Optimising the therapy experience

Guidelines for contracting therapy

Previous research, along with the interviews from our participants in this project, suggests that the contracting phase is where many problems can begin.

I sort of expected more of a framework of progress. - Client

This is a key stage, which if got right can prevent many problems later in therapy. In some therapies that did not go well there was no initial discussion about a contract and the patient was expected to turn up regularly for an indeterminate length of time with no clear description of what would happen in the sessions nor of what the eventual aim of the therapy would be.

Effective contracting can help to develop appropriate expectations of therapy as some clients It would have helped to have a clear contract at the start of therapy about patient versus therapist responsibilities and what could or couldn’t be provided in the NHS. - Therapist may come in with unrealistically high (or low) expectations about what may be achievable. It can be helpful to you in shaping client behaviour – e.g. letting you know about absences in good time, or undertaking between-session work at home. Contracting can also help the client get a picture of what therapy might look like – don’t forget that it may be their first experience of psychological therapy.

A therapy contract should ideally be an actual written document that you can each refer to as therapy progresses. It could contain elements such as:

  • The ‘brand name’ of your therapy.
  • What kind of activities happen in a typical therapy session, and why. This may include reference to the role of the therapist (including what you will and will not do).
  • How long overall the therapy is likely to take and, if not for a set period of time (such as with CBT or CAT), how and when decisions to end or continue will be made.
  • Practicalities such as the frequency and length of sessions, payment (if applicable), dealing with missed sessions, criteria and procedure for ending therapy early.
  • Agreements about how to handle boundary issues, such as unexpectedly meeting in public.
  • Confidentiality and its limits.
  • The fact that you receive supervision and why.
  • How to deal with dissatisfactions in therapy – this should include strong encouragement from you that you would welcome the client telling you they are unhappy with what is going on. This should also include details of who to contact in the case of a formal complaint.

Some therapists find it helpful to have a pre-drafted contract drawn up because so many of these areas are standard and will not vary from one client to the next. Contracting should be done as early as possible, probably in the first or second session.