Hey Jesse,
I agree that the 2-COM tool could be well utilized with a client who is less engaged in a session, whether that be from anxiety, negative symptoms, or perhaps active psychotic symptoms. I can see this tool being especially helpful to give to the client prior to our session (or as you said, for them to take home with them to complete prior to their next appointment) and it can be used to set a guideline for what to structure the next session about. I think it could also be helpful in engaging the more introverted client who might feel more comfortable writing about their topics of concern/feelings than they are talking about them. The only potential downside to this tool that I experienced was that it felt very clinical and less conducive to building the therapeutic relationship with the client, although I think this could be mitigated by having the client fill it out prior to the appointment and then using the tool as a jumping off point for the more therapeutic engagement part of the session.