Learning from complaints: psychotherapy contracts

UKCP does not make it a requirement to have a written contract. Our code of ethics and professional practice outlines that psychotherapists should:

"Explain to a client, or prospective client, your terms, fees and conditions and, have information readily available to clarify other related questions such as likely length of therapy, methods of practice to be used, the extent of your own involvement, complaints processes and how to make a complaint, as well as arrangements for referral and termination of therapy. (Code 14)

Confirm each client’s consent to the specifics of the service you will offer, through a clear contract at the outset of therapy. We do not specify a written contract, but in the case of any conflict, a clear written contract supports both the client and yourself. Help clients to understand the nature of any proposed therapy and its implications, what to expect, the risks involved, what is and is not being offered, and relevant alternative options. (Code 15)"

Why issue a written contract?

• Fees
• Method of Payment
• Cancellatation
• Termination
• Duration of appointment
• Holidays
• Contact between sessions
• Where will the appointment be held
• Information about your therapeutic executor
• Client’s state when attending therapy
• Notes/Reports
• The applicability of complaints procedure/UKCP code of ethics
• Confidentiality

A written contract is a transparent basis for informed consent. It gives you a level of certainty. Expectations are set out clearly. This means that a contract reduces the likelihood of complaints. And, in certain circumstances, a contract can ‘save’ a therapeutic relationship.

What should be included in a contract?

A contract sets out the rights and obligations of the therapist and clients. If you decide to have a written agreement with your client, here are a few provisions you could have in the agreement.

Fees

If you include fees in your contract. You might want to think about whether you want to insert something about whether fees will be reviewed and at what frequency.

Method of payment

How and when payment is made?  Cash or cheque at the time of the session?

One thing that has come up in complaints cases is not a good idea to get your client to do odd-jobs around the house in exchange for therapy sessions. This is likely to lead to a complaint for breach of boundaries and dual relationship.

Cancellation

We often receive enquiries and complaints from clients who have been asked to pay for appointments when they have not been able to attend because of an emergency. If you have a contract which includes a cancellation policy, you are less likely to have a complaint made against you.

Specify in your contract the minimum notice period required for cancelling, changing or postponing an appointment. Usually 48 hours seems reasonable but that may depend on your practice.

Termination

Generally speaking most contracts or agreements will state that the client can terminate therapy at any time.

You may want to include something about how you approach ending therapy. You might consider suggesting that it is ideal to talk in sessions about ending therapy over a minimum of sessions (not compulsory). Your client is more likely to approach this subject and bring matters to you – which could result in them terminating therapy or deciding, after they have discussed it with you, to stay in therapy.

This is an opportunity to encourage dialogue and allow therapy to be terminated in a less adversarial way.

Duration of appointment

It is a good idea to include something about not arriving too early (to preserve confidentiality of them and other clients). You will also want to set out what happens if they turn up late for their session.

Holidays

It is good practice to let clients know in advance if you are intending to take holiday and therefore will not be able to provide therapy during that period. Likewise, you may also want to specify how much notice (if any) you require should the client not be able to attend because of their holiday commitments.

Contact between sessions

Sometimes, clients send lengthy emails or attempt to have discussions with their therapist between sessions which is not always appropriate. If you have a provision covering contact between sessions it manages the client’s expectations.

You might decide to specify whether contact between sessions should be only for the purpose of arranging/rearranging appointments. You could state whether other contact will be acknowledged or not. You could also specify how the contact can be made (phone call/text/email).

Where will the appointment be held

This is self-explanatory. Coffee shops or outside in the garden are not appropriate venues for therapy.

Information about your therapeutic executor

It is useful to have information about what happens in the event of your illness or death. Who will be responsible for your clients and how will their confidentiality be respected.

Client’s state when attending therapy

This would include requiring a client to attend sessions free from the effects/influence of alcohol and drugs.

Notes/Reports

You may want to include a provision that you take notes and they are kept securely, for a period in accordance with data protection legislation.

The applicability of complaints procedure/UKCP code of ethics

Mention your professional membership and that you abide by and are subject to the UKCP’s complaints process and code of ethics.

Confidentiality

Given that confidentiality is a trigger for complaints, the client should be informed of circumstances in which the therapist may have to breach confidentiality.

If you decide to have a confidentiality provision, we recommend that you have a general provision which reassures the client that the psychotherapeutic relationship is confidential except in the following circumstances:

• Client’s safety or safety of others is at risk
• Discussing the work with your supervisor and the supervisor is also bound by confidentiality and reassure the client that you will only refer to the client by initial or first name
• Therapist being unable to practice due to accident or sudden incapacity a qualified colleague will contact the client and enquire about the client’s wish for further therapy.
• Compelled by a court of law to disclose notes/information about the client
• Non-payment of fees resulting in legal action being taken against you
• At the client’s request they would like you to breach confidentiality.

Conclusion

A contract is recommended so that there is clarity on what is expected of both sides. It also adds credibility to your practice and the profession because you are being transparent from the outset.

If you decide to have a written agreement here are some tips:

• Do not make it prescriptive or look like a list of rules. You want the client to feel safe and reassured
• If you have a written contract – abide by it. If, for example, you state that payment should made in advance, take it in advance
• Use plain simple language
• Length of contract – usually a page (maximum of 2 pages).