Table 5.
Components of the therapeutic contract
| Time: the time of the day and when the therapy session will be conducted and provision of change in exigencies |
| • Duration: duration of each session (say 40 min) |
| • Frequency of sessions: Frequency of the sessions will be______ per week. This should be mutually agreed between the client and therapist depending on the type of problems and symptoms and the psychotherapy planned |
| • What happens when someone is late to the session: In case therapist is getting late, they will try to inform the client about the same in advance, irrespective of the duration of delay. In case the session starts late due to the fact that the therapist was late, and the client can stay longer, then the therapy session would be conducted for the stipulated decided time. If the client arrives late, then the session may still end at the scheduled time, however if it is feasible on the part of the therapist, then the session may go to the full time. If either the therapist or the client is late by more than 15 min and don’t inform the other party than the session will stand cancelled. However, in such a situation the party responsible for the “no show” will have to bear the financial liability |
| • Cancellation: In the event of either the client or therapist is not available for the predetermined appointment, they are required to provide at least 24 h notice of cancellation or they will have to make payment for the session |
| • Fees: The fee for each session need to be predetermined. The contract can read as “the client is supposed to pay Rupees ____ for each 50 min session. It can be mentioned that the client is expected to make the payment prior to the beginning of the session. Further, it can be mentioned, after mutual negotiation that, if the duration of the session extends beyond the stipulated time frame than an additional fee may be/will be charged |
| • Emergency contact: If the client needs to contact the therapist in between the sessions, they can call/send message at _____number and leave the message and also mention that it is an emergency. If the therapist doesn’t call back the client in _____ time (say 30 min), patient should attend the emergency outpatient department of the hospital or the nearest health care facility |
| • Issues of confidentiality: The therapeutic contract needs to mention that the therapist will maintain confidentiality of the information revealed during the psychotherapy. However it also needs to provide the provisions under which the information would be disclosed to others, for example the confidentiality clause can be worded as |
| • Information shared by the client will be maintained strictly confidential except in the following situations |
| • To ensure the best treatment, therapist will at times discuss the case with his colleagues or supervisor, without disclosing the identity of the client |
| • In case the client is being seen by a team of doctors, then the details of the therapy will be discussed with the team members to seek supervision |
| • If the client communicates threat of bodily injury to self or to another person then the information would be disclosed to the family members and the legal authorities |
| • If the client is a minor, the details may be shared with the parents, as per the provisions of the mental health care act, 2017 |
| • When there is reasonable suspicion of child abuse or abuse of a dependent adult has occurred, or is likely to occur |
| • If ordered by a court of law, the details of the treatment will be revealed to that court |
| • In case of the couple and family therapy, the therapist may mention that “if you tell me a secret, you are asking me to help you disclose it, which I will assist you in doing.” “I maintain the right to disclose confidential information to other participants in the therapy, if I feel it is in the best interest of the family or couple to do so. You have equal rights to release information to outside parties but I will withhold it unless it is in your best interest” |
| • Therapist will disclose the information to a third person or agency, if client gives in written to release the information |
| • If the client files a case in the court against the therapist then the client loses his privilege of confidentiality |
| • Termination: If the client decides to discontinue the therapy, he will make this known to the therapist within a session, so that an end date can be fixed and the client and therapist can work towards an appropriate termination of therapy. Termination of therapy cannot be done telephonically or by text messages, nor be a sole decision of the client (This is to safeguard the client as frequently, during the therapy, client may have to discuss underlying difficult material which has been kept suppressed for the years. Certain defenses/aspects of client may stop them to discuss the same and that may convince their ego that they can’t afford therapy, don’t have the time for therapy, therapy is not working, or nothing is progressing, when, actually a breakthrough is on the card. So it is important that they ask for inner guidance with the help of their therapist when they have these doubts, rather than quit the therapy, just when life can begin to have new meaning) |
| • Gifts: No gifts will be accepted by the therapist from the client and neither the therapist will offer any gifts to the client |
| • Self-disclosure: The therapy will focus on the issues of the client and the therapist will not respond to any questions regarding the personal details, and any such attempt by the client will be interpreted |
| • Homework assignments: As part of the therapy client may be given homework assignments in between the sessions, which they are expected to carry out. If the client comes to the session, without completion of the homework assignment, then the therapist will have the right to cancel the session. However, in such situation, the client has to pay the fee for the session |
| • Documentation: The therapist may take notes during the therapy session |
| • Recording: The therapist may tape record/video record the therapy session for documentation and supervision purposes. It should also explicitly mentioned that the client cannot record the sessions, without the permission of the therapist |
| • Provision for revision: If required either by the therapist or the client, then the therapeutic contract will be revised after mutual discussion |
| • No suicide contract: In case, the client is suicidal, the contract can include the clause that the client is not going to harm her/him, and in case she/he has the urge to indulge in the self-harming behaviour, she/he will contact the therapist/designated person |
| • Termination of therapy: In which situations the therapist will terminate the therapy; what would be the obligations of the therapists and the client, in case either of them decide to terminate the therapy prematurely |
| • Complaints/dissatisfaction resolution procedure: It is useful include a compliant/dissatisfaction resolution procedure, wherein the client agrees to discuss any problems he may have regarding the therapist/therapy with the therapist first, so as to allow the therapist to resolve the same, before the client lodges any formal complaint |