Counseling Contracts

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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Introduction

The counseling contract is important in therapeutic relationship as it offers the basic agreement between the client and therapist where it highlights the expectations of the two, boundaries between them and the parameters of practice (Shahriah et al.,2019). Counselling contract has several roles that play a crucial role in fostering positive therapeutic relationship between the therapist and the client. counselling contract sets clear boundaries by establishing the responsibilities, roles, rights and limitations of client and therapist while at the same time, it highlights what is expected of a therapist in terms of upholding ethical conduct, maintaining high levels of professionalism and confidentiality and stipulates the responsibility of client in terms of participation and attendance to therapeutic sessions and how they should make payments (Chui et al.,2020). Counselling contracts assists in establishing trust between counsellor and therapist by teaming up in coming up with a contract and agreeing on how it will be implemented, creating a sense of trust and rapport between the two. To ensure accountability and transparency, the counseling contract specifies the commitments and roles of therapists and clients , thus providing framework for evaluating the progress dealing with emerging challenges and resolving conflicts that may arise. Counselling contract assists clients and therapists in managing risks and liability as it factors in important issues such as confidentiality and privacy, informed consent while laying bare the responsibility and rights of client and therapists, thus mitigating potential liability and risks that could culminate into legal disputes and misunderstanding during therapeutic process(Chui et al.,2020).

Given that the therapeutic relationship focuses on therapists and clients with intellectual disabilities, there are several challenges that are likely to occur in the counseling relationship. The main barriers and challenges include limited communication skills and understanding of the counselling contract, inability by clients to make autonomous decision and provide informed consent, lack of capacity to enter into counseling contracts particularly among clients with severe intellectual disability, and contextual and cultural challenges(Birdsey et al.,2021) .

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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The critical analysis focuses on evidence on how to overcome barriers in contracting with clients with intellectual disability and takes into account the existing barriers, legal and ethical considerations when developing and implementing counseling contracts, promoting accessibility to counseling and services and developing collaborative approach and solutions, and discusses the responsibility of client and therapists in ensuring effective implementation of counseling contract. The analysis will reflect what has been learnt from literature and provide requisite recommendations that should be adopted to ensure seamless adoption of counseling contracts and how to the break the barriers to therapy when the client is seeking for the services of therapeutic counseling.

The counseling contract

Therapeutic counseling contract has several purposes.

Setting clear expectation

The counseling agreement sets clear expectation by stipulating the format that counseling session will adopt. In the format of counseling sessions, counselling contract highlights how often it will take which may weekly, the specific duration of the counseling session such as 1 hour and the modality of the session that may include online counseling sessions ,face to face sessions or hybrid of online and face to face counseling (Avasthi et al.,2022).

Counseling agreement also states the payments and fees for the services that the client gets from the therapist. The agreement outlines the payment modalities that may include online payment, cash or cheques which should be convenient for both the client and the therapist. The agreement also stipulated who makes payment which may be out of pocket cash by the client and supported by third parties such as health insurance entities, family members or well-wishers. The terms of payment in the contract also state  any late payment policies and fees and missed session policy  due to  decision by the client to counsel sessions and if there are any related fees arising from missed sessions(Okamoto et al.,2019).

Counseling agreement sets the modalities for communication between the client and the therapist. The agreement considers how both the counselor and the therapist should communicate outside the counseling sessions including response time and availability of the therapist and limitations of response times for the client when communicating with the therapist. Setting clear expectation for counseling session offers requisite clarity on managing the expectations of the client and those of the therapist, hence facilitating a smooth process and preventing the occurrence of misunderstanding and conflicts (Avasthi et al.,2022).

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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Establishing boundaries

Counseling agreements plays a key role in setting professional boundaries between therapists and clients.

The British Association for Counselling and Psychotherapy (BACP) guides on ethical principles and professional standards in regards to setting boundaries between the client and counselors. The framework asserts that there should not be personal or professional relationship between the therapist and client or their close people such as relatives outside the framework on counselling agreement and context (BACP,2020). Having dual relationship outside the framework of counseling could alter therapeutic relationship and in some cases, it could cause harm to both therapist and client by failing to meet the goals set for counseling sessions. The guideline also stipulates other forms of relationship during and after counseling session such as sexual relationship and receiving solicited gifts from the clients that could lead to exploitation and abuse during the counseling session (BACP,2020).

Generally, setting boundaries in couseling contract is important in developing a positive therapeutic relationship, protects the counsellor and client from harm and creates an optimal environment for honest and open communication (Okamoto et al.,2019).

Informed consent

Counselling contracts set terms in which clients informed consent should be sought when making  counseling decisions, how to share client information and respect for autonomy of the client in regards to their preferences and needs for counseling services. Stipulating the terms for informed consent in the counseling relationship is instrumental in assisting clients to comprehend the nature of counselling session, the benefits and limitation of counseling, and guarantee them the freedom to select either to participate or avoid the session alongside providing several alternatives for clients to analyse and autonomously select those they meet their needs, goals and preferences (Blease et al., 2020). In the case where the client lacks the capacity to provide informed consent such as in cases of severe mental health problems, the informed consent stipulated in the contract states that relatives or guardians including spouses should provide informed consent (Darby and Weinstock, 2018).

Failure to include the informed consent clause in the couselling agreement could lead to legal liability where the therapist could be sued for misconduct or harm, the risk of conflicts and dispute could arise making it difficult to ascertain whether the rights and autonomy of the client were respected by the therapist, and the consellor could be deemed to act irresponsibly and unethical, which could damage the credulity of counseling sessions and could lead to disciplinary action by regulatory agencies(Blease et al.,2020).

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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Confidentiality and privacy

Privacy and confidentiality are legal and ethical principles that are essential in promoting counseling relationship and should be factored in when developing counseling agreement.

In regards to confidentiality, the counseling agreement should highlight was confidentiality is, possible limitations and make an assurance that the information shared during the session will be kept confidential. In case of disclosure, consent must be sought from the client and in cases where consent is not required, information can only be shared if holding it can cause harm to the patient and others. In addition, patient information should be divulged if it is required for further and specialized intervention and when it is legally required as in the case of court orders (Lustgarten et al.,2020).

In regards to privacy, data and information from the client should be collected, stored and utilized only for therapy purposes and must have prior consent from the client. According to data protection act 2018, individuals should have great control over their personal information and data and any data should only be used and stored according to the consent of the client (GOV.UK,2018). Therefore, in counselling contract, the client should be informed on their rights to privacy basing on data protection act 2018 and this should be within the contract.

Failure to include matters related to confidentiality and privacy in the counseling contract could lead to a number of consequences. When there is no clear provision in the couselling contract, clients may think that the therapist is not keeping their information private, which may breach trust between them, undermining the effectiveness of therapeutic sessions. Including  confidentiality and privacy clause in counselling agreement is a legal requirement of the counselor and hence, failure to take that responsibility may lead to legal consequences such as penalty and disciplinary action from regulatory agencies and law suits in cases where confidentiality and privacy is breached(Lustgarten et al.,2020).

Understanding the challenges

Although counseling contract is vital in fostering therapeutic relationship between therapist and client and provide a framework on how, understanding it may be challenging for some groups of clients (Chui et al., 2020). There are several factors that may prevent client from understanding the counseling contract.

Clients with challenges in their emotional state or those with vulnerable emotional state may not focus on comprehending the details of counseling contract and hence, they may provide consent to implementation of the agreement and engage on counseling session without understanding their rights, responsibility and expectations (Leyshon and Clark, 2005).

Language barriers where English is not the first language, particularly among immigrants and cultural barriers, especially if the client with intellectual disabilities and the therapist come from different culture may making it difficult for client to understand  counseling agreement. For instance, a therapist from collective culture but dealing with therapy that is based on individualistic culture may fail to understand the need to restrict professional relationship within the context of counselling session (Witner at al., 2022).

Counseling agreements use complex legal statements such as “indemnification” and abstract concepts such as ‘duty of care’ which make it difficult for people with intellectual disability to understand. Given that people with intellectual disability have challenges with their communication skills and have limited cognitive functioning, making it hard for them to understand and adapt to terms of contract agreement (Witner at al., 2022).

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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Most of the counseling agreement is lengthy with complex content. They cover numerous topics with lengthy details including terms of payment, expectations and goals of therapy, confidentiality clauses, and cancellation policies among others. Going through the information maybe be cumbersome for intellectual disabled client to review and understand, indicating that they may be engaging with couselling agreement that they do not fully understand, which in some cases may be harmful or unfair to them(Witner at al.,2022).

Some clients with intellectual disability may feel intimidated or embarrassed to ask questions about the contract, especially in cases where they are less informed about the contract and their condition and due to fear of being judged, they may not understand the clauses on the contract and make informed decision regarding their therapy (Jones, 2013).

Basing on the issues that affect the ability of clients with intellectual disability to understand the contract, it is evidence that clients have different characteristics, face different levels of severity, come from different cultural backgrounds and face other social and mental challenges, indicating that on-fit approach in developing and implementing contractual agreement is not effective. Therefore, it is imperative for therapists to guide client to develop counseling contract that is flexible and tailored according to the special needs of the client. When counseling contracts are tailored according to the needs of client, it will be more easier to understand the clauses and adhere to the terms of contract, making them more receptive and cooperative to counseling sessions (Jones, 2013).

Legal and ethical frameworks

In the UK, legal and ethical framework regulating and guiding counseling contracts play a key role in that therapeutic environment is professional and safe for both intellectual disabled client and the therapist.

Legal framework

There are several laws that guide the design and implementation of counseling contracts in the UK.

The General Data Protection regulation (GDPR) established standards for the protection of individual privacy and personal data applicable not only in the UK but also within the European union (EU).The law highlights the rights of individual whose data and information is used, granting individual control over their personal data and information including the need for clear consent from individual before using personal data (Edwards, 2018). The law sets the basic legal framework that therapists need to consider when planning on how to use and store private data and uphold individual privacy and rights, which is an important element of therapeutic counseling (Edwards, 2018). This law is augmented by the data protection act 2018(DPA) which governs the management of personal data and hence, counselors must adhere to its principles when gathering, using and storing of client data and information (GOV.UK, 2018). The legal frameworks align with record keeping clause of BACP (2020) where in the counseling contract; the client is informed on how session notes are recorded and stored alongside their rights to access the record, highlighting the importance of client autonomy in managing their personal information and data including providing consent to sharing of such information.

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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The mental capacity act 2005 sets the legal framework in which decision on behalf of people with mental incapacity and hence, counselors should consider this act when handling those clients. Generally, clients seeking counseling services have a right to make informed decision regarding their therapy. However, not all clients have that capacity including people with severe mental challenges, or those with severe intellectual disability that may need assistance (Fennell, 2014). Therefore, when developing counseling contract, therapists need to consider several regulations that guide patients with incapacity to get the right consent and make informed decision regarding their counseling session. BACP (2020) holds that it is important for counselors to obtain consent from the patient with sufficient and clear information. However, in the case of mental incapacity, the legal framework that can be applied is the Mental Capacity Act (MCA) 2005: code of practice that holds that decision making and consent for the client can be made by family members, social workers, health practitioners or any other figure with authority based on the best interest of the patient (GOV.UK, 2007). Basing on the legal frameworks and the regulations, consent is an important aspect of counseling contract whether one is of sound mental status or has mental incapacity. Involving the clause in the contract developed by both the therapist and the client or between the therapist and the person operating on behalf of the client gives it a legal basis and ensures that there are no ethical or legal challenges that may arise as a result of matters that arise from lack of informed consent when making decisions in counseling sessions.

References

Blease, C.R., Arnott, T., Kelley, J.M., Proctor, G., Kube, T., Gaab, J. and Locher, C., 2020. Attitudes about informed consent: An exploratory qualitative analysis of UK psychotherapy trainees. Frontiers in Psychiatry, 11, p.183.  https://doi.org/10.3389/fpsyt.2020.00183

Shahriah, S., Islam, S. and Arafat, K., 2019. Therapeutic Contract and Ethical Practice in Counselling and Psychotherapy. Bangladesh Journal of Bioethics, 10(3), pp.11-15. https://d1wqtxts1xzle7.cloudfront.net/101722000/35959-libre.pdf?1683002202=&response-content-disposition=inline%3B+filename%3DTherapeutic_Contract_and_Ethical_Practic.pdf&Expires=1713025335&Signature=dkKowSaIEJv-lVM~oscvzpr9EV9Ji49~qLaCNSsqPylrgfJjftzzWnvLQaMyyoIW8EuGeRw575Qufj7S85MiMgy7OCFZ–MF-V2xAEv4SsD9KyiVHkRYPi3JwrZ2B1o2VDeDiiMJOOxfxMOHUrqETTqVqYyAIDV8W424ElhMT6BgbWMlmAS1JYUgG9PAf8rvM7OvgTxB1IzFwpJh6o39R865PY5UYF0DWnFXDpGCDFMfHAtGO0a5D7ndC2mk7y1y69ni9~-hSu9cJIrMG7nyE~RXThigPK2FlkMfOoEeUTSaMvXwL1c~GmxUnrbRRxFLe7zLQ4IbfF5MSoE1sg9tUw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA

Avasthi, A., Grover, S. and Nischal, A., 2022. Ethical and legal issues in psychotherapy. Indian Journal of Psychiatry, 64(Suppl 1), pp.S47-S61. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_50_21

Darby, W.C. and Weinstock, R., 2018. The limits of confidentiality: Informed consent and psychotherapy. Focus, 16(4), pp.395-401. doi: 10.1176/appi.focus.20180020

Okamoto, A., Dattilio, F.M., Dobson, K.S. and Kazantzis, N., 2019. The therapeutic relationship in cognitive–behavioral therapy: Essential features and common challenges. Practice Innovations, 4(2), p.112. DOI: https://dx.doi.org/10.1037/pri0000088

Lustgarten, S.D., Garrison, Y.L., Sinnard, M.T. and Flynn, A.W., 2020. Digital privacy in mental healthcare: current issues and recommendations for technology use. Current opinion in psychology, 36, pp.25-31. doi: 10.1016/j.copsyc.2020.03.012

Chui, H., Palma, B., Jackson, J.L. and Hill, C.E., 2020. Therapist–client agreement on helpful and wished-for experiences in psychotherapy: Associations with outcome. Journal of Counseling Psychology, 67(3), p.349. DOI: 10.1080/10503307.2021.1916640

The British Association for Counselling and Psychotherapy (BACP).,2020. Making the contract in the counselling professions. https://www.bacp.co.uk/media/9411/bacp-making-the-contract-fact-sheet-gpia055-aug20.pdf

GOV.UK.2018. The Data Protection Act 2018 . https://www.gov.uk/data-protection

Edwards, L. ,2018. Data protection: Enter the General Data Protection Regulation. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3182454

Fennell, P. (2014). The Mental Capacity Act 2005, the Mental Health Act 1983, and the common law. International Journal of Mental Health and Capacity Law, 1(13), p163. https://doi.org/10.19164/ijmhcl.v1i13.178

GOV.UK.,2007.Mental Capacity Act 2005: Code of Practice. https://assets.publishing.service.gov.uk/media/5f6cc6138fa8f541f6763295/Mental-capacity-act-code-of-practice.pdf

Jones, R.A., 2013. Therapeutic relationships with individuals with learning disabilities: a qualitative study of the counselling psychologists’ experience. British Journal of Learning Disabilities, 42(3), pp.193-203. https://doi.org/10.1111/bld.12028

Witwer, A.N., Walton, K., Held, M.K., Rosencrans, M., Cobranchi, C., Fletcher, R., Crane, J.M., Chapman, R. and Havercamp, S., 2022. A scoping review of psychological interventions, accommodations, and assessments for adults with intellectual disability. Professional Psychology: Research and Practice, 53(6), p.615. https://doi.org/10.1037/pro0000474

Leyshon, S. and Clark, L.L., 2005. Legal and ethical issues in seeking the consent of adults with learning disability. British Journal of Neuroscience Nursing, 1(3), pp.126-131.

Birdsey, N., Walz, L. and Scrase, C., 2021. Best practice when working therapeutically with people with learning disabilities: A brief review. The Bulletin of the Faculty of People with Intellectual Disabilities, 19(1), pp.50-59. DOI: 10.53841/bpsfpid.2021.19.1.50

Enhancing Accessibility in Counseling Contracts for Individuals with Intellectual Disabilities

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By admin in Essays on January 16, 2025