For Clinicians: The Life Cycle of the Client Relationship

A note about what follows: There are a thousand ways to view the therapist/client relationship. Almost none of them are wrong. These views are usually informed by your theoretical orientation and your experiences. This might be helpful if you don’t have a way to view that relationship. I’m not trying to pry your fingers away from your way. Also, almost everything I’ve learned in this field has been from errors I have made rather than a careful study of the literature, so keep that in mind as you read.

I’m writing primarily to newish clinicians (interns and clinicians under supervision). If you’ve been doing this a while, you’re probably already awesome at what you do.

I’ve been thinking about this concept for a while. I’m pretty active with our internship program at our practice, so I get to see the beginnings of things. Internship can traditionally be about learning, fear, uncertainty, hope, discovery. There are three things I’ve seen that are most common among interns: 1) They document sessions as if the note is going to be published. 2) They rush to find the magic bullet that will set the client on the path to wellness. 3) They are eager to try out their new techniques.

I’m sure we all did these things in the beginning. However, if you’ve been in the field for a while, you don’t do that now. Likely because you found out it doesn’t work like that. But how does it work? Either nobody told me, or I wasn’t paying attention. Likely the latter, but I thought I might write about the lifecycle of the client relationship. And Erik Erickson’s Developmental Stages seem to fit nicely here.

So here’s the thought: Everything has a life cycle. People, relationships, plants, solar systems, etc. Mr. Erikson’s stages are known to “map” out the progress of a person throughout their life cycle. He also makes the point that each stage must be dealt with before moving on to the next stage for optimal development to occur. That’s what makes it a developmental model. One stage builds on the next.

So what about the life cycle of the client relationship? The client relationship has a beginning and an end. I wondered if there might be developmental stages along the way? And if we can understand the client relationship in this way, maybe it will help us meet the client where they are and not rush the process. It might also help us know what to work on and when.

Let’s take a look at that through the lens of Erikson’s stages. I’ll begin with Erikson’s stages and a brief description, followed by what that might look like in a clinical space with you and your client.

Trust vs. Mistrust (Infancy, 0-1 year): During this stage, infants learn to trust their caregivers to meet their basic needs. If caregivers are responsive and consistent, the infant develops a sense of trust. If caregivers are neglectful or inconsistent, the infant may develop mistrust.

The Client’s First Stage: The beginning of every therapeutic relationship has to resolve this tension first. The client can trust you; you know that. But the client doesn’t trust you. Well, the client shouldn’t trust you. Who trusts a stranger? So the beginning of the therapeutic alliance is about communicating to the client what you know is already true. You can be trusted. Trusted with what? Their time. Their secrets. Their PHI. Their shame. Their fears.

Clinicians that rush through this stage end up with “resistant” clients. In fact, as I look back at the multitude of clinical mistakes I’ve made, I wonder if every client that I had previously thought of as resistant was due to me not taking them through this stage first?

Gaining trust is about communicating your advocacy. The early question the client has, actually two questions (and they’ll likely not be asked out loud): 1. Can you help me? 2. Would you like to help me?

Over the years, my greatest struggle in this area has been with adolescent clients. My steepest hill and my most satisfying summit. You can’t bullshit them. You’re likely two or three degrees removed from them, and you represent a group of people that likely haven’t had their best interest at heart. But you have to earn their trust as much (if not more so) than your adult clients.

Kind of off topic, but I wonder how good you are at earning the trust of an animal you just met? And I wonder if that skill is transferable to humans? I think animals and adolescents have good instincts.

Autonomy vs. Shame and Doubt (Early Childhood, 1-3 years): Children begin to assert their independence by exploring their environment and making choices. If caregivers encourage this exploration and provide support, children develop a sense of autonomy. However, if caregivers are overly restrictive or critical, children may develop feelings of shame and doubt.

The Client’s Second Stage: Thinking about the client relationship, Erikson’s second stage really nails this. Once the client trusts you, the relationship can move toward a working stage. If the clinician can balance support and encourage the client to explore freely, the client begins to sense the autonomy of the relationship. Clinical autonomy can mean the client has both the freedom and the resources to chart their path. In many cases, the opposite of autonomy is dependence. Autonomy can only flourish in an atmosphere of trust. And the result of autonomy is progress.

Take a minute and think about when you learned to ride a bike. Who was there? How did it go? Were there training wheels involved? Before you knew how to ride a bike, just looking at a two wheeled contraption didn’t make sense. And then it did. But only if the person teaching you had a good balance between support and encouraging autonomy.

Side note: In your career you’ll have some clients tell you they need you. If you ever start to believe that, or enjoy that, talk to someone.

Initiative vs. Guilt (Preschool, 3-6 years): Children start to take initiative in activities and play. If encouraged, they develop a sense of purpose and initiative. However, if their efforts are criticized or controlled excessively, they may develop feelings of guilt.

The Client’s Third Stage: Once a client has trust, they’ll start to take initiatives toward meeting their goals. If they trust you, they’ll tell you what they really want; what they’re really afraid of. Once they have autonomy, they will (with your assistance) develop goals that are their own. They won’t be your goals. They will have a sense of ownership of their own goals. And once those two things are in place, you’ll see movement. Change. A client can appear tentative for all kinds of reasons, but shame and doubt probably lead the list.

Back to the bike analogy. If you’ve ever taught someone to ride a bike, when they finally take off, all wobbly like, you’re eventually standing still (after you jog along side for a minute). But when you are still, your eyes never leave the rider. Not at first. You offer encouragement and gentle correction and more encouragement. During this stage of the client life cycle, they’re moving, even if it is a little shaky at first.

Industry vs. Inferiority (School Age, 6-11 years): Children begin to develop a sense of competence by mastering new skills and tasks. Success in this stage leads to a feeling of industry, while failure or lack of encouragement may result in feelings of inferiority.

The Client’s Fourth Stage: This is a fun stage for the clinician (and the client). They begin to master their new skills. They develop nuance in the tools you introduced: “I tried this, but it didn’t work so well, so I tried this other way and I liked it more.” Symptom reduction shows up here. At this stage, if the client is feeling inferior, the clinician might want to look at the lack of encouragement as a cause.

Another side note: I guess it’s human nature, but clinicians are the worst at taking responsibility when things go off course. If a client isn’t engaged we call them resistant. If a client drops out, we tell ourselves they just weren’t ready. If they are slow to change we point to anything and everything except ourselves as a possible barrier. So I want you to hear two things about this: 1) If you’re providing clinical care, you’re messing up somewhere. 2) It’s OK, nobody’s going to take away your birthday. This doesn’t make you a failure. You’re not a bad person. You’re doing some things right and some things wrong. If you don’t know what you’re doing wrong, then you can add not knowing to your list.

Identity vs. Role Confusion (Adolescence, 12-18 years): Adolescents explore and develop a sense of self and identity. This involves figuring out one's values, beliefs, and goals. Successful resolution leads to a strong sense of identity, while failure to do so may result in role confusion and identity crisis.

The Client’s Fifth Stage: For many clients, the life cycle of therapy ends on the fourth stage. They can ride a bike without training wheels and without you jogging behind them. But if you have done an exceptional job at joining with the client, they just might stick around for this fifth stage.

This stage is less urgent. There are fewer bandages. Their hair isn’t on fire anymore. They are experience a resolution to what brought them to therapy in the first place. Sometimes, the client will then ask, “What’s next?” They realize they might have other things they would like to work on in therapy. They realize they might have some maladaptive relational patterns rooted in the past they want to examine and adjust. They might want to unlock the dark room they’ve kept hidden all these years. They might want to start to figure out who they really are.

Most people, and therefore most clients, do not have a fully intact sense of self. That takes a lot of intentional work. And in our time and our society, this work simply has a small price tag. Except among those who have done it. To those few, this pursuit is priceless. As a clinician, I hope you have done this work. I came late to it and wish I had tackled it much earlier.


Intimacy vs. Isolation (Young Adulthood, 19-40 years): Young adults seek intimate relationships and form close bonds with others. Successful navigation of this stage results in the development of meaningful relationships, while failure may lead to feelings of isolation and loneliness.

The Client’s Sixth Stage: While you’re working through the deeper waters with your client, if this work is supported and encouraged, a real intimacy begins to develop. We need fewer words here. Even a look can communicate a paragraph. There’s a connectedness that exists between the two of you. A client might be going through something during the week, and when they tell you about it they might say something like: “I heard you in my head saying…” This is intimacy. We usually use this phrase for couples, but you’ll find yourselves being able to finish each other’s sentences. Not that you would, but you could.

From time to time I’ll get a text or email from an old client. Sometimes they say something like, “I’m not sure if you remember me, but…” When I get that line, I know I didn’t do my best work in this stage. Other times I’ll be doing an intake and I’ll ask about their previous therapists. I can tell if they got t this stage by the way they describe their experience.

I had a client years ago, and during one of our sessions (on the first of May) the client mentioned James Taylor. I told them that James tells the story of his father, who always said on May 1st, “Hurray, hurray, the first of May. Outdoor fucking begins today!” Every May 1st since then I’ve gotten a text from my client reminding me of that “holiday.” It shouldn’t surprise you that we did some good work together.

Generativity vs. Stagnation (Middle Adulthood, 40-65 years): Adults focus on contributing to society and future generations, whether through work, parenthood, or community involvement. Those who succeed feel a sense of accomplishment and generativity, while those who do not may experience stagnation and a lack of purpose.

The Client’s Seventh Stage: This stage of the client life cycle can be really exciting. The client finally takes a break from their focus on themselves. They begin working on how they relate to the world around them. If the client is other focused in the beginning of therapy, we’d identify that as deflection. But here, it can be magical. How can they be a better spouse, citizen, neighbor? How can they make a difference in the world around them? This exploration can be a blast for both parties.

Integrity vs. Despair (Late Adulthood, 65+ years): Older adults reflect on their lives and experiences. If they feel a sense of fulfillment and acceptance of their life's accomplishments, they develop integrity and wisdom. However, if they dwell on regrets and unfulfilled goals, they may experience despair and bitterness.

The Client’s Eight Stage: I bet you know what we call this stage, but I’ll also bet you might not know how to do it. Termination is more than a brief note in their chart. Reflection is critical in the process and should take 2-3 sessions. But we don’t need to name it right away. When we sense the work is coming to a close, spending a little time in each session reflecting on their journey will prepare them for termination. Reflection, when there has been progress, is empowering. Be careful here to point out the work was done by the client. Also, and this is just modeling healthy communication, when the client thanks you for your hard work or they tell you that you are a great therapist, try this response: “Thank you. That means a lot to me.” If you get here, you did do some good work. You are a great therapist. Please don’t respond with: “You did all the work.” First, that’s a lie. Second, if that’s true, then the client wasted a lot of time and money while you munched on a bag of popcorn during their transformation.

Wrapping up:

Think about your current clients. Ask yourself a couple of questions:

What stage are they in?

What do we need to work on to get to the next stage?

Think about your former clients. Ask yourself a couple of questions:

What stage were they in when they left?

What could you have done better or different to keep them through the transition?

As I write this, I’m currently in Erikson’s Seventh Stage of my life. Maybe my view of the client’s life cycle has been impacted because I’ve been through most of these. I’ve also been through them all as a client. I’m grateful to the clinicians that took the time to guide me through with patience and insight. Those are the ones I remember the most.