contracts in psychotherapy


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, do not make it an endless process without a goal. Do not work for a process, but achieve a possible result.

For example, in the contract, we usually prescribe the starting goal of psychotherapy based on the client's request and state. 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, or lack of strength, we conclude a starting contract to research the condition and search for its causes. After the diagnosis, we conclude a new contract - for psychotherapy for depression, for 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. Long? But these are specific, foreseeable boundaries. And for working with depression, which lasted 10 years, 5 years of therapy is quite adequate.

The contract has another important part - it sounds like a question:

"How do you know you have achieved a result?" This will help create a clear picture of the desired state. In the case of lingering depression, we usually talk about disability recovery. About establishing contacts and expanding the circle of communication. 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 strike up friendships or romantic relationships. Naturally, when we meet, we do not turn away and, once in one space, we can exchange a few words.

The psychotherapeutic contract consists of two parts - administrative and therapeutic. The administrative part of the contract is

  • working conditions,
  • frequency of meetings,
  • the duration of each meeting,
  • conditions under which the duration of the meeting can be extended or shortened,
  • the cost of each meeting,
  • the ability to use audio recording,
  • confidentiality conditions,
  • actions of the therapist and client in emergencies.

I will write about some of these important points separately; they deserve special attention.

The therapeutic contract is the goals of therapy, 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 to avoid 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 a client leaves for sanatorium 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 item, 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 psychotherapy. In my opinion, working without a contract can be dangerous and ineffective, because the boundaries of the process and the responsibilities of each participant 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 who works in a particular method and is a member of an association of psychologists and psychotherapists. And also associations of representatives of their direction. He is committed to adhering to a code of ethics, undergoing personal psychotherapy, receiving supervision and developing his skills in refresher training courses.

What 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 and is certified to provide supervision. His task is to timely note departures from the therapeutic plan or wrong actions of the therapist. The supervisor is also able to determine if this is the therapist's personal process (part of his traumatic history to which he is responding) or the client's process.

Supervisions are conducted confidentially. That is, upon handing over the case, 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 how 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. These include compliance with 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 in psychotherapy. 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 ability to record 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.

Contract in transactional analysis always consists 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 not accept the client’s contract if the contract could endanger the client or other people. For example, a contract to adapt to a situation of domestic violence. Or to change another person (this is simply unrealistic). In such cases, I usually honestly say that I do not agree to contribute to violence. In therapy, we work with someone who came to therapy. And based on reality.

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

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

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