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Psychotherapy assessment checklist

Psychotherapy assessment checklist 2026

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The document is a comprehensive psychotherapy assessment checklist designed to gather personal data, medical history, current problems, and self-reported functioning of individuals seeking therapy. It includes sections for identifying major issues, rating their severity, detailing medical conditions, assessing daily and lifelong functioning, and evaluating mental health symptoms based on DSM-IV criteria. The checklist aims to facilitate the therapeutic process by providing therapists with essential information about the client's background and current challenges.

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Click ‘Get Form’ to open the psychotherapy assessment checklist in the editor.
Begin by filling out the 'Personal Data' section. Enter your name, date, address, age, and other relevant personal information. This helps establish your identity and context for therapy.
In the 'Main Problems' section, list the major issues you wish to address in therapy. Use the provided scale to rate their severity from 1 (not a problem) to 10 (couldn't be worse). This will guide your therapist in understanding your priorities.
Proceed to the 'Medical Problems' section. Indicate any serious medical conditions and medications you are currently taking. This information is crucial for your therapist's awareness of any health factors that may affect your treatment.
Continue through sections on current stressful events and daily functioning. Provide honest responses as they contribute significantly to your overall assessment.
Finally, review all entries for accuracy before saving or sharing the completed form with your therapist directly through our platform.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a risk assessment in psychotherapy?

Traditionally, risk assessment involves asking a person about suicidal thoughts, their frequency and intensity, and the intent, plan, and access to means to act on these thoughts [21].

What are the 5 main goals of psychotherapy?

The five major goals of the counseling process include facilitating behavioral change, enhancing the ability to form and maintain relationships, improving coping skills, promoting decision-making and personal potential, and supporting personal development.

What is a PAC evaluation?

PAC usually precedes the delivery of anesthesia for surgical and nonsurgical procedures. [1] The primary purpose of this endeavor is to assess known and diagnose unknown co-morbidities which directly or indirectly affect the perioperative management of the patients.

What assessment tool is used for mental health?

This wellbeing assessment uses the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) to measure wellbeing. Good mental wellbeing is about feeling good and functioning well. You may find that your mood goes both up and down so use this tool to monitor it over time.

What is a psychotherapy assessment?

A clinical assessment conducted by a psychotherapist is a comprehensive process designed to gather information about an individuals psychological, emotional, and mental health.

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What is a PAC in mental health?

DRCs PAIMI Advisory Council (PAC) advises our board and staff about issues in the mental health community.

What is the difference between a psych evaluation and a mental health evaluation?

Focus: A psychiatric evaluation focuses more on the medical aspects of mental health, such as diagnosing and treating psychiatric disorders with medication. On the other hand, a psychological evaluation focuses on understanding your thoughts, emotions, and behaviors, often without medication.

What is a PAC evaluation for mental health?

The Psychopathology in Autism Checklist (PAC) contains 30 items representing symptoms previously evaluated as specific to one of four major psychiatric disorders (psychosis, depression, anxiety and OCD) and not related to autism. Twelve items evaluated as indicators of general adjustment problems are also included.