Module: Counselling and the Law

Kevin Standish

LECTURE 3: CONTRACTS IN COUNSELLING

1. Understand the principles of contracting and its

application to therapy

2. Describe relevant information required when

contracting

3. Create a client contract with appropriate and

relevant information

4. Reflect on the importance of contracting within the

context of boundary issues

LEARNING OBJECTIVES

1. Contracting basics

2. Ethical principles and contractual duties

3. Administrative contract vs therapeutic contract

1. UNDERSTAND THE PRINCIPLES OF CONTRACTING AND ITS APPLICATION

TO THERAPY

A contract is defined as:1. A promise to do or supply

something2. An agreement3. An exchange of money

CONTRACTING BASICS

1. The court will look at the three key elements to determine if a contract has been form:

2. The promisor offers to do something in return for which the promisee agrees to provide something in return (the consideration)

3. For example: a therapist offers to provide therapy in return for with the client agrees to provide money.

WHAT MAKES A CONTRACT LEGALLY ENFORCEABLE?

1. Being trustworthy (fidelity)

When making the contract, the ethical principle of fidelity is about willingly agreeing to do what you can. Therefore, a good rule is to be clear about your own boundaries.

2. Autonomy (empowering clients)

This means that you have given the client all the information they need in order to decide whether or not to work with you. What would this include?

This includes your terms and conditions, and some exploration of your working style.

ETHICAL PRINCIPLES AND CONTRACTUAL DUTIES

3. Beneficence (actively benefiting clients)

Because this principle expresses the need to be working within your level of competence, it is important to have a clear understanding of the clients’ issues before agreeing to work with them. Offering clarity from the very beginning is good modelling, and allows clients to build up a trusting relationship.

4. Non-maleficence (avoiding harm to clients)

Clients most often feel aggrieved because they have expected something else from the counselling process. This is very often to do with a failure to be clear in the original agreement.

ETHICAL PRINCIPLES AND CONTRACTUAL DUTIES

5. Justice (treating clients fairly and equally)

The point of having a contract is that it is proof that you are treating your clients equally.

6.Self-respect (applying all the above to self)

Is your contract one you are happy with? Clear contracting makes your own boundaries clear. You are less open to manipulation, either conscious or unconscious, and more able to enter into a working alliance free from psychological game-playing.

ETHICAL PRINCIPLES AND CONTRACTUAL DUTIES

What are the differences between these two kinds of contracts?1. Administrative or business contract concerns the practical elements2. The therapeutic contract is a mutual understanding of the client’s reason for coming to therapy ie the working alliance

ADMINISTRATIVE CONTRACT VS THERAPEUTIC CONTRACT

1.Why do we need a therapeutic contract? 2. What terms go into a therapeutic contract?

2. THE THERAPEUTIC CONTRACT: THE IMPORTANCE OF CONTRACTING

WITHIN THE CONTEXT OF BOUNDARY ISSUES

EthicalLegal

Practical

1.WHY DO WE NEED A THERAPEUTIC CONTRACT?

1. Keep it simple but comprehensive

2. Consider capacity to consent3. Keep it in writing4. Reviewed regularly

3. WHAT PRINCIPALS GO INTO A THERAPEUTIC CONTRACT

For consent to be valid the patient must:

 

• be able to understand in broad terms the nature and purpose of the procedure;

• be offered sufficient information to make an informed decision;

• believe the information and be able to weigh it in the balance to arrive at a decision;

• be acting voluntarily and free from pressure;

• be aware that he or she can refuse.

 

Source: BMAED, 2004: 72 

INFORMED CONSENT

INFORMED CONSENT

• using the informed consent approach is not a one-off event: the signing of an agreement specifying the nature of the contact, and the risks and benefits involved.

• informed consent really represents more of a process of dialogue, continuous updating and checking out with the client, rather than a once and for all event.

• ‘Consent is an ongoing dialogue between the patient and mental health professional in which both parties exchange information, ask questions, and come to an agreement on the course of psychotherapy...Both parties must be active partici-pants. A document cannot replace this important process. The emphasis is on communication, not the form’ (Packman et al., 1994: 193).

INFORMED CONSENT

1. Terms and conditions2. Personal client and data3. Files and access4. FeesIt needs to be a Written Contract that isSIGNED and DATED

4. ADMINISTRATIVE CONTRACT: RELEVANT INFORMATION

REQUIRED WHEN CONTRACTING

1.Venue, time, frequency2.Duration of commitment3.Therapeutic boundaries

5. ELEMENTS TO CONSIDER FOR INCLUSION IN THE THERAPEUTIC CONTRACT

Core reading

Mitchels, B. & Bond, T (2010)

1. chapter 3 liability in Tort: negligence

2. chapter 4 contracts

3. Bond, T. (2010) chapter 5 safety, negligence and insurance

4. Jenkins (2007) 4 - Professional Negligence, Liability and Duty of Care

CORE READINGS

Sills, C. ( 2006) Contracts in Counselling and Psychotherapy

1.  Chapter 1 - Contracts and Contract Making

2.  Chapter 7 - Contracts and Harmful Behaviour

3. Part II: Theoretical Approaches

4.  Chapter 2 - The Use of Contracts in the Psychodynamic/Psychoanalytic Approach

5.  Chapter 3 - Cognitive Therapy: A Down-to-earth and Accessible Approach

6.  Chapter 4 - Contracting within Person-centred Counselling and Psychotherapy

7.  Tribe, R. & Morrissey, J (editors) (2005) chapter 4 psychological contracts with and with in organisations by Michael Carroll

8. chapter in 11 complaints: professional ethical issues by Tim Gallagher and Rebecca Haworth.

ADVANCED READING