Free Therapist Training›EFT Couples Therapy Toolkit›Intake Form and Safety Screen
Last updated: November 11, 2026
A couples therapy intake form is a plan for the first sessions with a couple: what to ask both partners together, what to ask each partner alone, and how to decide whether joint therapy can safely go ahead. The template, written for emotionally focused couples therapy (EFCT), covers the first contact, the joint sessions, an individual session with each partner that includes a safety screen, the decision about joint work, and a joint feedback session.
A completed example for an invented couple follows the template. Both are part of the free EFT Couples Therapy Toolkit from the Sentio MFT program, which teaches EFCT among the therapy models in its curriculum.
These are some items to consider when you plan the first sessions with a couple and screen each partner for safety. Use what fits the couple and your setting. It is not an official form, just some helpful ideas from the Sentio MFT program.
Download the PDFMake an editable copy
1. First contact
- Who is coming, how they heard of you, and what they want help with, in a sentence or two.
- Explain the format: joint sessions first, then one session alone with each partner, then a joint session to agree on goals and a plan.
- Send the consent form and your policy on information shared in individual sessions before the first session.
- If the caller mentions violence or fear of a partner, ask whether it is safe to talk now and offer to see that partner alone first.
2. Joint sessions
| Topic | What to ask about |
|---|---|
| The problem | Each partner's view, in their own words; why now |
| Relationship history | How they met, the good times, when the distress began, major events |
| A recent fight, step by step | What set it off, what each partner did and felt, how it ended: the first look at the cycle |
| Strengths | What still works between them |
| Goals and commitment | What each wants from therapy; whether both are here to work on the relationship |
| Consent and the secrets policy | Who the client is, how information from individual sessions is handled, recordings, records |
3. Individual session with each partner: safety screen
Screen every couple, whatever brings them in. Ask each partner alone, never with the other partner present or able to overhear, including on video calls. Ask about specific behaviors rather than about "abuse" or "violence," and about both directions. A written, behaviorally specific questionnaire adds to the interview; most published screening questionnaires are copyrighted, so get one from its author or publisher. Have each partner fill it in alone, in a private setting.
| Area | What to ask about | Result |
|---|---|---|
| Physical violence | Ever, and in the past year: pushing, grabbing, slapping, hitting, kicking, choking or strangling, throwing things, use of a weapon; injuries; by either partner | |
| Threats and intimidation | Threats to hurt or kill the partner, the children, pets or themselves; breaking things; blocking a door | |
| Sexual coercion | Being forced or pressured into sexual contact | |
| Control | Monitoring the phone, money or whereabouts; controlling daily activities; limiting contact with friends or family; jealousy that restricts the partner | |
| Fear and voice | Is this partner afraid of the other? Can this partner say what they think in joint sessions without paying for it later? Does this partner want joint therapy, or feel pushed into it? | |
| Danger signs | Threats to kill; strangling or choking; a weapon used or threatened; a gun in the home; violence that is getting worse or more frequent; forced sex; violence during pregnancy; stalking; a recent or planned separation, especially from a controlling partner; constant, violent jealousy; threats of suicide by the partner who uses violence | |
| Affairs | A current or past affair, and whether the other partner knows | |
| Commitment | Whether this partner has decided to leave or is deciding whether to stay | |
| Substance use | Alcohol and drugs, and whether use gets in the way of daily life or the therapy | |
| Individual health | Depression, anxiety, trauma, suicidal thoughts, current treatment and medication | |
| Attachment history | Family of origin, earlier relationships, losses and trauma | |
| Anything else | Is there anything this partner wants you to know, or does not want shared with the other partner? Remind the partner of your secrets policy before the answer. |
4. Decision before joint work continues
| Finding | What to do |
|---|---|
| No violence, no fear, no control, and both partners freely choose joint therapy | Proceed with joint sessions; ask about safety at the start of each session |
| Either partner is afraid of the other, cannot speak freely in front of the other, or does not freely choose joint therapy | Individual treatment comes first or replaces joint sessions. Talk with the partner at risk, alone, about safety and next steps before anything is said in a joint session. |
| Violence that caused an injury needing medical care, severe violence, or controlling behavior | Do not begin or continue joint sessions. Make a safety plan with the partner at risk and refer to domestic violence services and individual treatment. |
| Danger signs, or either partner in imminent danger | Treat as urgent: safety planning the same day and referral to domestic violence services. A trained assessor can use the Danger Assessment (dangerassessment.org). |
| The partner who used violence denies responsibility for it | Joint EFCT cannot go forward; refer for individual or specialized treatment |
| A gun in the home, where there has been any violence, threat or fear | Treat it as a danger sign. Joint work waits until the partner at risk is safe and the gun is out of the home. |
| An ongoing affair the involved partner will not end or disclose | Follow your secrets policy; joint work is unlikely to help while the affair continues |
| One partner has decided to leave | Discuss whether joint sessions can help with separating, or refer each partner for individual support |
| Substance use or individual mental health that gets in the way | Refer for that treatment first or alongside joint work |
| Risk to self | Assess and plan for safety with that partner; individual care comes first |
Some specialized programs treat low-to-moderate situational violence, with no injuries and no fear, in joint sessions with added safety procedures such as a private check-in with each partner at every session.
5. Joint feedback session
- Describe the cycle back to the couple in words neither partner hears as blame.
- Agree on goals, the plan, the frequency of sessions and how progress will be checked.
- Confirm the consent form, the secrets policy and the safety agreements.
In the United States, the National Domestic Violence Hotline answers 24 hours a day at 1-800-799-7233, by text (send START to 88788) and by chat at thehotline.org. For a mental health crisis, call or text 988.
What Does a Completed Couples Therapy Intake Look Like?
Marcus and Lena are an invented couple. The example follows their intake from Marcus's first call to the joint feedback session, with what each partner said alone in the safety screen and the decision to go ahead with joint EFCT.
| Step | Example entry |
|---|---|
| First contact | Marcus called after a fight in which Lena said she did not know how much longer she could do this. Explained the format; sent the consent form and secrets policy. He did not mention violence or fear. |
| Joint sessions (1 and 2) | Marcus: "We're like roommates." Lena: "Nothing I do is enough." Together 12 years, married 10, two children; distance grew after Ruby's birth and Lena's move to night shifts. Reviewed a recent fight step by step: Marcus pursues with criticism, Lena goes quiet and leaves the room. Strengths: humor, co-parenting, both want the marriage. Reviewed consent and the secrets policy; both signed. |
| Lena alone (session 3) | Marcus raises his voice when upset and keeps following her to keep talking. Not afraid of him; never hurt or threatened; free to speak in joint sessions and wants them. No sexual coercion, no monitoring of phone or money. No affair. Wants to stay married. Rarely drinks. Poor sleep in night-shift weeks; no depression or suicidal thoughts. History: exacting, critical mother; learned to stay quiet and get things right. Nothing she wants kept from Marcus. |
| Marcus alone (session 4) | Once slammed a door during a fight last spring; nothing broken, no threats. No pushing, hitting or other physical aggression by either partner. No weapons in the home. No affair. Wants to stay married. Two or three beers on weekends. No mental health concerns or suicidal thoughts. History: parents divorced when he was 10; father called less and less. Raised the night of his mother's stroke as the moment he "learned I can't count on her." |
| Danger signs | None reported by either partner; no gun in the home |
| Decision | No contraindication to joint EFCT found. Proceed with joint sessions; safety question at the start of every session; either partner can call a 20-minute pause when a fight escalates and return to finish it; the therapist will meet either partner alone if anything changes. |
| Joint feedback (session 5) | Described the cycle back: "The more Marcus pushes to reach Lena, the more she shuts down to keep the peace, and the more she shuts down, the harder he pushes." Both agreed. Goals and plan agreed; weekly sessions; progress checked every six sessions. |
What Should a Couples Therapy Intake Include?
A couples therapy intake covers each partner's view of the problem, the history of the relationship, a recent fight traced step by step, the couple's strengths and goals, and consent, along with a safety screen done with each partner alone. It ends with a decision about whether joint therapy can go ahead and a joint session to agree on goals and a plan.
Screen every couple, whatever brings them in. Bograd and Mederos (1999, as cited in Todahl & Walters, 2011) urged therapists to screen everyone who seeks therapy for intimate partner violence (IPV), and Bradford (2010) recommends screening for all couples.
Screening continues after intake. In one couples program for IPV, the therapists meet briefly with each partner alone at the start and end of every joint session to check, in confidence, for increased risk or new violence, and the authors describe careful screening and ongoing monitoring as the basis for deciding whether joint therapy can proceed safely (Stith et al., 2012).
Why Screen Each Partner Alone?
Each partner needs a chance to report violence, fear and control without the other partner listening. Guidelines call for screening all couples through individual interviews with both partners and through more than one method, such as a written questionnaire and a verbal interview (Stith et al., 2012).
McCollum and Stith (2008) recommend assessing each partner individually, with screening tools that let each one report fully on violence used or experienced. They also hold that when either partner is afraid of the other, or worried about speaking freely in front of the other, individual treatment should come before, or replace, joint treatment. Whether a partner can speak freely is a question to ask when the other partner is out of the room.
Both practices are less common than the guidelines call for. In a survey of couple therapists, only 37.2 percent of those who screened always interviewed partners separately; 78.9 percent used no written self-report instrument, and of those who did, only 7.5 percent used a standardized, behaviorally specific questionnaire designed to measure violence (Schacht et al., 2009, as cited in Stith et al., 2012).
When Is Joint Couples Therapy Not the Right Choice?
Joint sessions should not begin, or should stop, when either partner is afraid of the other, when violence has been severe or has caused injury, when one partner controls the other, when anyone is in imminent danger, or when the partner who used violence denies responsibility for it. In those cases individual treatment and safety planning come first.
McCollum and Stith (2008) put individual treatment first whenever either partner is afraid of the other or cannot speak freely, and their program excludes couples when either partner has used severe violence that needed medical care, or when the couple will not remove handguns from immediate access. Stith et al. (2012) report that most current programs exclude highly violent couples and couples in which intimate terrorism is occurring, and that one program offers joint therapy only when the violence is low to moderate and neither partner is in imminent danger.
Johnson and colleagues wrote that EFCT is not recommended for couples in which abuse is ongoing (Johnson et al., 1999). The partner who used violence needs to take responsibility for it before couple treatment starts (Bograd & Mederos, 1999, as cited in Vall et al., 2018), and no client should feel coerced into joint treatment (McCollum & Stith, 2008). One EFCT practitioner lists ongoing affairs and serious substance abuse among signs of potential contraindications for treatment (Simakhodskaya, 2018); treat either as a possible reason to delay or adapt joint work.
Some couples with a history of violence can be seen together. A systematic review and meta-analysis of six studies concluded that preliminary data suggest couples therapy is a viable treatment for IPV in select situations; the authors note that some studies indicate couples with situational violence may benefit (Karakurt et al., 2016). Slootmaeckers and Migerode (2020) describe EFCT with situational couple violence, illustrated by a Stage 1 case of de-escalation. The evidence base is small.
What If a Partner Discloses Violence?
Safety comes before the couples work. Talk with that partner alone about safety and next steps, do not raise the disclosure in a joint session without that partner's agreement, and refer to domestic violence services and individual treatment. Give the partner the National Domestic Violence Hotline, which answers by phone, text and chat, free and around the clock, and for risk of suicide, the 988 Suicide and Crisis Lifeline.
What a partner tells you alone is that partner's confidence. The AAMFT Code of Ethics bars revealing one person's confidences to others in the client unit without that person's prior written permission (American Association for Marriage and Family Therapy [AAMFT], 2026, Standard 2.2), and the Stith group holds its safety check-ins separately so that each partner can report risk in confidence (Stith et al., 2012). For other information from individual sessions, follow the policy the couple signed; the consent and secrets policy template sets out three options.
Some answers call for urgent action. The abusive partner's access to a gun, earlier threats with a weapon, strangulation, forced sex, stalking, abuse during pregnancy and separation from a controlling partner are linked to a higher risk that a woman will be killed by her partner (Campbell et al., 2003; Glass et al., 2008). Any of these calls for a full risk assessment and safety planning in place of joint sessions. The Danger Assessment, a validated lethality risk instrument (Campbell et al., 2009), is free to download, but its weighted scoring and interpretation require certification training.
Practice next
Rehearse asking the safety questions plainly and calmly, with a peer playing each partner in turn, until you can ask about choking, threats and fear in the same even voice you use for sleep and alcohol. The free Deliberate Practice in EFCT webinar, in which Sam Jinich and Hanna Levenson demonstrate EFCT skills to rehearse with a peer or a supervisor, shows how this kind of rehearsal works. For explaining the assessment format to a couple, the closest exercise in the APA book Deliberate Practice in Emotionally Focused Couple Therapy is Exercise 7, Providing a Rationale for Emotionally Focused Couple Therapy (Levenson et al., 2025). Supervisors who want to build this rehearsal into supervision can bring it to the DP Consultation Group.
Keep reading
Couples Therapy Informed Consent and No-Secrets Policy, a consent form template with three policies for information from individual sessions and notes on California rules
EFT Case Conceptualization, a template and completed example that link the couple's cycle to the attachment fears and needs underneath it
EFT Negative Cycle Worksheet, a map of each partner's side of the negative cycle, with a version the couple fills in between sessions
Free EFT Couples Therapy Toolkit, every template in the series, from intake to supervision
Frequently Asked Questions
Should I screen for domestic violence in couples therapy?
Yes, with every couple, whatever brings them in. Bradford (2010) recommends screening for all couples, and Stith et al. (2012) describe the general guidelines as screening all couples through individual interviews with both partners. Keep checking after intake, since careful screening and ongoing monitoring are the basis for deciding whether joint therapy can proceed safely.
Can I use a questionnaire for the screen?
Yes, alongside a private interview with each partner, since guidelines call for both written questionnaires and verbal interviews (Stith et al., 2012). Several published screens, including the Revised Conflict Tactics Scales (CTS2), HITS, the Woman Abuse Screening Tool (WAST) and the Partner Violence Screen, are copyrighted, so use them only with the copyright holder's permission. The Danger Assessment, a lethality risk instrument, is free to download, but its scoring requires certification training.
What if one partner does not want to meet with me alone?
Explain that you meet alone with each partner as a routine part of assessing every couple and that you ask both partners the same questions, so neither is singled out. Guidelines call for screening all couples through individual interviews with both partners (Stith et al., 2012). Hold the decision about joint therapy until you have met with each partner alone.
Can EFCT help couples when there has been violence?
Sometimes. A meta-analysis of six studies found preliminary support for couples therapy for intimate partner violence in select situations (Karakurt et al., 2016), and Slootmaeckers and Migerode (2020) describe EFCT with situational couple violence. Most programs that offer joint treatment exclude highly violent couples and couples in which intimate terrorism is occurring, and one accepts couples only when the violence is low to moderate and neither partner is in imminent danger (Stith et al., 2012).
What if a partner has decided to leave?
Ask about commitment with each partner alone. If one partner has decided to leave, discuss with the couple whether joint sessions can help them separate, or refer each partner for individual support. Joint therapy should be something both partners choose freely (McCollum & Stith, 2008).
References
American Association for Marriage and Family Therapy. (2026). AAMFT code of ethics. https://www.aamft.org/common/Uploaded%20files/Legal%20Ethics/AAMFT%20Code%20of%20Ethics.pdf
Bradford, K. (2010). Screening couples for intimate partner violence. Journal of Family Psychotherapy, 21(1), 76–82. https://doi.org/10.1080/08975351003618650
Campbell, J. C., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, M. A., Gary, F., Glass, N., McFarlane, J., Sachs, C., Sharps, P., Ulrich, Y., Wilt, S. A., Manganello, J., Xu, X., Schollenberger, J., Frye, V., & Laughon, K. (2003). Risk factors for femicide in abusive relationships: Results from a multisite case control study. American Journal of Public Health, 93(7), 1089–1097. https://doi.org/10.2105/AJPH.93.7.1089
Campbell, J. C., Webster, D. W., & Glass, N. (2009). The Danger Assessment: Validation of a lethality risk assessment instrument for intimate partner femicide. Journal of Interpersonal Violence, 24(4), 653–674. https://doi.org/10.1177/0886260508317180
Glass, N., Laughon, K., Campbell, J., Block, C. R., Hanson, G., Sharps, P. W., & Taliaferro, E. (2008). Non-fatal strangulation is an important risk factor for homicide of women. The Journal of Emergency Medicine, 35(3), 329–335. https://doi.org/10.1016/j.jemermed.2007.02.065
Johnson, S. M., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6(1), 67–79. https://doi.org/10.1093/clipsy.6.1.67
Karakurt, G., Whiting, K., van Esch, C., Bolen, S. D., & Calabrese, J. R. (2016). Couples therapy for intimate partner violence: A systematic review and meta-analysis. Journal of Marital and Family Therapy, 42(4), 567–583. https://doi.org/10.1111/jmft.12178
Levenson, H., Jinich, S., Vaz, A., & Rousmaniere, T. (2025). Deliberate practice in emotionally focused couple therapy. American Psychological Association. ISBN 978-1-4338-4296-2. https://doi.org/10.1037/0000436-000
McCollum, E. E., & Stith, S. M. (2008). Couples treatment for interpersonal violence: A review of outcome research literature and current clinical practices. Violence and Victims, 23(2), 187–201. https://doi.org/10.1891/0886-6708.23.2.187
National Domestic Violence Hotline. (n.d.). Get help. https://www.thehotline.org/get-help/
988 Suicide & Crisis Lifeline. (n.d.). 988 Suicide & Crisis Lifeline. https://988lifeline.org/
Simakhodskaya, Z. (2018). The moment of meeting: First EFT session. The EFT Community News (Special Issue 2018), 4–5. International Centre for Excellence in Emotionally Focused Therapy. https://iceeft.com/wp-content/uploads/2018/11/SpecialIssue2018.pdf
Slootmaeckers, J., & Migerode, L. (2020). EFT and intimate partner violence: A roadmap to de-escalating violent patterns. Family Process, 59(2), 328–345. https://doi.org/10.1111/famp.12468
Stith, S. M., McCollum, E. E., Amanor-Boadu, Y., & Smith, D. (2012). Systemic perspectives on intimate partner violence treatment. Journal of Marital and Family Therapy, 38(1), 220–240. https://doi.org/10.1111/j.1752-0606.2011.00245.x
Todahl, J., & Walters, E. (2011). Universal screening for intimate partner violence: A systematic review. Journal of Marital and Family Therapy, 37(3), 355–369. https://doi.org/10.1111/j.1752-0606.2009.00179.x
Vall, B., Päivinen, H., & Holma, J. (2018). Results of the Jyväskylä research project on couple therapy for intimate partner violence: Topics and strategies in successful therapy processes. Journal of Family Therapy, 40(1), 63–82. https://doi.org/10.1111/1467-6427.12170
