Recently I began working with a new client and I had the first two sessions with a counsellor, so I've been on both sides of the contacting process, and by coincidence, the counselling school has set an assessment task that included writing a draft contract. It’s no surprise that I now feel like sharing my thoughts about contracting with counselling clients.
My day job often puts me in touch with nurses and other healthcare practitioners who have been whisked into a paranoid frenzy in relation to anything legal, but many people meet nurses through the NHS or a private healthcare provider.
This means that most of the people I’ve worked with don’t make a contract with a nurse as an individual practitioner in the same way that they do with counselling clients. Over the coming months and years I’ll be curious to hear other counsellors’ thoughts and experiences about contracting and I anticipate that their attitude will be very different from the one I’m most used to hearing; that a clear statement of expectations will keep the practitioner ‘out of trouble’, prevent disciplinary measures or avoid litigation.
As a nurse, I have a different take on the legal elements of my practice: a clear and explicit statement of expectations can enhance the relationship between a caregiver and the person they treat; which is not to say that legal issues are irrelevant, more that if we get the relationship right, legal action is less likely. What I’ve learned so far suggests that this is transferable to the counselling room, so here's my take on how I think a contract might help me and my clients.
All expectations great and small
I think the first thing that a clear contract offers is an opportunity for both client and counsellor to state what they are offering and what they want from the relationship. That gives us both the chance to consider how that sits with our expectations. If there's a mismatch we can ask questions and the answers may help us to decide to continue, or the client may decide to seek help elsewhere. Either way, the contract is helping us both to avoid disappointment.
Valuing client autonomy
The contracting stage is often the first opportunity the counsellor gets get to be clear about their attitude towards the client's autonomy. Clients who are new to counselling may be surprised by how free they are in the relationship with their counsellor. This may be especially so if they've been using medically led services such as GPs and NHS hospitals, where many relationships (though by no means all) are conducted along some degree of transactional, hegemonic and paternalistic lines. While consent is a regular feature of medically led care, my experience suggests that much greater attention is paid to ensuring the client understands and accepts the balance of risks and benefits in the counselling room rather than in the consulting room.
This approach helps both client and counsellor to avoid unpleasant surprises.
A Supporting partnership
I think that the tendency toward transactional, hegemonic and paternalistic relationships in healthcare institutions can be traced along a number of avenues, all of which lead to one origin: power. Many column inches are written about the asymmetry of power in healthcare and how it operates as a barrier to achieving true partnership with the people we treat. The process of reducing the asymmetry is slow. I've been a nurse for 25 years, it was there when I started and it's still there now.
It seems to me that there are two reasons for counselling to have a different approach to partnership. One is that the work of counselling is the relationship. Counselling is about forming and conducting a relationship and not what we do to the client. You might even say that the client does the work while the counsellor facilitates and actively listens to the client’s stories of the work they've done.
Ready? Steady? Go!
I imagine most counsellors have some experience of working in organisations where demand exceeds supply, with a list of clients who are waiting for a counsellor to be available. I gather from conversations and blog posts that the same is true in private practice. Many counsellors report that they need to mindfully and carefully balance work with leisure because the number of clients and associated work they could take exceeds the healthy working week . These are two examples of how counselling work begins only when the counsellor is ready.
On the flip side, there's the idea that the client might start a series of sessions but not be ready. Anne Crisp has researched the experience of working with unprepared clients. Her work suggests a range of reasons why a person might not be ready for counselling.
As a novice counsellor, I get a lot from reading her work. Whatever the reason, there's plenty of evidence that the therapeutic effect of counselling will only begin when the relationship develops, so it seems worth taking the time to check that clients understand what they’re signing up to.
For now, I’m trying to keep in mind that counselling is a relationship with a purpose, and where there are expectations, it’s good to make sure they are clear...and I hope that’s where contracting can help.
Ciaran Hurley lives in Sheffield and is in the second year of training, currently volunteering at a mental health charity as a trainee counsellor and is passionate about reducing the stigma of mental health. He takes care of his wellbeing by making music with friends, making graphic art, making time to be outdoors and eating well. Tweet him @cpbych
Anne Crisp (2013) Strangers in a strange land Therapy Today 24 (1) 32-34
Anne Crisp (2016) Stranger in a strange land: Take 2 Counselling & Psychotherapy Journal (online on 28 September 2017 at )