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Bangladesh Journal of Bioethics 2019; 10(3): 11-15 

 

11 

 

Therapeutic Contract and Ethical Practice in Counselling and Psychotherapy 

Sunjida Shahriah1, Sunjida Islam2, Khalid Arafat3 

1. Professor & Director, Phoenix Wellness Centre, Dhaka, Bangladesh.  

Email: sshahriah@yahoo.com   (corresponding author) 

2.. Counsellor and Psychologist, Phoenix Wellness Centre, Dhaka, Bangladesh. 

3. Coordinator, Phoenix Wellness Centre, Dhaka, Bangladesh. 

Abstract: Psychotherapists and counsellors confront several ethical dilemmas as they tend to 

provide effective services. There has been much debate among psychotherapists and counsellors 

alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the 

therapeutic process and often hindering the work done in sessions. In contrast, many counsellors 

and psychotherapists use those agreements to revisit specific therapeutic topics and establish the 

guidelines necessary for this professional arrangement. No matter the opinion or preference of 

contracts, the development of written and/or verbal consent of specific topics in psychotherapy 

remains essential. This remains one of the formal features of the arrangement and starting 

relationship in current counselling and psychotherapy practice. This paper aims to discuss the 

necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice.  

Key words: Therapeutic contract, counselling, psychotherapy, ethics. 

 

Introduction: Therapeutic contract is a 

mutual agreement in counselling or 

psychotherapy, among the therapist and the 

client. It indicates the rights and 

responsibilities of both to ensure target 

treatment goal. Contracting also ensures that 

“the counseling process will be performed in 

a good and safe manner and, as a written 

document, provides the necessary space for 

legal intervention if the responsibilities 

outlined are not met”1. Specific contract is 

mandatory to assess the output of individual 

session to ensuring both ethical concerns 

and the therapeutic process. A practitioner 

evaluates the situation and context of a 

contract for better management of the client. 

The practitioner and client are related to 

each other as equals. Hence, they share 

responsibility for the change the client wants 

to make2. There are already considerable  

discussions and debate on the utility of 

contracts among psychotherapists and 

counsellors alike. Some see contracts as 

restricting the healing process and often 

hindering the work conducted in sessions. 

The agreement can restrict both the capacity 

to perform specific treatment procedures and 

the scope of the role of the therapist. The 

innovation and ability for clients to extend 

their limits of freedom could be undermined 

by defined protocols or contracts3. On the 

contrary, those arrangements are used by 

certain therapists to revisit specific 

individual therapy subjects and create the 

appropriate criteria for this professional 

structure3. Contracts create an equilibrium of 

power and balance for sessions very often4. 

No matter the view or desire of contracts, it 

remains important to develop written and/or 

verbal agreement for a particular 



Bangladesh Journal of Bioethics 2019; 10(3): 11-15 

 

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psychotherapy subject/patient. This part is 

one of the official aspects of the 

psychotherapy agreement and original 

partnership, whether in private practice, 

community clinics, hospitals, schools, or in 

the legal system3. This paper aims to discuss 

the necessity and ethical demand of 

therapeutic contract in counselling and 

psychotherapy practice. 

Theoretical Concepts: Psychotherapists 

differ widely in the utility of contracts in 

practice, beyond the theoretical origins of 

psychotherapy contracts3. Traditionally from 

the psychoanalytic field, the first contracts 

used formally in therapy emerged, where the 

arrangement was used mostly like a one-way 

negotiation with the client's desires that the 

therapist had. In Freudian perspectives, both 

the client and the therapist are allowed to 

break a contract at any point, as this 

“separation was not seen as a negative 

reaction, but rather a choice to leave certain 

problems unresolved”4. Family structures 

and ecological constructs were the first to 

incorporate contracts as an integral method 

of boundary setting, as the utility of a 

therapeutic contract grew over time. 

Contracts not only offered protections 

between other family members but from 

individuals involved in the treatment process 

outside of therapy5. In the 1960s, during the 

development of brief therapy approaches 

and treatments, therapeutic contracting 

became more prevalent in psychotherapy6. 

The use of contracts as a critical aspect of 

treatment has been highlighted by short-term 

models, as described by Tudor7. The method 

that therapy can occur over time has always 

been determined by contracts that are 

organized and precise in course of care and 

nature. It is especially applicable for those 

who are placed in residential treatment, 

hospital or short-term rehabilitation settings 

and have specific contracts to address 

certain medical or mental health issues7. 

However, more recently, psychotherapists 

and counsellor from the postmodern 

perspective see therapeutic contracts as a 

socially constructed process, as they came 

into the therapeutic agreement with 

preconceived notions about what the 

contract looked like or what the expectations 

for therapy entailed, along with the goals for 

therapy most often phrased in the “language 

of the clients, where more strengths, 

solutions, and narratives are emphasized in 

the initial contract”3. 

Therapeutic Contract and Ethics: It is not 

surprising that the intentions and usage of 

contracts in sessions vary among counsellors 

and psychotherapists. Typically, counselling 

contracts begin with a short overview of the 

services that are offered to the clients, as 

highlighting the treatment specifications 

delivered by the professionals8. Commonly, 

psychotherapists are seen as facilitators with 

basic therapeutic objectives, expected to 

focus with during the process of mental 

health care for individuals. However, in the 

therapeutic process, clients sometimes may 

feel unnoticed or unheard, jeopardizing their 

desire to address broader problems beyond 

the expectations agreed upon3.  

Historically, psychotherapists have used 

three forms of therapeutic contracts.  

Firstly, an administrative contract which 

deals with therapy's logistical supports, such 

as location, venue, length, details of the 

organization, and secrecy. To highlight the 



Bangladesh Journal of Bioethics 2019; 10(3): 11-15 

 

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setup and configurations of the counseling 

process, this is regarded as a fundamental 

text9. Secondly, a written contract, the 

document that the therapist has formulated 

for a particular cause or intent that helps to 

describe treatment. This establishes trust and 

confidence that the therapist will work in 

psychotherapy/counselling on a particular 

topic or that in meetings the therapist will 

honour a clear ethical/legal issue9. Finally, 

the purpose and focus of therapy is 

established by a professional contract. On 

what the emphasis of the job will be, the 

therapist and client share a legally binding 

arrangement. Here collaborative and 

mutually agreed attempts are taken to set 

targets9. 

There are some ethical facets of a traditional 

contract with counsellor/psychotherapist that 

should be addressed in therapeutic contract:3  

1) The treatment type/style that the 

counsellor/psychotherapist is offering; 

2) The types of resources given and what 

exists in a normal session;  

3) How long treatment will take and over 

what specified time frame;  

4) Payment procedure/arrangements and 

how postponed appointments are dealt 

with;  

5) How to discuss questions of secrecy and 

their boundaries in counselling and 

psychotherapy;   

6) How to deal with unforeseen events 

during treatment.  

The relationships between the client and the 

counsellor/psychotherapist also more 

subjective and less formalized, as goals are 

typically co-constructed and chosen, and 

counsellor/psychotherapist works as 

facilitator providing fresh insights and 

visions on what objectives are to be 

accomplished. However, one of the 

disadvantages of such contracts is that in 

times of distress or turmoil, it also does not 

arrange the lives of clients and families 

efficiently. Moreover, to decide what 

progress happens in the counselling phase 

and when cessation of care is implemented, 

the therapist can experience some 

uncertainty1,3,10. The body of a contract 

should start with confidentiality statements, 

positive words and continue to the specifics 

of the meetings, how the therapy will 

commence, how long it will last, how it will 

be completed, facts about missing meetings, 

where and how the sessions will take place. 

Information on reimbursement, rates, and 

how various conditions impact these rates 

(e.g. missed visits, forms of psychotherapy 

delivered) should be concluded in 

contracts3,9,10. In order to outline the rules 

and steps for mandatory documentation and 

other legal responsibilities, counsellor and 

psychotherapists should be motivated 

enough to state the ethical code(s) of their 

assigned occupation or professional code of 

ethics as followed by the corresponding 

national association11,12.  

For the safety and ethical clearance, 

appropriate informed consent from clients 

about the process, procedures, plan, and 

risks vs. benefits of the treatment is 

mandatory3,11,12. All professional counsellors 

and psychotherapists must also get written 

consent about any videotaping, audio 

recording, or permitting third-party 

observation taking place11,12. Moreover, for 

authorizations to release or obtain 

information to outside parties, the they must 



Bangladesh Journal of Bioethics 2019; 10(3): 11-15 

 

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obtain consent from each individual 

competent to execute this waiver. Verbal 

contracting is usually not enough consent for 

in the ethical codes11,12. From the ethical 

point of view, the therapeutic contract 

should address how information will be 

either shared with or kept confidential from 

other members of the system. Data from 

cannot be published without permission 

from client involved in therapy3,11,12. For 

some families, there may be good reasons 

for information to be kept confidential (e.g., 

safety for a partner in a violent environment, 

establishing rapport with an adolescent in a 

family system)3,9,13. Besides, other 

therapeutic systems may benefit from a “no 

secrets” policy within the contract to protect 

the best interest of the system (the identified 

patient in a systemic approach) from 

information that might be in conflict with 

therapeutic goals3,13. With a “no secrets” 

policy stated directly in the contract, the 

therapist is able to exercise his or her 

clinical judgment regarding the need to 

share privately disclosed information with 

the system. While information may be 

ethically shared with other members in the 

therapy process, any communication with 

third parties (e.g., individual therapists, 

physicians, schools, attorneys, and other 

family members outside the therapeutic 

system) requires an authorization to release 

information. Information from a couple’s or 

family’s treatment may not be released 

without permission from each person 

involved in therapy, while for minors, 

parental permission should be 

mandatory13,14. Conversely, in case of 

minors, besides parental consent and 

contract, an assent should be taken from the 

minor patient to make it ethically sound14,15. 

There have been debates in the mental 

health field regarding the use of “no-harm 

contracts” for decades. These contracts are 

sometimes used when a partner or family 

member struggles with suicidal ideation or 

other self-harming behaviors, like cutting or 

over-medicating16. A variety of reported 

risks have been advocated against the use of 

no-harm or no-suicide arrangements with 

depressed clients3,16. Some clients may feel 

a sense of faith in their protection, knowing 

that the contract protects the therapist rather 

than the client. Others could withhold 

information about a recent suicide attempt or 

actions, fearing that disclosure of this 

information may jeopardize their therapy 

status16. Alternatingly, many have also used 

safety planning as a way to recognize early 

risks of self-harm, protect the home 

environment, and use other services. A “no-

substance use contract” can facilitate 

productive explorations of the addictive 

behaviors of individuals. Allowing the 

substance abuser to identify the parameters 

of this contract (e.g., abstinence vs. limited 

use of the substance, length of time) places 

responsibility on that family member and, in 

many cases, can help him or her 

acknowledge addictive behaviours17. It may 

imply in any ethical or self-harm issues such 

as drug abuse, pornographic addiction, 

gambling, practicing unsafe sex, cyber 

bullying threat, sexual harassment, etc. Such 

as emergency medical or legal support need 

must be notified immediately to a safe 

person declared by the client earlier16,17.  

Conclusion: In professional practice, both 

the counsellor/ psychotherapist and the 

client should integrate concrete expectations 



Bangladesh Journal of Bioethics 2019; 10(3): 11-15 

 

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into the treatment contract with an 

awareness of the problem. The therapist and 

each member of the system should 

collaboratively agree on goals. It will be 

important for the counseling system to 

determine how many sessions will occur. 

There must be a clear agreement how both 

client and therapist will understand the 

measurable and observable change that 

desired treatment contract has been fulfilled. 

The therapist is free to exercise his or her 

professional maturity on the need of the 

patients, to act on the best interest of the 

patients and adopt policies specified 

explicitly in the contract on possible ethical 

issues that may arise during sessions. 

 

References: 

1. Beahrs JO, Gutheil TG. Informed consent in 

psychotherapy. Am J Psychiatr. 2001;158(1):4-

10. 

2. Stewart I, Joines V. TA Today: a new 

introduction to transactional analysis. 

Nottingham: Life space Publishing; 1987. 

3. Zubatsk M, Hiefner A. Therapeutic contract in 

couple and family therapy. In: Lebow J, 

Chambers A, Breunlin D. (eds). Encyclopedia of 

couple and family therapy. Philadelphia: 

Springer; 2017. 

4. Sills C. Contracts in counseling and 

psychotherapy. Newbury Park: Pine Forge Press; 

2006. 

5. Gray A. An introduction to the therapeutic 

frame. New York: Routledge; 2013. 

6. Elton-Wilson J. Integration and eclecticism in 

brief time-focused therapy. In: Palmer S, Woolfe 

R. (eds.). Integrative and eclectic counselling and 

psychotherapy. London: Sage Publication; 1999. 

7. Tudor K. (ed.). Transactional analysis 

approaches to brief therapy: what do you say 

between saying hello and goodbye? Thousand 

Oaks: Sage; 2002. 

8. Beall L. The corrupt contract: problems in 

conjoint therapy with parents and children. Am J 

Orthopsychiatr. 1972;42(1):77-81. 

9. Croarkin P, Berg J, Spira J. Informed consent for 

psychotherapy: a look at therapists' 

understanding, opinions, and practices. Am J 

Psychother. 2003;57(3):384-400. 

10. Barnett JE. The ethical practice of 

psychotherapy: easily within our reach. J Clin 

Psychol. 2008;64(5):569-575. 

11. Canadian Counselling and Psychotherapy 

Association (CCPA). The Code of Ethics. 2017. 

(Available at: https://www.ccpa-accp.ca/wp-

content/uploads/2014/10/CodeofEthics_en.pdf). 

(Accessed on February 14, 2019). 

12. American Counseling Association (ACA). ACA 

Code of Ethics. 2014. (Available at: 

https://www.counseling.org/docs/default-

source/default-document-library/2014-code-of-

ethics-

finaladdressc97d33f16116603abcacff0000bee5e

7.pdf) (Accessed on February 15, 2019). 

13. Lebow J. Integrative family therapy for disputes 

involving child custody and visitation. J Fam 

Psychol. 2003;17(2):181-192. 

14. Redding RE. Children's competence to provide 

informed consent for mental health treatment. 

Wash Lee Law Rev. 1993;50(2):695-753. 

15. McCabe MA. Involving children and adolescents 

in medical decision making: developmental and 

clinical considerations. J Pediatr Psychol. 

1996;21(4):505-516. 

16. Farrow TL, O'Brien AJ. 'No-suicide contracts' 

and informed consent: an analysis of ethical 

issues. Nurs Ethics. 2003;10(2):199-207. 

17. Diamond J. Narrative means to sober ends: 

treating addiction and its aftermath. New York: 

Guilford; 2000. 

 

 

Authors’ contribution: S Shahriah was involved in 

concept and design; S Shahriah, S Islam, K Arafat 

were equally involved in the literature search, 

compilation, manuscript writing and revision. 

 

Conflict of interest: None declared. 


