Do you mean a treatment contract? If so, that's how all of the major treatment centers actually work. You have to commit to taking certain steps for recovery, not so much expecting that you will actually follow through the whole time, but making sure you are aware that you are there to make an effort. (It also covers their bases when they can say that you have to stay above, for instance, a certain weight to be safely treated outpatient.)

It never actually made a difference for me, because the T always set the expectations so low that it impeded my recovery. If I did this again, I would ask my T to have me join in making the goals and discussing them at least every month to keep them in mind.

A therapist I had been seeing 1 year ago, offered me a contract when I saw her, just once, this summer, because I was afraid of (trigger) killing myself.

She said I would write a contract, on 2 sheets of paper, and she would keep one. It was "I promise I will call her/someone if I feel I am about to hurt myself too badly". I did not want to sign it, because 1) she had been dismissive for the entire session, so I knew I would not want to call her, 2) and she had made me feel worse, so a contract with her was stupid. I mean, for a contract to be efficient, you would have to be willing to respect the word you gave to the person, and for this to respect the other person. And it was not the case. She had just shown me I could not get help and I was responsible for it. So no, if I was to call someone for help instead of killing myself, it would be out of fear for myself, and not to respect a meaningless contract. I still signed it, because she was saying I was ungrateful for refusing what she offered after having asked for help. I burned it 2 days later, because it was void anyway.


So, my experience was not very good, but it was not with my actual therapist/someone I actually trusted, and I would have a very different reaction if it was the case.

Thank you FMW I am sure at treatment centers they do, but what about the individual therapists who work alone...etc.?

I do like the idea of reviewing the goals monthly to keep the focus on what needs to be worked on.

About: That would unnerve me as well! I do not think I could believe the sincerity of the Therapist due to her dismissive attitude.

I guess it is safe to say maybe a contract is agreed upon if someone is having struggles with suicidal thoughts, etc.


T.

I don’t officially have a contract with my T, but on his website it says “A therapeutic contract is established after several face to face sessions and verbal agreement,” so I guess I have a verbal contract with him? Did your T bring up a contract, TAS, or is this something you were thinking of yourself? I think having a regular “check-in” about your goals/progress can be a good thing if it is something you want. And it can be helpful to spell out each of your responsibilities. If you do make a contract with your T, I would make sure that you really do agree with whatever gets put into it.

When I was in college, I saw a T at the school counseling center, and he threatened to hospitalize me if I didn’t sign a “no-harm contract” with him. So I signed it, but it didn’t mean anything to me. Just like About, I never considered it a real contract, because I felt coerced into signing it. I ended up involuntarily hospitalized after I did hurt myself, and when I saw the school T again, it was awful. I was so traumatized from the whole experience of being held against my will, but all the T wanted to talk about was how I had broken the contract and he couldn’t trust me. So I never went back, and it took me almost 15 years to try therapy again.

What’s funny about no-harm/no-suicide contracts is that all the books that I’ve read on how to be a therapist say that in general, they don’t work. That having a client sign one generally makes the T feel better, but doesn’t actually do anything for the client.

Certainly, a self-harm contract is more for legal matters than anything else.

I have seen a treatment plan contract, though, that can be helpful if you and your T really work on it together. It would include things like signs that tell the T you are struggling, what you can ask for when you need support and who to contact - for instance, when to contact your T versus calling a friend - and signs that will demonstrate that you are progressing. It could include a description of coping tools that you promise to have at your disposal - even just silly putty on your desk - to try to get through emotional hurdles with some DBT skills. And, it can include a list of general CBT challenges for statements that frequent your thoughts in a negative manner. Really, entering into therapy is a contract in and of itself, but putting something like this into writing, at least for me, made me feel like I had direct actions to take to maintain accountability and my T had clear guidance and expectations to best do her job.

It's really all about what YOU want and not what your T wants. And, if you are not comfortable with a contract, maybe you could talk to your T to discuss the intention and your reservations?

Nannabee and FMW: I apologize for the delay in replying.

Nannabee: He actually brought up a contract...I kindly told him I did not think I could do therapy if it was governed by a contract. He agreed with me saying, "That is why I have held off with going through with a contract." I think if I had to sign a contract, I would quit. Just the thought of it scares me so much. At least he heard me on it and didn't force it.

I am sorry you had such a difficult experience with a former T. I hope your new T is much better and truly is motivated to help you along your journey

FMW: I like how you explained the treatment-plan contract. It makes sense in regards to struggles, goals, etc.

The Therapist I see was very understanding when I explained I could not continue Therapy under the terms of a contract. He broached the subject because of the 'no outside contact.' I told him I would rather honor his request sincerely from within than to do it because I signed a contract that says 'I have to.' I guess I wanted to be able to honor what he feels is therapeutically best for me instead of honoring it because of the contract I signed. I don't know it that makes sense, if it doesn't, I apologize.

Thank you both for replying. Things have been very hectic, my intention was not to ignore either of you.

Happy Thanksgiving! T.