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Counselling online initial assessment.

Susannah Mcintosh Online Counselling Assessment: About the way I work

I will endeavour to create your online counselling sessions that provides a supportive, non-judgmental environment, in which you will be given time and space to understand and gain insight into what is troubling you. This process can foster growth and lead to positive change in your life. I will not be able to offer advice in the course of my work. I may direct you to alternative agencies if you need further specialist support. There may be occasions where I ask questions about what you have stated on your application form or during a therapy session This is to help seek further clarity and understanding of your difficulty or to clarify an interpretation in our communication. You are free to ignore my questions and responses, or alternatively spend time between sessions exchanges reflecting on them.

 ‘Online’ counselling is different to face-to-face work as misunderstandings may occur due to a lack of usual facial expressions and tone of voice. It is therefore important for us both to feel comfortable to ask for clarification if we are unsure of something we say or refer to within our exchanges and leads to a misunderstanding or rupture in the counselling relationship occurring.  

Please answer the questions listed below with the returning agreement document. The information you provide helps to form the initial assessment of online counselling being suitable as support for you and the personal issues you would like to explore in counselling.


  1. Please provide brief details below regarding the issues you would like to explore in counselling:

I’m feeling overwhelmed with everything – work, kids, money worries, my marriage – there just seems to be too much on my plate and no hope of anything changing soon. I feel constantly on edge, I haven’t been sleeping well for months and I feel as though I’m failing in all areas of my life. I really don’t know how to get myself out of this dark place. I want to be the confident, happy person I was before.


  1. Have you received counselling, psychological, or crisis intervention support in the past, or are receiving such support currently? If so please provide brief details of the nature and outcome of the support received and also what you found helpful/unhelpful from the support?



  1. If you are currently taking medication for a mental health issue, please include details and dosage below:



  1. Do you have the support of a friend or family members if you needed to talk to someone about a personal matter which is troubling you if you became distressed during the process of counselling?



  1. Please let me know if you have any current thoughts about ending your life and whether you have at any time in the past had such thoughts or have acted upon them and, if so please, outline what support you sought at the time to overcome the suicidal thoughts?





Over the last 2 weeks how often have you been bothered by    any of the following problems?    not at all   several days  more than half the days  nearly every day

1. Feeling nervous, anxious or on edge                                      0           1             2            3

2. Not being able to stop or control worrying                           0           1            2           3

3. Worrying too much about different things                            0           1            2            3

4. Trouble relaxing                                                                         0           1            2            3

5. Being so restless that it is hard to sit still                             0            1            2            3

6. Becoming easily annoyed or irritable                                   0            1             2            3

7. Feeling afraid as if something awful might happen           0            1             2            3

           GAD-7 total score =                                                   




Over the last 2 weeks period) how often have you been bothered by any of the following problems?              not      at all        several days       more than half the days nearly every day

1.          Little interest or pleasure in doing things                 0            1            2            3

2.          Feeling down, depressed, or hopeless                        0            1            2            3

3.          Trouble falling or staying asleep, or sleeping too much

                                                                                                        0            1            2            3

4.          Feeling tired or having little energy                            0            1            2            3

5.          Poor appetite or overeating                                         0            1            2            3

6.          Feeling bad about yourself — or that you are a failure or have let yourself or your family down                                                                                  0            1            2            3

7.          Trouble concentrating on things, such as reading the newspaper or watching television                                                                                      0              1            2            3

8.          Moving or speaking so slowly that other people could have noticed?  Or the opposite — being    

             so fidgety or restless that you have been moving around a lot more than usual     

                                                                                                        0            1            2            3

9.          Thoughts that you would be better off dead or of hurting yourself in some way    

                                                                                                       0            1            2            3





Please complete the following information below and return the agreement to me as an attachment if you would like to proceed with online counselling:

Full name: 




Date of Birth: 


Emergency contact number ( in the event of technology breakdown which disrupts a counselling appointment):  

The details requested below, in respect of your GP, and home address are taken in order I need to ask your permission to secure additional support for you. The earlier question about serious self-harm also addresses safety, as I do need to gather this information to help assess if online counselling is suitable as support for the issues you would like to bring to your sessions.

GP Name and Address: 


Are you seeking online  counselling/supervision via  Email, IM (instant messenging), or  webcam?

Email and IM

Further requests



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