A Client Turns 18: Clinical and Administrative Considerations

When a client turns 18, the shift is more than a birthday milestone. It marks a legal and clinical transition that affects consent, confidentiality, communication, and the therapeutic relationship itself.

For clinicians, working thoughtfully through this transition helps support continuity of care while honoring the client’s growing autonomy.

Understanding What Changes at 18

Once a client turns 18, they are legally considered an adult. This impacts several aspects of treatment, including:

• Consent for treatment now belongs to the client
• Release of information must be authorized by the client
• Parents or guardians no longer have automatic access to clinical information
• Billing and insurance communication may shift

Even when family involvement remains clinically appropriate, these changes need to be addressed clearly and intentionally.

Preparing for the Transition Ahead of Time

Ideally, conversations about turning 18 begin before the birthday itself. Introducing the topic early can reduce confusion and anxiety for both clients and caregivers.

Helpful preparation may include:

• Explaining upcoming changes in consent and confidentiality
• Discussing how communication with parents or guardians may evolve
• Reviewing policies around releases of information
• Giving the client space to ask questions and express concerns

Proactive conversations help normalize the transition and reinforce trust.

Supporting Client Autonomy

Turning 18 often coincides with broader developmental changes related to independence, identity, and decision-making. Clinically, this is an opportunity to support autonomy while maintaining appropriate support.

This may look like:

• Inviting the client to take a more active role in scheduling or treatment planning
• Checking in about goals as they enter adulthood
• Exploring how they want others involved in their care

Shifting responsibility gradually can help clients feel empowered rather than overwhelmed.

Navigating Parent and Caregiver Involvement

For families who have been closely involved in treatment, this transition can bring up strong emotions. Parents may feel anxious about losing insight, while clients may feel pulled between independence and support.

Best practices include:

• Naming the shift openly with all parties
• Clarifying what information can and cannot be shared
• Using releases of information thoughtfully and intentionally
• Reinforcing that boundaries are part of ethical care, not rejection

Clear communication helps reduce misunderstandings and protect the therapeutic alliance.

Administrative and Documentation Considerations

Turning 18 often requires updates beyond the clinical conversation.

Clinicians and practices may need to:

• Obtain updated consent forms signed by the client
• Review and update releases of information
• Adjust portal access and communication preferences
• Ensure billing and insurance information is accurate

At Great Lakes Psychology Group, we have a Patient Portal that can support this transition. Updated forms can be shared and billing information can be managed through the portal, helping clients take a more active role in their care.

Having systems in place to support these updates can make the transition smoother for everyone involved.

A Developmentally Informed Lens

While 18 marks a legal shift, emotional and relational development does not change overnight. Clients may need time to grow into their new role, and flexibility within clear boundaries is often helpful.

Holding a developmentally informed perspective allows clinicians to balance autonomy with support, honoring where the client is rather than where they are “supposed” to be.

Supporting Continuity of Care

Handled with intention, the transition to adulthood can strengthen the therapeutic relationship. Clients who feel respected and supported during this shift are often more likely to stay engaged in treatment.

By approaching the transition with clarity, collaboration, and compassion, clinicians can help ensure that turning 18 becomes a moment of growth rather than disruption.