Establishing a client contract
In Towergate Professional Risks’ 20 years of insuring
practitioners of the talking therapies, we have noticed a general
reluctance to agree in writing with the client the contractual
aspects of the therapeutic relationship. Establishing boundaries is
crucial in ensuring a safe working environment for the therapist
(as well as the client), and creating a contract between
practitioner and client can protect both parties against painful
and costly complaints and civil action.
This applies equally as much to child psychologists as it does
to those practitioners treating adults.
In this regard, the term ‘client’ in this document applies
equally, of not more so, to the parent or guardian as it does to
the child. Legally, the child cannot enter into a contract and
therefore getting the support and understanding of the parent or
guardian is imperative to allow the relationship to begin with
everyone aware of the responsibilities and commitments of each
party.
Throughout the remainder of the document, the reader should
interpret where client means child, parent or guardian, or
both.
A written contract that is signed by both the therapist and the
client at the outset of the therapy is not just good ‘risk
management’ for the therapist, it also helps to support the
creation of a working alliance - the sense that client and
therapist are engaged in a shared enterprise that can support the
client to remain in the therapy and work problems through rather
than to leave and attack it from the outside.
Risk management is particularly important when working with the
type of client who is more likely than others to find fault with
the therapist or therapy. Although the principle of ‘informed
consent’ is widely used (i.e. a client has given consent to the
treatment or the course of action based on having been informed
about possible risks and anticipated difficulties) it is not yet
applied by the UK courts.
In the UK the courts rely on sufficient consent, employing the
Bolam Principle (1957), which states that a ‘doctor’ is not
negligent when acting in accordance with a practice that is
accepted at the time as reasonable by a body of other
practitioners, even though other ‘doctors’ might adopt a different
practice.
More and more ‘Particulars of Claim’ in civil actions against
therapists outline the claimant’s understanding of the original
contract - usually differing considerably from the therapist’s
understanding - and contain difficulties with many of the areas
covered in the example Initial Therapy Promise we can provide you
with (see details below of requesting this document).
Informed consent means that the ground rules and procedures of
the therapy as well as its potential risks and benefits should be
given to the client at the start in writing. This should include
information about length and frequency of sessions, payment and
cancellation arrangements, holidays, illness, confidentiality,
discussions with third parties such as supervisors, other
colleagues and other medical practitioners such as the GP and the
use of ‘case’ material for training or research purposes, including
the recording of sessions.
The sample document we can provide you with has been compiled
from a variety of sources, and is only intended to be a guideline.
Each therapist will need to put their own stamp on any contract /
promise document based around the specific therapy and that
therapist’s way of working. Towergate Professional Risks’ knowledge
of the substance of complaints and civil actions against therapists
has shown us that the possibility that the client could complain
was usually present at the beginning.
We do believe that a contracted / promised ‘assessment period’
is a vital component to a successful outcome and to flagging up any
‘clues’ such as a protracted disagreement with a family member,
colleague or other professional who the client wants to ‘destroy’
or ‘make pay’. Where this is the case it would be wise to consider
adapting the document to reflect this.
Where it has not been obvious at the outset that a client fits
the profile of a potential complainant it is always wise to raise
in writing at the beginning of the therapy any ‘relational hurdles’
that are obvious at the start, and to allow room for review
sessions that focus on any new hurdles that are encountered along
the journey. Our experience shows that this can work very well.
We welcome requests for the Initial Therapy Promise document we
have put together and we hope that you will use this document as a
springboard to come up with what works for you and that you will
share what you design with colleagues as best practice. This is
partly to encourage a higher standard of good practice across
disciplines and to guard against therapy becoming a clash of
personalities or values or ideologies rather than a professional
relationship.
We ask for you to request for this document rather than allowing
you to download it from here as we need you to confirm that you are
happy with the following first:
- Whilst the document contains terms that may form a binding
contract between you and your client, it is not a comprehensive
document prepared by those with appropriate legal knowledge and, as
such, we are not providing legal advice and it is not intended to
be used as a formal legal document
- It is purely a suggestion, developed from our experience as a
broker for therapists, of those matters our clients might want to
set out and agree with their client at the beginning of their
professional relationship to avoid misunderstanding
- If you do want to establish a comprehensive legal terms of
business we advise you to seek legal advice and
- We do not accept any liability that may arise if the client
chooses to use the document in any way
Please email us at professionalrisks@towergate.co.uk
or call us on 0113 391 9598 to request the Initial
Therapy Promise document.
Remember
- Stick to the contract / promise, and then re-contract when
necessary. For example, if a client comes for help with making a
career choice then don’t move into exploration of early childhood
unless specifically agreed.
- Be open about the possibility of onward referral from the
outset. This can avoid a client feeling unhelpfully rejected if you
do decide that you are no longer the best person for the job.
- Remember that a written contract / promise is not there to
cramp your style but rather to let you be more creative in a safe
space