Trust is everything between a therapist and their patient/client and it is fascinating how trust arises and disintegrates. Some clients will engage you because they like your CV, the look of your face and even because you are what they consider a little bit out there. When you are established, much of your work comes through referrals weeks, months or even decades after you treated or helped someone.
Therapy is such an intimate relationship where clients make themselves vulnerable to you in order for you to help them with a myriad of problems, but only if they trust you. There may even be times when you set a client up to be angry with you to force them to be independent and get on with solving their own dilemmas.
Our job as therapists is not always to be liked but to motivate the client to move into a resourceful state even when they are not aware we are using such techniques. Trust, however, must always be one of the major underlying principles of our work so the client knows you are willing to go that extra mile for them when required. All the preceding is, however, not so far apart from the fact that you, in professional practice, require remuneration for your services; or if you work for an agency the client has a contract with them too. Whilst contracts are talked about during training of therapists many new therapists have very little idea how to handle the financial side of their business. The contract is based on many kinds of social rules, expectancies and situational expectations of the client. Some of those may have been discussed before the first session but some may come under what is called unconscious expectations that have never ever been consciously addressed.
Hypnosis and the therapies around it are considered quite mystical to many clients that walk in the door and it may be something they have heard about but have no real knowledge of the process of hypnosis or what it entails. Since hypnosis is a nominalisation, offering over-protracted descriptions of it to clients is self-defeating because hypnotherapy is an experiential therapy not an analytical extravaganza, as Milton Erickson was apt to point out.
Many clients are worried of course if they can afford therapy or if they can afford to continue in therapy. They have not generally come to the conclusion that after therapy they will be handing their affairs better because their attention span is in the short-term focus, trying to deal with their immediate problems. So as the therapist it is our duty to help them to make the suit according to the cloth they bring with them and this must include respect around financial issues and the therapy process. Misunderstandings always arise out of one partner not being aware of the contract or refusing to honour their side of the bargain and inevitably such misunderstandings lead to ill feeling and can undo therapeutic gain.
Clients must also know what is expected of them during the therapeutic process so that they can orientate themselves to the generative process of change. Whether this is done orally or in writing it can never be fully explored but there does need to be a basic understanding. The problem, however, with verbal contracts is there is not an official record of them and they are widely open to interpretation. It is very easy to move into the ‘he said/ she said’ mode of thinking after the event. For the most part well-trained therapists get very good results with their clients. There are times, however, when therapeutic accidents may occur and therapists find themselves under scrutiny. In one’s whole career, therapists who help people with profound mental health problems, will encounter at least one suicide. We are not gods but simply professionals doing the best we know how for our clients and it is imperative that records of the contract between the therapist and the client are clear. From time to time therapists also get sued and some of these law suits may be valid but others could be what are called nuisance suits where people are opportunistically after a pay-out.
Again in these circumstances the onus is on the practitioner to prove the circumstances of therapy, showing what the agreement was and what took place. Let us remember that the ideas of today are going to be the amusement of future generations. There are times when clients don’t want to pay their bill even when they are in ecstasy about the service you have given them. As therapists, however, you still have to pay your accountant, insurance premiums and taxes as well as staff. So it is nothing less than smart to use written contracts with your clients. It takes not more then five minutes on the first session to get your clients to look through a contract and sign it. Legally you must also give them a copy of the contract so everyone knows what is expected of them to a responsible degree and that prevents misunderstandings.
Contracts can be written to suit the therapy that you do and clients can have sight of the contract before they commission your services. You do no have to be bound to curing the ear-picking habit of 60 years in 10 minutes but you can be clear about how you will seek to find the best way to help them. This is not a substitution for a code ethics but simply a better way to make it clear to everyone how they can best be comfortable in a new situation with someone they have not met before.
Sure, there are therapists who come up with a host of excuses why this would not be a good idea. They talk about how it deflects from their honour or how everyone should trust everyone else but in reality they cannot define those expectations and certainly, if their clients are asked, they are unsure about them too. Contracts are part of our everyday life from purchasing a tram ticket to buying a house. Is it not disrespectful to ask your clients to forgo such a clear understanding of what the therapeutic process will entail?
This article was first published in Hypnosis Australia Online Journal, 2008.
Dr Tracie O’Keefe DCH, BHSc, ND, Clinical Hypnotherapist, Psychotherapist. Counsellor, PACFA registered Mental Health Professional and Naturopath In Sydney. You can get help by booking an appointment with her at Australian Health & Education Centre.