What Is a Diagnostic Assessment? What to Expect at Your Intake Appointment for Holistic Mental Health Care
- 3 hours ago
- 5 min read
If you are starting therapy, you may be wondering, " What is a diagnostic assessment, and what actually happens in that first appointment.
At MindBalance Mental Health Care, your intake appointment is a 60-minute session designed to begin getting to know you. It is a starting point. It is not the whole story of who you are.
This first appointment is sometimes called an intake, a first appointment, or a diagnostic assessment. The language often depends on whether you are using insurance and how services are billed.
Let’s review what it means and what you can expect.
What Is a Diagnostic Assessment?
A diagnostic assessment is a 60-minute appointment focused on:
• Understanding your presenting concerns
• Learning about your history and lived experiences
• Identifying initial goals for therapy
• Determining next steps together
If you are planning to use insurance, this appointment is also when your therapist assesses whether your concerns meet the criteria for a mental health diagnosis.
Mental health diagnoses are based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, commonly referred to as the DSM 5 TR. This is the diagnostic guidebook used by mental health professionals across the United States. It outlines specific symptom patterns, duration requirements, and levels of impairment that must be present for a diagnosis.
In other words, your therapist is listening carefully for patterns of symptoms, how long they have been present, and how they are affecting different areas of your life.
How Insurance Shapes the Diagnostic Assessment
If you are using insurance, your coverage is tied to what is called medical necessity. Insurance companies typically cover therapy services only when a person has a medical condition that meets diagnostic criteria and causes meaningful impairment in daily functioning.
Medical necessity generally looks at:
• Symptoms you are experiencing
• How those symptoms are affecting work, school, relationships, or daily life
• Whether those symptoms meet DSM 5 TR criteria for a mental health diagnosis
We discuss this further in our blog post, "Does Health Insurance Cover Therapy?", which explains how insurance and therapy intersect.
When therapy is billed to insurance, it becomes part of a larger medical system. This system can provide access to care. It can also feel limiting and reductionistic. We believe it is important to name both truths.
Diagnosis can be helpful. It can offer language for your experience. It can validate what you have been feeling. It can open doors to services, accommodations, medication support, or other resources.
Diagnosis can also feel pathologizing. Labels can feel heavy. They can carry stigma. They can miss context, culture, trauma, and systemic oppression.
As Dr. Jennifer Mullan writes in Decolonizing Therapy, “the DSM is inherently political and provides symptom lists without context, which can create division and pathologize difference.” (p. 164) Dr. Mullan also reminds us that “diagnosis can be a transient, fluid, short-term tool and not something meant to permanently define a person.” (p. 164)
We hold this tension intentionally. We recognize the power a diagnosis holds. We approach assessment with care, humility, and transparency.
What Happens Before Your Intake Appointment
Prior to your intake, you will receive paperwork in your client portal. This includes consent forms, policies, a history form, and screening questionnaires.
All paperwork must be completed at least 24 hours before your scheduled appointment. If all the paperwork is not completed, we will contact you to reschedule your appointment so you have time to complete it. The initial paperwork will take about 30-40 minutes to complete.
This allows our team to:
• Process your forms
• Verify insurance and benefits
• Address any billing questions ahead of time
• Give your therapist time to review your history and screeners
Your history form is an opportunity to share about your life, background, identity, stressors, strengths, and current concerns. Some of the questions may feel personal or even invasive. We understand that.
You are invited to share what feels safe and possible in this first session. You can always let your therapist know what you would prefer to discuss later.
What We Talk About During Your 60-Minute Diagnostic Assessment for Holistic Mental Health Care
The intake is a conversation. It is structured but also relational.
As part of the diagnostic assessment process for starting holistic mental health care. Your therapist will review your history, ask clarifying questions, and explore:
• What brings you to therapy now
• How long have your concerns been present
• How your emotions, thoughts, and behaviors are impacting your life
• Your support systems and coping strategies
• Your cultural, family, and social context
Part of the appointment also includes reviewing:
• Your therapist’s responsibilities as a mandated reporter
• Confidentiality and its limits
• Risks and benefits of therapy
Therapy can be meaningful and transformative. It can also be difficult. There are times when things may feel worse before they feel better. Outcomes are not guaranteed. We will collaborate with you and adjust if something is not working. If your goals are not being met, we will talk openly about other options and supports.
Clarifying Your Goals
An important part of holistic mental health care is identifying what you want to shift.
Goals are not just about diagnosis. They are about your lived experience.
You might ask yourself:
• What do I want to feel less of
• What do I want to feel more of
• How do I want my thinking to change
• What behaviors do I want to see differently
• What would tell me I am ready to graduate from therapy
For some, goals include:
• Feeling less anxious, sad, angry, or on edge
• Reducing intrusive or negative thoughts
• Sleeping more consistently
• Improving communication in relationships
• Reducing conflict at work or home
• Learning coping skills
• Getting connected to additional supports such as ADHD or autism evaluations, dietitians, or medication providers
Insurance language often focuses on symptom reduction and functional improvement. We care about those shifts too. And we also care about meaning, identity, empowerment, and alignment with your values.
Holistic mental health means we look at the whole person, not just a checklist of symptoms.
Think of It as the Trailer, Not the Whole Movie
We know we cannot fully understand a person in 60-minutes.
Think of the intake as the trailer. It is a big picture overview of the highlights that feel most important for your therapist to understand right now.
At the end of the appointment, you and your therapist will decide together whether to move forward and schedule your next therapy appointment. They may share initial impressions, discuss a possible diagnosis if using insurance, and suggest next steps.
If you continue, ongoing therapy sessions are typically 45 to 50 minutes. These appointments are more collaborative and focused on the work itself. You will not have to complete the same paperwork again. Instead, you begin building rhythm and partnership with your therapist.
Some people prefer structured sessions with specific tools and strategies. Others want more open processing space. Over time, you and your therapist will shape the approach together.
Ready to Take the Next Step?
If you are considering therapy, we invite you to start with a consultation appointment. During this brief call, you can ask questions and determine whether our approach feels like a good fit.
You may also find it helpful to read:
When you are ready, you can schedule your initial consultation through our website. We are honored to collaborate with you as you consider what support and healing might look like for you.
Educational Disclaimer
The information shared in this blog is for educational and informational purposes only and reflects our perspectives and understanding at the time of writing. It is not intended as medical, mental health, legal, or insurance advice, and should not be relied on as such. Reading this content does not create a therapeutic or professional relationship. For guidance specific to your situation, we encourage you to consult with a qualified professional.