Counselling Contracts

[Cherrypie]

What do you thinking about signing a counselling contract before you start a counselling relationship? I wonder how clients and therapists feel about this?

As a therapist would you consider still working with someone who refused to sign a contract or is is absolutely necessary in your opinion? Is it an ethical requirement? A protection of yourself and your rights in the relationship as well as the clients?

As a client or therapist is there anything in your contract that you are not happy/feel uncomfortable about? Has a contract ever been helpful in resolving issues later on in the relationship? Sorry!! A million questions..

On one hand I can understand that both parties may feel some security in knowing where they stand perhaps but it also strikes me as some kind of pre-nuptial agreement and feels a little as though you are starting out with the default of not trusting one another which seems a shame.. I have no doubt my feelings about it though are also a reflection on me and how I view relationships..

I wonder how you feel about it?

[mel]

I think its important that counsellor knows about GP and history of drugs and treatment. But needs to be aware of possible judgemnt of client.

For client.... persosnally I didnt care. If I didnt want to come back anymore... or worst even, if I didnt want to pay anyomre, i didnt!

This is about feelings but client and counsellor need to be safe in some kind of contained womb. A contract I believe.
Its important and teaches by example.

[Cherrypie]

Hi Mel,

thankyou for your input on this as it really interests me. I believe that the BACP reccomends a contract is best practice but I wonder how important they are in reality and how making one can affect the counselling relationship..

It seems you have quite contradictory views about contracts. On one hand you say it is 'important' and creates perhaps a 'womb', which to me evokes a contract creating a protective and nurturing space to grow perhaps but then your reality as a client is that you in fact ignored it and did as you pleased..

So I suppose what I wonder was there really any point in having it if you didn't care about it?

Cherrypie

[andyhp]

I have not had to resort to a contract to settle a dispute as there haven't been any yet but I do believe it is best practice to work with a fully detailed contract. I am strongly in favour of informed consent for a client and this should mean that absolutely nothing is hidden, from who I am and what I do, to fees, insurance, qualifications, insurance record keeping and limits of confidentiality etc. It should all be crystal clear and rather than 'covering myself' it is for informed consent that I believe contracts are important. To give informed consent means first being fully informed.

So yes there is an ethical element and also an element of protecting I guess but for me it's not about a default position of not trusting but as I've said about being informed, having clarity.

Having said all that I don't think that by itself a contract goes anywhere near creating the safe space that I believe therapy needs to be. I'm not saying it won't help but I feel that trust, care, respect, and affirmation are not the same as the 'business' side of things. They are not things I feel I can that contract for.

I think I see having clarity from the outset more as a possible starting point for trust though rather than a default position of not trusting.

I've not met a client who expressed any issue with signing a contract so far and I do find it hard to picture a scenario where a client would not want to sign one....most private clients check that I use one! I guess I'd have to hear the reasons for not wanting to sign before I could make a decision on whether to work with them or not.

Would you sign/not sign a contract? If not why not? Your questions seem to focus on the issue of signing one and what feelings that could entail...what about working without one as a client...would you be happy with that?

Is this erring toward the other 'big question'...paying for the therapetic relationship?

[Cherrypie]

Hmmmm.. thankyou very much Andy I really appreciate your perspective and it is making me think..

I have possibly been slightly rumbled here as yes I have posed this threads question for personal reasons in that I have been asked to sign a contract for the first time. My surprising reaction (even to myself) was that I instantly felt offended by it. I think mainly I felt untrusted by some of the paragraphs in particular and the idea of 'rules' rattled my cage generally it seems.. Boundaries are important of course, I know all the reasons why, the safety aspect, la la la, but having them listed in such a way all together felt a bit overwhelming for me and I felt an instant resistance.. A childish resistance maybe :)

I have previously worked for a long time (as a client) without one and was happy to do so as I felt it was kind of part of a mutual unspoken agreement of trust and to respect one another.. Issues of course occasionaly arose and they were dealt with and sometimes negotiated as we went along. I must admit to at times feeling like I was bumping into invisible barriers and had wished there were some kind of information leaflet to start with but I don't feel I ever hoped for a contract. A resounding yes to being informed, absolutely, wish I had more of that but why do I have to sign to say that I have been informed unless you just wish to wave it at me if I get something wrong or if I dare to challenge you on something within it.

Actually now I think about it, going back a bit further, I have had the experience on one occasion of being asked to sign a contract. I think it felt quite upsetting to me as I had literally arrived to the place in a state of high emotion and I was presented with forms and asked for money there and then before we started (as though I might do a runner after the event?!) I felt quite shocked and somewhat offended if I am honest. Sad too.. the business side of it did feel odd..uneasy for me.. I think I felt slightly embarrassed too.. that I, small and broken person, have come to you, together, 'professional' efficient person with your waiting lists, forms and contracts. Well..that was just what it evoked for me personally..

I wonder what good this contract ever was really was as I of course signed it, in desperation, to be polite, because there seemed no choice not to and I did so without taking a word of it in and because I would have frankly signed my life away at that moment if it meant help at the end of it.. Well...there.. that seems to have been quite an event for me (that I hadn't recalled when I started this thread!) so of course this may well be massively colouring my view of course..

Its very complicated isn't it..my personal reasons for feeling the way I do about contracts could take a few sessions maybe if you took it to its starting point. Why was I offended in the first place? What did I think counselling was before I walked in there? What were my feelings about the 'business' of helping others. Were my expectations unrealistic..probably yes.

Now as you say, many of your clients have agreed to this without a hitch so its undoubtedly a me thing and very likely also connected to my slightly confused feelings about the therapeutic relationship itself. And yes..because of this same feeling the idea of paying for it and charging for it I might add, is still difficult for me to accept still.. I am working on it..

I am so sorry I have gone on and on.. How much do I owe you all??

I'd still love to hear anyone else view.. for or against a contract..or even just the feelings it evoked.. which may have been none whatsoever!?

xCherrypie

[Fluffy Flowers]

I had a contract the first time I entered counselling. I didn't know what I was signing, I didn't even remember it after leaving the room, just that I had to give more than 24 hours notice of cancelling appointments. I think it gave me that 'naughty little girl' feeling and I felt I always had to do the right thing and always abide by it. I wanted to please her (because that's all I had known with people previously) and I think her having this contract restrained me somewhat.

She originally said we would have to sign it every 6 weeks but I saw her for a year and I only ever signed the first one.

Since then I have never had another contact issue come up, other than when I entered into group therapy and we had the rules we had to abide by, but we didn't sign anything, it was just verbally agreed.

I have heard of people signing contracts to say they won't self harm whilst in therapy and stuff and that to me seems contradictory, and does come down to the therapist covering themself, not necessarily considering the client and their needs.

I don't think this is an issue specific for your Cherry, but maybe a lot of people, like both of us, signed a contract without necessarily really taking it in, but feeling the negative impact later. Have you discussed your issues about the contract with the person who wanted you to sign one?

I can see a time and place for a contract, but I think the content is very important, and also the way it is done. For example, giving the contract to someone and asking them to bring it when they come back next week might be a good way to do it because you get that time to digest it, think of questions to ask, etc.

I sympathise Cherry, and hope you manage to find a place where you do feel secure with who you are seeing and how it is done.

[andyhp]

Hello Cherry Pie and Fluffy Flowers,

A few points - not all contracts have to be written they can be verbal (I don't think this is best practice) - personally not only would I give someone time to read the contract but I would give them their own copy after it was agreed and signed - anything in the contract can be revisited if after reflection there is something of concern, if this cannot be resolved then of course there is a problem - I wouldn't 'thrust' a contract under someones nose at the start of a meeting, as long as the limits of confidentiality have been clarified it can wait until nearer the end of the meeting - if after reading a copy for a week a client doesn't wish to sign it then they do not have to, again though, we may have a 'therapy stopping' problem.

Under what circumstances do you think a therapist would 'wave' a contract at a client - if they later refuse to pay the agreed amount?

What about if you had a dispute with your therapist? E.g. they just inform you at one meeting that they have put their fees up?

A contract is mutually entered into...I have responsibility for what I sign and you have responsibility for what you sign. We both then have responsibility for holding to that contract. Why is this an 'issue'...is it the contract itself or your feelings around signing the contract? Any or all of this can be talked about in the meetings...if you do not do this whose responsibility is that? Does concern over contracts include concern about 'how can we contract for a relationship'? Personally, as I have said I don't believe we can outside of defing some of the boundaries of that relationship e.g when/where

There is, and in other threads has been, talk of therapists 'covering themselves'. Yes, in working with a contract I am to some extent covering myself, if that is the phrase we are going to use. I certainly would be less likely to face disciplinary action by my governing body if I have a fully detailed written and signed contract if what was under dispute was covered by the contract e.g. no-one could claim I refused to speak to them out of office hours if it clearly states in the contract that contact is limited to office hours. All of this works the other way round though does it not? I am concerned about the issue of therapists 'covering themselves' when it moves to topics like self harm and suicide. First off I have not heard of or used a contract covering self harm although as I said in another thread I have heard of and have had 'agreements' with clients over not attempting suicide. I want to be crystal clear about something though...if by 'covering themselves' you are referring to a therapist trying to give themself protection in a moral or 'responsibility' sense by having such an agreement then you may have a point, it would depend on each individual therapist to address their motives for this. If on the other hand you mean some kind of legal 'covering' then there is, as far as I am aware, no need for any therapist to cover themself. If a client completes suicide no therapist, unless they actively assisted, has any legal responsibility. You can tell me you have a plan, intent, and the means and I do not have any legal responsibility for what you do or for telling anyone what you are about to do. I'm not saying I wouldn't try to stop you but I have no legal respionsibility to do so, so I don't have a need to cover myself in any legal way.

For me it seems many of the issues around to contract or not to contract etc stem not from contracts themselves but around how do we define what a therapeutic relationship is...can it be defined by a contract... does writing it all down in a professional way 'take something away' from the human contact?
Maybe it does...maybe it doesn't...maybe it does for some and not others..

I kinda think that like with all these 'big' questions, outside of things like 'best practice' and abiding by ethical codes, which can mostly be applied in a blanket sense, I am left with the feeling that the essence of therapy is about a relationship founded in real contact between two unique and individual human beings and 'how' that relationship is can be neither limited, defined or experienced by anything or anyone other than those two people.

[Cherrypie]

Thankyou very much Fluffy.. :hug: I felt you understood where I was coming from and I had imagined no one would.

I was particularly glad to hear you didn't think it was probably just me as I really do wonder sometimes why I struggle with seemingly simple things when other people possibly don't need give them another thought.. Maybe I do over analyse the meaning in everything giving issues way more importance sometimes than they should have.. but anyway..I digress..yet again..

I have since discussed the issue yes, and will have to again as I felt so strongly about it I have considered not continuing but I am thinking about it and I have been assured there is flexibility on the issue.. whatever that means..

Incidentally I also had feelings of being naughty and now required to behave..told off or policed in some way, restricted, suffocated!! Oh I could get quite catastrophic about it for some reason! And this is before we have even started!!

I plainly need the counselling though eh...

xCherrypie

[Fluffy Flowers]

:) I'm glad I was able to offer you some reassurance that you are not alone in this.

It's good you have discussed the issue but I do agree that you do need to discuss it again because it will be a huge block for you, in terms of what you can get and receive, unless you can work through this.

When you said 'I plainly need the counselling though eh...', that made me a bit sad, and want to cuddle you. Try to remember that every single person has issues, problems, blocks, all sorts, all throughout their life. I don't think this contract problem indicates you plainly need counselling. I think it indicates someone who is very self aware and able to look at her actions and thoughts and look as to what they mean and why, someone who is willing to put herself out of her comfort zone when it's necessary, someone who is very strong because she haven't given up, despite that urge.

You're a strong person Cherry, and yes you may need/want therapy, but that's not a bad thing, it takes a strong person to recognise when they need help. I don't know, but I get the feeling you're a bit down on yourself about it. I could be wrong, so feel free to correct me, but if you are down on yourself for it, or for struggling with the contract, try to look at the positives for going into therapy and what it shows you about yourself (strength, a want for better things, hope, good self awareness). It's not the most pleasant thing being in therapy, but its definitely not a negative thing, or something to beat yourself up over, same as the reasons you might enter into therapy. I'm not saying this very well, lol. What I'm basically trying to say is you're an awesome person and there are things we all struggle with that others appear to not to, or don't, it doesn't mean anything negative, it just means that that is something you struggle with. Nothing more nothing less.

:hug:

[Cherrypie]

Fluffy.. thankyou.. you are ace.. so glad you are here with us..

:arms:

xCherrypie

[Cherrypie]

a 'therapy stopping' problem. Wow that sounds technical... whats one of them? You end therapy?

Andy we were posting at the same time it seems and I have only just seen your reply. Thankyou for your input as its really helpful to get a differing perspective.

I realise I have probably reacted completely irrationaly to this but it seems my buttons have been pressed so my emotions have taken over unfortunately. I am sure I will behave, sign whatever I need to sign in the end but I will just feel dissapointed.. When I can be more objective I will look at it in more depth though as it is tied up with my feelings about paying for relationships so exploring it in more depth may well prove important and hopefully helpful for me.. vital in fact.

As for a counsellor 'waving' a contract.. That made me smile a little as of course that was me getting a little carried away..my dramatic licence and I don't think/hope it wouldn't happen in reality but if you are never going to actually pull it out of the bag so to speak then why have one to start with..

I must admit this is my topic of choice but for some reason I do feel quite depressed by it?!

xCherrypie

[Katmandu40]

Cherrypie, I have to say I have never had a formal contract for therapy and I am pretty sure I would be very put off if one was shoved under my nose at the first session! I'm thinking about this and trying to put my finger on just why this would offend me. One of the things that comes up is the position I think it would place me in. I would feel (and this is just me) I was somehow placed in a subsurbiant (sp) position from the very start. I'm coming to the therapist for help and expect to be treated with a certain amount of respect and I get a contract shoved in my face. I wouldn't like that. I think whoever said "trust" played a part, I would agree. If a therapist has certain rules he/she wants followed, fine...make them clear. My therapist (psychiatrist) told me from the start...no weapons would be allowed...I thought that was rather funny at the time, but I agreed. Make clear what the boundries are and discuss them, but a contract??!! It's not what I would call a normal business relationship...nor would I want to think of it that way and a contract....CHEAPENS....that's the word I'm looking for...it cheapens the relationship, before a relationship even has a chance to be.

I have agreements with my shrink...verbal. I have an agreement that suicide is not an option. It doesn't mean that if I become suicidal, she will stop seeing me....it means I need help...more than usual. She has made this clear. But, now I'm rambling on.

[Fluffy Flowers]

I must admit this is my topic of choice but for some reason I do feel quite depressed by it?!

:hug: :rose:

My PM box is open if you want a chat or vent or anything, away from the board.

In terms of what Katmandu said, that also makes a lot of sense to me. It maybe feels a bit degrading? Or like I am inferior or something. But exactly what was said about not being equal.

I hope you're doing ok Cherry.

x

[shrinknightmare]

Have never had to sign a contract up front. Once I had to sign a no harm contract whilst counsellor was away, which only went for 2 weeks but thinking it is something different to what your talking about.

[mel]

It seems you have quite contradictory views about contracts. On one hand you say it is 'important' and creates perhaps a 'womb', which to me evokes a contract creating a protective and nurturing space to grow perhaps but then your reality as a client is that you in fact ignored it and did as you pleased..

So I suppose what I wonder was there really any point in having it if you didn't care about it?

interesting question cherrypie

Yes as a client I would not be able to accept goodness and care. Boundaries. I wouldnt WANT it. I would kick against them [like the client/child is supposed to] but in reality it is what I NEED and hopefully through therapy will be able to accept one day.
So when you talkl about feeling childish or childlike in your reaction towards signing a contract... I think you are on the right track and it has something to do with a very young part of yourself

SO I think a contract is vital but that doesnt mean that I have to be grateful :)