
   
2. Describe a time you overcame a challenge. What strategies did you use?
   
   
   
   
   
   
   
   
   
   
   

Section 6: Additional Notes

Is there anything else you’d like me to know about your background or experiences?

Red Flags Reference

Use this reference to identify warning signs across mood, behavior, and thought patterns. If you observe any of these, gently explore further and consider safety planning or referral.

1. Mood & Emotional Indicators

• Persistent sadness, tearfulness, or hopelessness lasting more than two weeks



• Marked irritability or anger outbursts beyond typical teen mood swings



• Sudden emotional flatness or numbness—appearing “shut down”

2. Behavioral Changes

• Social withdrawal: avoiding friends, skipping classes, isolating in hallways



• Noticeable drop in academic performance or loss of interest in favorite activities



• Risk-taking behaviors: substance use, reckless driving, self-harming actions (cutting, burning)



• Sleep disturbances: insomnia, excessive sleeping, frequent fatigue

3. Thought Content & Speech

• Expressions of self-harm or suicide (“I wish I wasn’t here,” “I can’t go on”)



• Preoccupation with death, dying, or violent themes in conversation or writing



• Extreme feelings of worthlessness, excessive guilt, or self-blame

4. Recommended Actions

• Clarify: Ask open questions (e.g., “When you say you don’t want to be here, what does that feel like?”).
• Validate & Listen: Show empathy (“That sounds really hard. I’m here to help.”).
• Safety Planning: If self-harm or suicidal thoughts are present, begin a safety plan immediately (remove means, identify supports, emergency contacts).
• Consult & Refer: Discuss concerns with your supervisor or school mental-health team. Refer out for crisis intervention or intensive therapy as needed.

Emergency Response: If you believe the student is at imminent risk of harming themselves or others, do not leave them alone. Follow your school’s crisis protocol immediately or call 911.