CONTRACT WITH THE CLIENT IN PSYCHOTHERAPY

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Rights and obligations, rules, prohibitions, client and therapist safety, suicidal clients, work with "psychiatric clients", boundaries of competence, etc.

• Rights and obligations
• Responsibility and guarantees
• Passes and penalty
• How to draw up a contract
• Conflicting rules
• What the client can count on
• Conflicts
• Transfer
• Perfection
• Pricing and trading

Video about a contract with a client in psychotherapy.

Today we will reveal the issue of the contract between a psychotherapist and a client in psychotherapy. What is it and why?

This is the so-called collaboration agreement, the purpose of which is to relieve the client of psychological difficulties. The psychotherapy contract, either verbally or in writing, helps to clarify the client-therapist relationship, as well as fosters a supportive relationship for therapy.

The contract allows you to feel freer and adequately respond to emergency situations such as sudden missed meetings, and also regulates the personal boundaries of everyone and the process as a whole.

The conclusion of a contract for future psychotherapy, discussion of organizational issues, possible force majeure and difficulties, happens at the very beginning of the interaction between the client and the psychotherapist.

The psychotherapeutic contract consists of two parts - administrative and therapeutic. The administrative part of the contract is the working conditions, the frequency of meetings, the duration of each meeting, the conditions under which the duration of the meeting can be extended or reduced, the cost of each meeting, confidentiality conditions, and actions in emergency situations.

The therapeutic contract is the goals of the therapy, the stages (therapeutic plans), the responsibility of the client and the therapist in the process of psychotherapy, the possibility of cooperation with other specialists.

Psychotherapy, and coaching too, is not a service in the usual sense of the layman. The therapist cannot guarantee the result. The result depends on the activity of the client and the skill of the psychotherapist, but they are not limited to this. The quality of this service is also influenced by the client's abilities / limitations, the subjective emotional components of the personality / character of both participants, the peculiarities of their contact, external stressors and much more.

The therapist expects from the client not just formal performance of tasks, but complete emotional and mental involvement.

The therapist, having accepted payment, by definition a tangible amount for himself, cannot do all the work 100%, since half of the work is done by the client himself.

The client often does not know the “map” by which the therapist works and has misconceptions and expectations about techniques and methods. Sometimes the therapist refuses to offer the client specific actions or recommendations, expecting trust from the client, sometimes he analyzes the behavior as an expert and points out distortions in the assessment of what is happening and the conclusions drawn. Sometimes the therapist requires not to succumb to his emotional impulses, but to analyze them, at other times he helps to learn to “let go of control” and express your feelings without holding them back.

A serious difficulty in the therapist-client relationship is inevitable resistance. This is truly a test of effective psychotherapy, and the temptation to quit the process halfway through a period when the client is experiencing unbearable emotions and genuinely negative emotions towards their therapist. It is very difficult not to trust your feelings, to analyze your behavior and thoughts when strong emotions overwhelm. It is very difficult to continue doing what is unpleasant and unbearable despite the emotional logic.

The client-therapist relationship is emotionally charged. For many, they become the closest / confidential in life, in a certain sense, intimate. This can provoke dramas of love, addiction, resentment, frustration of hopes and expectations. The therapist is responsible for keeping the relationship constructive. It makes sense for the client to understand how hard this emotional work is. It is not easy for the therapist to be aware that he / she sometimes causes emotional pain in the client and cannot smooth it out in the name of his / her peace of mind. It is often difficult for the client to accept the limitations of the professional relationship, the abandonment of the therapist's special personal relationship with him / her after the client has decided to confide and open up in his feelings and have experienced incredible intimacy. Falling in love, parting, limitations in contact, feelings of guilt, rejection, the inability to get what you want passionately - this journey through emotional fulfillment sometimes resembles a minefield.

Falling in love with a therapist is a frequent occurrence. Sometimes the therapist is the first member of the opposite sex with whom the client has complete, unconditional trust. Against the background of the strongest emotions, the strongest feeling can form. The client takes these emotions for "destiny", for love that knows no boundaries. Hope rests on these experiences and on the fear that there will never be such a connection with anyone again. It is also fueled by the fact that many therapists are so loyal that the client has become accustomed to trusting that the therapist will never hurt him / her. Sometimes it seems sincerely that "stupid rules" are just a bureaucratic formality. In order to describe the validity of these rules, you will have to highlight a separate article. The psychologist, on a mental level, also resonates with the client, responds to love, worries about the suffering caused, experiences feelings of guilt and resentment. You have to cope with the feelings of both in order to keep the contract in a constructive way.

Psychotherapy is paradoxical. The therapist often operates with unusual questions that contradict common sense at first glance. Asking the client what is the essence of the problem and how the client is going to solve it causes bewilderment - "if I could solve it myself, I would not come to an expert." And nevertheless, this is not a whim and not a game - this approach works, people, answering at first glance obvious questions, make discoveries and change their behavior, as they could not do for many years earlier. The psychotherapist has to deal with the client's natural irritation at the beginning of the process.

My guess is that after reading the text above, some clients are surprised to learn about the therapist's vulnerability. Many believe that psychologists should be completely free from resentment, guilt, and irritability before engaging in psychotherapy. Another prejudice is that the psychologist should be completely neutral and restrained, and the third is that the psychologist / therapist is obliged to take care of the client's feelings and comfort at any cost, regardless of payment and their interests. Some are convinced that we have no right to refuse help.

It is important for us to tactfully make it clear to clients that we can be high-quality professionals, being vulnerable - clients are not to blame for not knowing our world. It is advisable to clarify the features of these relationships even before this leads to complications. However, for this I am writing this article.

Clients often do not understand why they cannot avoid coming to a therapy session if they do not have a desire, mood or another reason. It is frustrating for many clients that the therapist charges for canceled and missed sessions, missed assignments, lateness and protracted therapy times, especially given how close they are. These rules are simply necessary in order for the client to treat psychotherapy responsibly for his own benefit, they are also necessary for the specialist to be in balance and not be annoyed about the loss of time, energy and mental effort, this is also important in the context of responsibility towards to other clients. Given the above, it is obvious how important the emotional state of the therapist is for the quality of work for the benefit of clients. Simple, relevant rules help all three designated categories of actors. The therapist often prepares for the session, revises the materials, analyzes them, creates the appropriate mood. In addition, the therapist can see a limited number of clients per day, allotting 60-180 minutes to each. It is usually not possible to make changes to the schedule more than two days in advance. A meeting or two canceled at the last minute could create tensions over financial security. The profession requires continuous and expensive training and supervision. The therapist needs to rent a suitable room, pay a lot of costs. Mental comfort and balance require an appropriate standard of living, not the other way around. It makes sense to immediately familiarize the client with the cancellation and admission rules. The usual rule is cancellation in less than two days is paid for the cost of one hour of therapy, however, there is a well-founded tradition of paying more for a missed session than for a attended one. Exceptions are force majeure (see dictionary), not client inconvenience. These rules are set by the therapist.

The rules in therapy are mainly set by the traditional setting and by the therapist himself. It is important for the client to understand that they do not always correspond to his (client's) ideas about logic and fairness, the rights and obligations of both parties should not be absolutely symmetrical.

The therapist may refuse services to the client if he does not see the prospects for the usefulness of therapy. The therapist may refuse services to the client if he experiences emotions for the client that interfere with the quality of therapy. It is preferable to offer the client contacts of a more suitable service or specialist. It is very important to understand the boundaries of your competence. The psychotherapist can offer the client to undergo psychodiagnostics from an expert - this is professional. Seeking a second opinion or gathering a consultation is possible only with the permission of the client. It is appropriate to recommend that you undergo an appropriate medical examination.

The psychotherapist himself decides, in his expert opinion, to whom to offer one-time meetings, to whom a therapeutic course (under a wholesale contract). The therapist should not work with the client, which is more necessary in the context of the request and the actual conflict.

In my opinion, the therapist should present at least an approximate plan and goals of therapy, duration and cost. This is not always possible given the many components of success.

It is important for the client to understand that the relevance of psychotherapy cannot be measured by a sense of comfort, avoidance, denial, repression, projection, transference - all this is normal in high-quality psychotherapy. The client often does not understand the validity of the most effective interventions; they work with unconscious material. At the same time, the principle of "magic pendel" and the need to go into the unbearable far, are not always therapeutically justified.

Many therapy approaches depend not only on the client's emotional involvement, but also on mental effort and assignment. The therapist has the right to expect complete completion of the assignments, regardless of whether the client likes them or not. In case of difficulties with assignments, I insist that the client write to me about their barriers, and we discussed how to overcome them or change the assignment to a more suitable one. If the client simply does not complete the assignment, I reserve the right to refuse to continue working.

It must be admitted that the question of the rights and obligations indicated in the contract turns out to be very relative in the case of psychotherapy. Rather, it serves to familiarize the client with an approximate "map" and the laws of the space in which therapy takes place and the disposition of the relationship with the therapist. The concepts that we use in the contract are ambiguous and can be interpreted in different ways - such as responsibility, care, initiative, involvement, etc. It is necessary to discuss them, but it is not possible to make clear rules. In this article, I propose a relatively dry and limited version of the contract, which you can supplement based on the materials of this article at your discretion.

The right to confidentiality of the client in the work of the therapist gives way to the risk to life and health. Simply put, if the client indicates that he wants to cause physical harm to himself or to another person, the therapist not only has the right, but is obliged to intervene. The therapist can alert law enforcement or call a psychiatric ambulance, even if this jeopardizes trust with the client. The psychotherapist does not bear legal and moral responsibility if the client concealed his suicidal or violent plans, in the event that he asked the client about it, but the client denied.

The therapist can insist on the signing of a “security contract” in which the client, in the event of specified thoughts or desires, immediately goes to the hospital or calls the helpline. It is common practice to present the client with a choice - either a signed contract or immediate involuntary hospitalization.

In the case of mental disorders, the psychotherapist has no grounds for involuntary hospitalization if the client refuses. The therapist can use authority to insist on additional diagnostics by dispelling myths about risks by suggesting that the client's rights to freedom and adequate risk-free testing are well respected. Sometimes a second opinion is appropriate.

Also in the context of the issue of psychiatric safety, it should be said about special cases with clients with possible mental disorders (hallucinations, voices, etc.). It is imperative that at the very beginning of work, when questioning a client, it is worth asking a question about the presence of such symptoms. In the case of an affirmative answer, be sure to document this, clarify the details of the voices, hallucinations, finding out what they say and where they lead (often in schizophrenic patients, voices lead to harm to themselves or others). It is important to pay attention to this in time and direct the client to diagnostics, to other specialists. This security issue is extremely important.

For clarity, below I give an example of a contract between a client and a psychotherapist:

SETTING

1. Frequency of meetings. The frequency of meetings is suggested based on the therapist's understanding of the client's difficulties.

Duration of the course. Depends on the request. The client terminates

therapy, when he and the psychologist understand that the goals of psychotherapy have been achieved.

client.

1. The duration of each meeting is determined by the psychotherapist and negotiated with the client. In some cases, the time for an individual appointment can be increased - the therapist notifies the client.
2. No-show and cancellation (or postponement) of the consultation.

- Failure to appear means that the client did not show up at the appointed time and did not warn.

- Cancellation or postponement means that the consultation is canceled or postponed for another time. If the client misses the consultation and does not notify the therapist about it at least 24 hours in advance, without a valid reason, then the client must pay for the missed session.

RIGHTS AND OBLIGATIONS OF THE PSYCHOLOGIST

- The psychologist has the right to inviolability and respect for privacy.

- The psychologist has the right to expect and demand fair compensation for his work.

- The psychologist has the right to request and receive relevant (reliable)

information from the client about those aspects of life that bother him.

- If the client's request relates to the activities of other specialists, then

the psychologist undertakes to recommend him another specialist, qualifications and

whose specialization corresponds to the assistance required by the client.

- The psychotherapist observes complete confidentiality with respect to any information provided by the client, except for situations directly related to a serious risk to the life and health of both the client and any person.

- The therapist does not enter into a personal relationship with the client.

RIGHTS AND OBLIGATIONS OF THE CLIENT:

-Pays for appointments.

- If the client receives advice from other psychologists or specialists

other profile (psychiatrist, neurologist, etc.), the client is obliged to inform about

this psychologist.

- The client refrains from physical aggression and harm to the therapist or himself.

- If the client decides to stop psychological work on his own

initiative, then he undertakes to notify the psychotherapist personally, at one of the sessions.

- The client has the right to call a psychologist on organizational issues.

-The client warns about the cancellation of appointments a day in advance or pays for the missed appointment.

Depending on the specifics of a particular case, individual details of the contract are discussed on an individual basis.

An agreement between the client and the psychotherapist is a prerequisite for starting psychotherapy. Why? Because it is a very important component of your overall success. The contract brings clarity and safety to the psychotherapeutic relationship.

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