A mental health assessment is usually the first stop in therapy.  A mental health assessment includes collecting information from the client on family history, drug and alcohol history, current mental status including a suicide risk assessment, medical history including current medications, trauma history, prior mental health treatment, and an assessment of the clients strengths and resources.  The assessment culminates in a diagnosis, prognosis and treatment plan that will guide the therapy sessions.  Most insurance companies will require an assessment as this helps justify their expenditure for treatment.  Clients who pay out of pocket for their services may be less interested in an assessment preferring instead to simply create a treatment plan in that first session  and begin counseling.