Contracting is key to a successful therapeutic relationship. Many problems could be avoided if therapists were clear about what they are offering and clients clearly understood the terms of engagement. Misunderstandings can arise when assumptions are made, or when clients feel misled or have unrealistic expectations.
Our Commitments to clients include ‘agreeing with clients on how we will work together’ (3c), ‘communicating clearly what clients have a right to expect from us’ (4a) and ‘communicating any benefits, costs and commitments that clients may reasonably expect’ (4b).
Complaints about contracting
Clients have complained about their therapists because of:
- not being clear about what they are providing or not communicating their terms clearly enough - "they never told me"
- relying on a verbal contract - with no proof of what was agreed or common point of reference
- assumptions and misunderstandings over the parameters of the work or what the client should expect
- problems and misunderstandings over who the contract is with
Key considerations for practice
It is the therapist's responsibility to negotiate a contract with clients. A clear contract provides the parameters or the frame within which the client feels safe enough to proceed and within which the real work of counselling and psychotherapy can take place.
Be explicit and transparent, but aim for a balance.
- Provide enough information to cover what is important, but not so much that your clients feel overloaded and are unlikely to retain it
- Don't use legal jargon
- Check your clients understand all the terms of the contract and give them the opportunity to ask any questions so they can proceed on the basis of informed consent
Put it in writing
Provide clients with a written record of what has been agreed. A verbal contract is legally binding, but clients have a lot to take in at an assessment or the first session, and they're unlikely to remember everything you said. A written record helps avoid confusion and disagreements later over what was offered.
Consider including the following in a contract:
- Your and your client’s contact details, and agreement as to how and when you can contact each other
- Number (whether fixed or open-ended), length, location and time of sessions
- Fees, and when and how payment is to be made
- Your cancellation notice and DNA policy, and notice of termination
- Client’s GP details and emergency contact, and the circumstances in which they might be used
- Privacy statement explaining what records you keep, who can access them, how long they will be kept and the client’s right to see them
- Confidentiality and any limitations or exceptions
- Complaints procedure
- Information about your supervision
- Reference to the Ethical Framework that you follow
- Whether you allow sessions to be recorded (especially if online or by phone)
- Whether you're willing to write letters or reports and if there's any additional fee
- What would happen if you're incapacitated for any reason
- Client’s signature to indicate their agreement to your terms
Consider discussing a therapeutic contract so you can agree on client goals etc. Describe (at least verbally) the way you work and what a client might expect from you.
Avoid promising outcomes that you are uncertain about achieving or that are not within your power to achieve.
Be clear who the contract is with
This is particularly important when working with children and young people or with couples.
- Parents may expect to be involved in their child’s therapy - is the client the child or the parent, or both?
- If switching between seeing couples individually and together, make it clear in advance where the boundaries lie and to whom confidentiality is owed.
Changes to the contract
Sometimes it may be necessary to amend the contract part way through the therapy. This could be due to a change to the appointment day or time, the number of sessions, the sessional fee, terms of payment, or the therapeutic contract – what you are working on together. If so:
- ensure that you discuss and negotiate any changes with your client
- obtain their agreement
- consider providing a revised written contract