As a new clinician, it can be helpful to understand that therapy is often (but not always) a process that unfolds in stages. While every client’s journey is unique, having a general sense of these stages can give you a roadmap to follow. It’s important to remember that these stages are fluid, and you may move back and forth between them depending on the client’s needs. As a clinical supervisor, I’ve worked with many therapist trainees, and I know how helpful it can be to have a guide to structure your sessions. Let’s walk through the general stages of therapy and what you can expect.
1. Rapport Building
Before any therapeutic work can truly begin, it’s essential to establish rapport with your client. As I mentioned in a previous post, the first few sessions are all about building trust and creating a safe space for your client to open up. Without this foundation, the client may struggle to fully engage in the therapeutic process.
Take the time to get to know your client as a person, beyond their presenting problem. Show empathy, validate their feelings, and allow space for them to express any initial anxieties they may have about therapy. It’s not uncommon for clients to be hesitant at first, and it’s your job to make them feel comfortable enough to explore deeper issues.
This stage has no end, but you can expect typically at least a few sessions before the client starts to get comfortable. If you are working with teens/kids, you might play games and ask get-to-know-you questions. With adults, it may look a bit more like asking about their past.
2. Psychoeducation
Once you’ve established rapport, the next stage often involves providing psychoeducation. This means helping the client understand what they’re experiencing, whether it’s related to anxiety, depression, trauma, or other mental health concerns. Clients may not always have a clear understanding of their symptoms, so explaining the psychological or biological factors at play can be incredibly empowering for them.
Psychoeducation also involves explaining therapeutic approaches you may use, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or mindfulness strategies. By helping the client understand the "why" behind the work you’re doing together, you can increase their engagement and sense of agency in the process.
This is a step that some therapists skip, and I have seen how that leads to poor maintenance of progress. So please know it is important!
3. Skill Building
Once the client has a better understanding of their symptoms and what might be contributing to their distress, the next stage often involves skill building. This is where you can begin to introduce specific coping strategies and tools that the client can use in their daily life to manage their symptoms more effectively.
For example, if you’re working with a client who has anxiety, you might teach them grounding techniques, breathing exercises, or cognitive restructuring to help them challenge irrational thoughts. If the client is struggling with emotional regulation, you might introduce mindfulness practices or distress tolerance skills.
The key during this stage is to provide practical tools that align with the client’s needs and goals, and to give them Instructions to practice these skills both in and out of sessions. Importantly, you may want to talk through why these skills are helpful. It is a bit of a tight-rope walk to explain the importance of skills without oversimplifying and making your client feel that skills will solve all their problems. That is, many a client has been turned away from therapy because their therapist said over and over "just take deep breaths when you're nervous."
4. Processing Emotions and Thoughts
As the client becomes more comfortable and gains new coping skills, you can move into deeper emotional work. This stage is often about helping the client process difficult emotions, unhelpful thought patterns, or traumatic experiences that may be contributing to their current challenges.
This stage may take time, as some clients may need to build up trust before they feel safe enough to explore painful memories or feelings. When clients are ready, this is where you help them gain insight into how their past has shaped their present and work with them to reframe unhelpful beliefs.
While this stage can be challenging, it’s often where the most profound healing takes place. Having coping skills at the ready helps clients not practice getting distressed when talking about triggering topics. Be patient and compassionate, and encourage the client to take things at their own pace.
5. Review and Consolidation
As therapy progresses, it’s important to regularly review the client’s progress. This stage is about helping the client consolidate what they’ve learned and reinforcing the positive changes they’ve made. It’s also a time to assess whether their initial goals have been met and to discuss next steps.
Sometimes, clients may be ready to reduce the frequency of sessions or even terminate therapy altogether. Other times, they may need additional support or new goals to work toward. This is a collaborative process, and it’s important to check in with the client regularly to ensure they feel satisfied with the direction of therapy.
Ongoing Assessment: Always Stay Curious
Throughout every stage of therapy, one of your most important roles as a therapist is to continually assess your client’s symptoms, progress, and underlying issues. Therapy is not a linear process, and clients’ needs can change over time. This is why ongoing assessment is crucial.
You should be regularly asking yourself:
"Are the interventions we’re using still effective?"
"Is the client’s mood or behavior shifting?"
"Are there any underlying issues that haven’t been addressed yet?"
This also means assessing for risk factors, such as suicidality, self-harm, or worsening symptoms. Regularly checking in on the client’s overall well-being ensures that you are providing the appropriate level of care.
In addition to formal assessments, don’t underestimate the power of simply asking the client how they feel therapy is going. Their feedback can be invaluable in shaping the course of treatment.
Final Thoughts:
Therapy often unfolds in stages, from building rapport to skill development and deeper emotional processing. But no matter what stage you’re in, remember to always assess your client’s progress and stay attuned to their needs. As a new clinician, having this general framework can help you navigate the therapeutic process with more confidence and flexibility.
You don’t need to have all the answers right away—trust the process and keep learning alongside your client.
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