Contract In Psychotherapy

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

When I was choosing the direction of work in psychology, structure was important to me. Having attended many different seminars, having read a huge number of primary sources, I settled on two areas - modern psychoanalysis and transactional analysis

The method I work in is transactional analysis. It has a clear structure and an important part of that structure is the contract. A contract is a verbal or written agreement about what happens and what does not happen in psychotherapy. The contract allows you to determine the place of each participant, that is, therapist and client, in the work process. The contract also allows the therapy to be made less abstract. In other words, not to make it an endless process without a goal, not to work for the process, but to achieve a possible result.

For example, in the contract, we usually prescribe a starting indicative goal of psychotherapy, based on the request and the state of the client. This usually provides safety and gives a sense of the finality of the process. Many people have a feeling that therapy is something eternal with no foreseeable end. For example, if a client comes to me in a state of persistent depression, apathy, lack of strength, we conclude a start-up contract for researching the state and searching for its causes. After the diagnosis, we conclude a new contract - for psychotherapy for depression, lasting at least 2 years. After 10-15 sessions, I can roughly determine the approximate duration of the work. And the contract is extended for a certain period of time. For example, two to five years. For a long time? But these are specific, foreseeable boundaries. And for working with depression that lasted 10 years, 5 years of therapy is quite adequate.

There is another important part in the contract - it sounds like a question:

"How do you know that you have achieved a result?" This will help create a clear picture of the desired state. In the case of prolonged depression, we usually talk about restoring work capacity, establishing contacts and expanding the circle of friends, improving physical well-being.

Also in the psychological contract, the boundaries in the relationship between the client and the therapist are important. For example, in my contract with clients, I always stipulate the possibilities of contact between sessions and its boundaries. In an acute condition, clients can write to me. In emergency situations, call. But we don't meet for coffee, we don't go to the movies, and we don't form friendships or romantic relationships. Naturally, when we meet, we do not turn away and, once in the same space, we can exchange a few words.

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, the possibility of using an audio recording, confidentiality conditions, therapist's and client's actions in emergencies. I will write about some of these important points separately, they deserve special attention.

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. Also, I usually include some additional points. For example, certain clients are asked to end the session with certain phrases so that there are no awkward pauses. Such phrases help to end the session organically and give both therapist and client the opportunity to feel calm and comfortable at the end. These special conditions also include periods of interruption of therapy, for example, on vacation or during a hospital stay, if the client leaves for spa treatment or simply undergoes treatment for chronic diseases at a certain frequency.

Special conditions also usually include the ability of the therapist to involve emergency services in the process if there is a threat to the life of the client or those around him.

We usually discuss each point, and the client has the opportunity to agree or disagree. If I see that a person is in a very stable condition and our work with him will not be long-term, I can omit some points of the contract and return to them if necessary.

Even if I do not focus on some points, I always conclude a basic contract. In my opinion, working without a contract can be dangerous and ineffective, since the boundaries of the process and the responsibilities of each of its participants are not defined.

A separate point at the beginning of work under the conditions of long-term psychotherapy is the discussion of the possibility of supervision. Each psychotherapist working in a particular method and being a member of an association of psychologists and psychotherapists, as well as an association of representatives of his field, undertakes to comply with the code of ethics, undergo personal psychotherapy, receive supervision and develop their skills in training courses for continuing education.

What is supervision? This is similar to the support of a supervisor in writing a paper, but support is provided in the work with clients. A supervisor is a psychotherapist with extensive professional experience, certified to conduct supervision, who is able to timely notice deviations from the therapeutic plan or incorrect actions of the psychotherapist. The supervisor is also able to determine if this is the therapist's personal process (part of his traumatic history to which he responds) or the client's process.

Supervision is conducted on a confidential basis, that is, when the case is presented, the supervised psychotherapist does not provide the supervisor with any identifying information that can identify the client. It is the case that is taken out, and clients can be given fictitious names, gender and age, and external characteristics can change. Even psychotherapists with over 20 or 30 years of experience are supervised. This helps to ensure that the choice of psychotherapy tactics is dictated by professional experience and knowledge, and not by personal speculation.

The psychotherapist needs personal psychotherapy so that everything that happens to him in life does not influence the way he behaves with the client. Psychotherapists are ordinary people who also face life or relationship problems. If, for some reason, the psychotherapist decided not to stay in a toxic and uncomfortable relationship for him, but to get out of them, his depressed moral state in this regard should not be reflected in his work with the client.

The psychotherapist also has contracts with her supervisor, which include respect for ethics and confidentiality. In order for the practice of the psychotherapist to be pure and as effective as possible, a certain number of hours of supervision is necessary for the corresponding number of hours of psychotherapy with the client.

The client has the right to expand and change his contract with the therapist. For this, there are so-called mini-contracts. This is, in fact, a contract for work, concluded at each session (the request with which the client came and the possibility of audio recording of a specific session). Also, the client may be interested in the results of psychodiagnostics, which the therapist does at different stages of work, the therapeutic plan and changes noticeable from the outside.

The contract in transactional analysis is always made of all three ego states. The ego state of the Inner Parent (values and rules learned from parental figures and society), the ego state of the Adult (awareness “here and now”), and the ego state of the Inner Child (emotional experience). If the contract is contrary to your values, causes internal criticism, does not correspond to reality or causes internal protest - it should be changed to the point in which all three ego states will "agree."

The therapist may also refuse to accept the client's contract if the contract could pose a risk to the client or others. For example, a contract for adaptation to a situation of domestic violence. Or to change another person (this is simply unrealistic). In such cases, I usually say honestly that I do not agree to contribute to the violence. In therapy, we work with those who come to therapy. And we start from reality.

Why am I sharing this information with you? For me, the issue of the safety of my clients is acute. You have the right to require your therapist to sign a contact and have information about whether he is receiving supervision and whether he is undergoing personal therapy. This is a very important component of the success of your overall work.

/ The article was posted in the publication "Mirror of the Week": /