we demystify what goes on behind the therapy room door join us on this Voyage of Discovery and co-creative conversations this is the therapy show behind closed doors podcast with Bob cook and Jackie Jones so welcome back to the therapy show behind closed doors with myself Jackie Jones and the wonderful Mr Bob cook and in this EP we're going to be looking at um something around contracts which I know we've looked at before but this one is advantages and disadvantages of Contracting in the therapy process right so Contracting one of my favorite subjects and Central tenant in transaction analysis Psychotherapy and I'm sure others but um as well but I was born and bred when I started to train in ta therapy in the whole world of Contracting so Contracting is something which I've always done in the last 40 years yeah and I'm sure you've have I'm sure contractual Theory as well yeah so I thought it'd be useful uh I think the other two podcasts are much more General about Contracting so let's start and talk about Contracting right there's different types of contracts there's business contracts sometimes called admin contracts tracks yeah uh or even business yeah business or admin usually called um and then um we have treatment contracts yeah is concerned with the actual uh goal of therapy or what we want from therapy so anybody who goes to specifically in the TA world but I suspect the other disciplines well have the sort of work business admin contracts and then they need to talk about treatment contracts in my view um and I want to talk about the advantages and positives of that because I know some disciplines who don't use contracts and um certainly aren't so specific about them uh whereas ta is pretty sort of like contractual theory is really a major tenant in ta yeah um so if we look at the let's get the admin contracts business contracts work contracts out of the way which any of those categories names we can use and then you I'll go through what would be in my admin contract and I'm sure there may or may not be um so in yours so number one and there's no linear order it's a bit like um TV talent shows when they give the result out they say no linear order in no particular order yeah no particular order XXXX so this is in no particular order so number one uh costs fees how much it's going to cost if it's normal therapy as opposed to say lowcost therapy so at the man Institute the 30 odd therapist are qualified and they may start off from about 50 for the hour and then we have low cost therapy uh which is uh you know low income a lot of students tend to use that um route and that will be1 15s fee for 50 minutes and there's up to 26 sessions whereas if you have um you know away from the low cost route it isn't limited 26 sessions for example it's much more go easy now oh gosh sorry about that BL you just the thought of fees and you've had an allergic reaction and things like I I think I've just come from having a massage and I so I think I've relaxed so much that I've sneezed anyway so 50 minutes 15 pounds so it's quite I think it's a good deal that absolutely so fee structure first um that well I'll say not in linear order but anyway uh like how often you have to pay that it's usually weekly um sometimes people pay monthly I inan psycho analytical world you pay yearly by the way um and then things like um you know holidays do people have to pay for holidays you know the admin structure yeah needs to be spelled out I think in any contracts really so you know what services you've got yes so I think that's important um how often you come so nowadays different from when I started therapy 40 years ago there's much more um people asking for fortnite therapy because of the actual Financial cost and today's society so they may pay for forn nightly U I'm sorry they might come fortnightly I I like weekly therapy so um that would be in my admin cost and then there's things like you know what do we do when we are ill or uh things like that so different therapist have different rules like 24-hour therapy or sorry therapist notice or 7 hours therapy notice things like uh those sorts of things particularly um any to any more to add I might have left out in the admin uh no I don't think so um I think for me it's about not um ending therapy abruptly there's something in there about you know coming to a an agreement an ending or whatever yeah um and just that if they don't arrive on time you know that's kind of them losing part of that hour um yeah and that I don't offer emergency out of was Services kind of thing do you know what I mean that and then does you know what they should do contact the GP or go to A&E or whatever I've just got that on as as standard and and then it's face to face in my case yeah yeah where yours I don't know if yours is online or it's online and face to face whichever yeah you have that put into the contract well so those admin business contracts need to be stated I think because you are paying for a service and I do think this should be an agreement absolutely should be bilateral yeah both of you and some therapist ask you to sign these business contracts by the way um I never went that far I I was okay with the verbal agreement yeah and also another contract which might come up at the beginning of therapy is some rules of therapy like you know confidentiality yeah I've got that in mind as well not turning up under the influence of drink or drug yeah some specific ones according to different you know therapists might be yeah there as well that's all done under the business of um Psychotherapy not I think they're very important contracts because these business contracts because they spell out the terms of service and they they you know also outline the boundaries of the service that's offered yeah I know I know we've probably touched on this in the previous podcast but I also have um like a form gathering information that's attached to it that my clients get either sent out or you know they get it in the session with emergency contact details and you know have they previously had therapy why are they come to therapy what are they hoping to get out of therapy GP address their address just basic information about themselves are they on any medication that sort of stuff yeah so for business contracts I don't have any disadvantages no me neither they're positive in terms of providing a safe structure yeah transparent struct both the client and the therapist I think it's that safe yeah yeah almost like a legal framework yes you're going to buy Services then there needs to be an agreement yeah Bally I think some people that I've come across over the years have been quite sketchy with information you know they won't give the full address or they'll say they don't actually know what the doctor's address is or whatever and I get a bit curious about that yeah and then it's up to you whether you want to take that client on yeah would I take a client on if they didn't give the doctors address interesting question things like that but individual therapists will have their own style here yeah yeah so that's interesting yeah you are right um okay so we now move on to the treatment contract would somebody actually want psychologically and what they want to change and how come they've come to therapy in the first place and I think that it's really important to have an outcome Focus agreement yes conts because again you're buying into a service absolutely yeah yeah a lot money for it and I think that contract or agreement should be explored and spelled out at the beginning of the therapy process yeah at the beginning yeah yeah I think it's a good opening session to have with the client to talk about that and for lots of reasons um one because I I think it provides safety structure and boundaries but it also gives a Guiding Light or framework of where both of you are heading yeah and ta therapist particularly but other therapists um also talk about the difference between soft and hard contracts so a soft contract would be something which is more vague like say for an exploring cont okay we'll just explore the them of depression or will explore Theology of your anxiety or will explore how come uh you know you have had eating disorders for the however long you've had it or we'll explore how you become the way you are and there's nothing wrong I think with exploring contracts and for many therapists they will accept exploring contracts I think I put a visor on it though and that is what do you do when you finished exploring so you can have explor and then what and I think what it needs to happen is once you've explored what you are exploring then you make a contract another contract or you review yeah because you explore depression for a long time or disore explore anxiety or generalized anxiety or whatever we're talking about and then what it's like what happens then so I think the name needs to be a contract hopefully out of the exploring will will come where you're heading yeah I think that's what I always do I think I always start off with an exploratory contract because that's the part of getting to know the client and and everything building the relationship yeah the important bit though I think Jackie I agree by the way lot of therapists do that is like how do long do you explore for yeah because that can be a defense process put up by the client to keep you away from actual in you know going towards change um and that you make a change contract after the exploring yes yeah yeah now people listen to podcast might think that's a bit um well obviously I do that but lots of therapists don't do that and also they can keep exploring for a very long time absolutely yeah and going round and round in circles and not really getting anywhere yeah that's either the manipulation by the uh client I'm using manipulation in unaware place not actually manipulation from a con conscious place or the therapist gets caught up in the process as well yeah but they both go around and around number one that then becomes very expensive yeah yeah number two no change happens which might be the aim of the game by the client or unawarely of course the therapist and uh number three rein firms the script of the client do you think that's sometimes a criticism of psychotherapists that that's what they do is just do an exploratory contract and don't actually come to a resolution at the end of it they just go for years in an explosion fashion yeah and it's often yes I do think that and often that's said in many different ways you've said distinct way there um but it's the therapist has an open doesn't how can I explain you has an open-ended contract yeah words they can just explore and explore and explore and the the client then puts up the defense systems and they explore and explore and explore and then they can get caught up in repetitive behaviors or games both parties yeah and nothing much might H much might not happen except for it might move into P timing yes move into um confirming the client's script or it might move into confirming the therapist script or it might move into as I say a sort of unstructured vague nebulous time time process uh and I think that is often thrown or might be thrown at there because the we're not actually doing anything yeah seem to be um Pas timing or explore things or you know where's the results and all these sorts of things which can be thrown in the therapists and I think it's very important to move some time and I think it's up to the timing of the therapist and the client when this happens by the way from an exploring contract to a much more specific one yeah because the title of this is and advantages and disadvantages of having a contract so one of the advantages would be having Clarity and commitment from both parties yes and also yes and also an outcome yes yeah yeah that both parties have agreed on the outcome yes which could be instead of being depressed that I want to be relaxed yeah you know instead of feeling unhappy in my life I want to have more contentment yeah yeah so there's a actual structured outcome and that outcome depending what type of therapist you are you might want to go further and say how will I know when you've got that outcome I was just about to say that yeah when will we know that you've got there with content and what does that look like how will it be for you yeah yeah yeah so that has to be put into it so you've got a specific behavioral observable outcome focused agreement yeah cuz a lot of the time on my contract where there is a section what do you want from therapy people will put to be happier yeah well do you have to spit that down then you have to ask I think an important question than you in the cloud is it achievable yes absolutely yeah so that's one big Advantage providing I think uh a structure sequence and a direction in therapy which is bilaterally agreed by both people and both people will know when you you've got there yeah and having that there will be structure and boundaries around that whether it is a you know a a I don't know how you say it a time restraint contract that you're going to work together for x amount of weeks or whatever it is yeah yeah yeah a second Advantage is that provides transparency between the two people absolutely yeah yeah it's not sort of like hidden away or not said or you know we've got an explicit agreement going on yeah yeah and like you said that may be that you review it or you go back to it it's not just like made and then put in a drawer and forgotten about thirdly it provides psychological security and safety I think yeah fourthly while you're making the contract it builds up a relationship forming process between therapist and client so there's a more robust Rob bust a bond because it take quite a a while one session two sessions whatever to get to this contract absolutely yeah yeah so you might spend four sessions making the treatment contract you might when you make the business contract pretty quickly in sort of about 20 minutes but yeah talking about um a treatment contract I think people listening to this are going to put a time in it I think you need to give yourself at least four sessions to make it no if you make it in one session fine but you see I think there's more to this you need to also ask how might you stop yourself you might to the client I mean how might they sabotage themselves or stop themselves from achieving the achieving contract that's a discussion which you might have in the process of making the contract yeah yeah so there's lots of layers to it I think one one of the things that I was thinking about was empowerment as well the client being involved in the process of the contract it's not like in the good old days where you know the I don't know the psychoanalyst would say this is what's wrong with you and this is what I'm going to do they're actually involved in the process of the contract and the treatment planning absolutely but nowadays there's a word for this co-created relationship yeah the two of you have a a bilateral co-created relationship and that's very diff from like you have just said from 100 years ago where it was much more of a one up one down analyst position yeah and they know that having that empowerment and that involvement in it there's no surprises to them either so hopefully do you know what I mean that gives them that safety security and that you know that safe space and everything yeah so I think that's a really important Advantage by the way that the client will feel empowered or at least the potential for empowerment yeah in taking charge of the process in um working out an agreement of gold and to and also talking about how they could stop that or sabotage that will I agree with you potentially a very empowering situation for the client yeah and you touch then on goals as well you know that there maybe are some specific things things within the contract that the client wants to achieve it might be that they've come for a specific reason you know I don't know that they want to go abroad on holiday this time next year and that's their end goal that's what they want to achieve but the anxious and frightened to Flying whatever yeah agree more and I think it's really important that you give yourself some sessions to explore these sabotage mechanisms yeah um and also what they need to do to deal with their sabotage mechanisms and how will it look like when you've achieved the outcome of the contract yeah so you won't do this in one session or if you do zooming through too far you far too quickly for my liking it should be giving yourself four or five sessions to do the Contracting and building a rour up in a co-created process with the client as you go along yeah and I'm sure you do Contracting in this way don't you yes yeah definitely I I was thinking as you were talking then I think it's part of the exploratory contract that I used to draw up the other contract if that makes sense I'm getting to know the client while we're doing the contract over you know a few weeks yeah I'm not sure I'd take four or five weeks but definitely a couple of weeks yeah okay a fifth advantage and a for people listening uh one is that the agreement is chosen between the two people so both of them know what they're doing yes tip in this though if the Contracting goes a bit haywi or quite often and I this has happened a lot when supervision when I talked to the therapist um and it's unbelievable in one ways but um the therapists thought they made a contract about X how however the client has thought they made a contract about why in other words they both have different contracts yeah that's because it's not been explicitly enough it's not been specific enough is that one of the disadvantages that it's kind of misaligned it can be and it can be a disadvantage of a contract you could P that in the disadvantage column I suppose that if the therapist doesn't check out in the explicitness of the contract cont yeah why some therapists write it down um the therapist can think they've got one particular contract but actually the client thinks they've got another one and it and the danger of that of course is people go two ways and not go the same direction and I suppose you can put that in the disadvantage con yeah yeah and that that again the client can feel like they've been misunderstood or misheard or whatever it is yeah yeah so dis while we're on disadvantages might might as well over there then one huge disadvantage and I'll tell you some therapists that really don't like contracts GTO therapists they don't deal with contracts um and one of the major disadvantages they would say and other people who perhaps don't deal with contracts either as in therapeutic process is that um the clients might often adapt to what the um therapist is suggesting and therefore um they adapt to please the IST and you end up in a with an adapted contract rather than transaction analysis terms an adult to adult contract yeah and I suppose in the early days if it's the first time you've met that person if you were to do the contract in the first session or in the first couple of weeks you wouldn't really know whether that was adaptive or not because you haven't built up that relationship yeah and they're very well defended often yeah the second one would be um that by having goals agreements contracts you might be predetermining the Journey of the the the actual therapy Road rather than letting things emerge in a very organic way yeah be I think I don't know whether it's a disadvantage or a misunderstanding around contract sometimes is that once it's made and you've signed it in Blood and sweat and tears it can't be changed whereas it it can it can be you know what I mean reviewed and assessed and adapted dependent on what how the therap is going and what the client wants they might decide that actually this isn't what I want to be looking at yes that's very true um I think it's important to have reviews and all those things because some people I I I do think that they think it's quite rigid if you have a you know a contract around treatment rather than well what happens if if I turn up one day and I don't want to talk about that and you know something's happened and I want to talk about this and it's like well that's okay we can talk about that yeah that's right that's so that's a that's another disadvantage and also when I said emerge I mean that so the psychodynamic psychotherapist perhaps for example don't I think work with these sort of contractual processes they would argue and especially Castell therapist as well that it's really important to allow um underlying unconscious processes to emerge rather than have a predetermined contract yeah and if you have contracts and goals and all that sort of stuff then you'll miss out what might emerge and you also what might happen is that the client might go underground yes yeah yeah or and also another disadvantage if You' got to predetermine specific cont you may miss out on a lot of other things absolutely some people would some th would say well I just like to go with what emerges in a therapeutic session and then we'll really go with that unconscious process rather than have a a specific behavior observable achievable road yeah I think is is there a happy Med between the two Bob what say a little bit more about that what you just that there's an overarching contract with an overarching aim or a direction let's say that is is not rigid you know I think some clients I don't know they don't like the formal contract or the formal nature of a contract it can feel quite restrictive to them well are you talking about the difference between again it comes from the TA World these terms General overall AR reaching contracts and sessional contracts yeah maybe maybe yeah you know so we'll go with what emerges every session but we have a general direction yeah yeah I think when you know I've had clients that have said to me you know when you first sent me the you know the form to fill out and and all this sort of stuff I thought was very formal but then once we discussed that the reason why I do that you know it's for your safety as well as mine and that you know we have the business side of things covered they kind of understood it but yeah if if that was to be explored in a session under a you know a treatment contract they might not like the formal setting of it that all makes sense to me so maybe there's a middle ground um I was talking to one of uh therapist friend of mine who runs long Psychotherapy uh intensives and teaches off them and he said oh when I'm with ta therapist after the therapy when they're asking questions they often say where was the contract he didn't make a contract because they're taught always ta thies to make contracts you you know which are behave unobservable and his answer was well I just wanted to see what emerged yeah and we'll go from there and do you think that's okay uh well I think it's okay yes of course it depends on the style and what you believe in psychotherapeutic processes and principles um uh I I think out of what may emerge you may make agreement yeah I think that's what I like do you know what I mean that yeah there is room for something to emerge and the co-creation in the conversation and everything but that overarching it there is some sort of Direction there yeah definitely and um see if you went to see a psychoanalyst they still exist by the way yeah say to you might be a different form but their methods might be very similar in terms of interpretation yeah two three four interpretations a session um free association just letting person talk and deal with what emerges and then interpret it um the ideas of transfer and everything else um they would probably see contracts as an anatomy because it takes away for or it may take away free association so I don't think it's about right and Wrongs I think it's about different styles I personally like a halfway house yeah I think I do too yeah and it's understanding as well that some people will like a a structure to it and other people won't and it's being adaptable as well TA today which is probably the best well best well people might argue but I think it's probably the well-known the most well-known introductory book to TA on that written by in Van joins came out 1989 there different additions they have at least two chapters on contracts but and they're very where the way we are talking here you make a contract observable specific achievable look for sabotages what do they need to achieve the contract it's like a sort of uh one two 3 for Psychotherapy yeah and for me very useful especially for beginning therapist actually I think yeah I think I needed the contract probably more than the client in the early days May yeah maybe because it provides structure of thir um I think quite often that was will get more experienced I've done many many clinical hours probably then start to feel safe with well let's just see what emerges and then we can go from there yeah so there's advant disadvantages and advantage of contracts probably I do like a halfway house I think I do like to think I do like well I do have a I suppose is an agreement let's see what just emerges over to you and then out of that we may bilaterally agree on the direction we're going yeah and I think that's the important bit is to have that conversation with the client so that they know what it is that we're doing whether it's a sessional contract or or whatever it is yeah I think it's really important to look out for adapt what I would call adapted contracts yes you know because you know if they're just adapting from their unconscious part of themselves on ta child eego St and somehow the therapist is taken that direction then they could just reinforce their script so I think it's really important for thers to think about that the contracts come from and ta was adult to adult the age they are rather than a younger self yeah thank you very much Bob yeah I like I've always liked talking about contracts yeah me too I mean I it what I was first trained in yeah and it's good to look at it from both points of view the advantages and the disadvantages and I'm happy that there is a halfway house I feel comfortable in that place yeah okay thank you okay so what we're going to be doing next time I'm really looking forward to this one is Shadow and Light Within the therapy process so am I roll on next week until next time Bob see you next week byee you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode