The therapist-client contract
Many therapists worry about how to work with ROGD youth. The following sample parent-therapist contract might help. It's not perfect - but then nothing is. All thoughtful comments gratefully received.
Therapist-Client Contract
This document outlines key aspects of our work together to ensure transparency and understanding within our therapeutic relationship. The psychotherapeutic process is a partnership built on authenticity, trust, and mutual respect, and this contract clarifies the framework for this.
1. The First Session
The first session will be provided free of charge. In this session I can explain my therapeutic approach and you can decide together whether you think this will be a good fit for you.
2. The Psychotherapeutic Process
The process of psychotherapy involves exploring your thoughts, feelings, and behaviour in a supportive and reflective environment. Together, we will work through issues that might include identity, relationships, self-perception, and mental health challenges.
Key components of this process include:
Exploration of Self: Examining how different aspects of your life contribute to how you perceive your sense of self.
Critical Thinking: Encouraging self-reflection and understanding of the broader social and cultural influences that affect your life.
Emotional Growth: Building emotional resilience, self-acceptance, and personal strength.
Building self-awareness: Cultivating self-awareness is central to developing a deeper understanding of how your beliefs, emotions, and behaviour may shape your experience of the world and yourself.
Psychoeducation: Throughout our sessions, I will provide information and education on psychological concepts to help you better understand your experiences and make informed decisions about your mental health and well-being.
The Unconscious: The unconscious mind plays a significant role in shaping our thoughts, behaviour, and feelings. In therapy, we may explore how unconscious beliefs or desires, particularly around sex, gender and identity, might be influencing your current experiences and decisions.
Therapy is not a quick fix but rather a gradual process of self-discovery and growth, and it requires both patience and effort. This can be a challenging process and it can often be uncomfortable. Hopefully we will be able to collaborate together honestly so that we can discuss these challenges as they arise.
3. Understanding of Gender Dysphoria
Gender dysphoria is a psychological condition where individuals experience discomfort with their biological sex and may express a desire to transition to the opposite sex. Certain biopsychosocial factors may influence one's feelings of gender dysphoria. The therapeutic process will involve learning about your emotional distress and gaining a deeper of understanding about what’s going on. If it is appropriate, we will also explore how biological reality, social roles, and cultural expectations around sex and gender may be contributing factors. My approach will encourage careful consideration of these influences as well as deeper exploration into any unconscious motivating factors that should be addressed.
4. Therapeutic Approach and Treatment Options
I am an integrative therapist, meaning I draw from multiple therapeutic approaches to tailor the treatment to your unique needs. In particular, I tend to combine psychodynamic therapy with Carl Rogers’ humanistic approach alongside the more pro-active approach that is offered by CBT.
Psychodynamic Approach: This approach focuses on understanding how unconscious thoughts, past experiences, and early relationships shape your current feelings, behaviour, and identity. By bringing these unconscious influences to light, we can gain deeper insights into any internal conflicts or emotional struggles you may be facing, particularly around gender identity.
Humanistic counselling: Grounded in the belief that every individual has an innate capacity for growth and self-actualisation, this approach emphasises empathy, unconditional positive regard, and non-judgmental acceptance. I aim to create a safe, supportive space where you feel heard and respected as you explore your identity and experiences.
Cognitive Behavioural Therapy (CBT): This approach focuses on identifying and challenging negative thought patterns and behaviour that may be contributing to emotional distress. In the context of gender dysphoria, we will explore how your thoughts about yourself and your identity may be impacting your emotions, working together to develop healthier, more balanced perspectives.
By integrating these approaches, we will work both on uncovering deeper emotional patterns and fostering a compassionate, affirming environment for personal growth and self-understanding.
5. Names and Pronouns
In this space, I will respect your preferences regarding names and pronouns. However, if you are under 18, I will also respect your parents’ preferences regarding names and pronouns. This can be complicated and I will encourage open discussion about the role these preferences play in your sense of self, how they relate to broader social narratives around gender and how our experience of our biological sex is an important part of understanding personal identity. My perspective is that we should explore each and every decision with honesty and integrity
6. Parental Involvement
Parental involvement can be a key factor in ensuring a healthy support system for young clients. As such it is recommended that:
Every 4th or 5th session, parents or guardians will be invited to join the session. This helps ensure family involvement, enhances communication, and fosters understanding between you and your parents.
Every 7th or 8th session, I will meet with your parents alone. This session allows them to voice any concerns or questions they may have about your therapeutic process, as well as provide insights from their perspective.
7. Truth-telling
My role is to offer honest and straightforward guidance. If you would prefer that I always speak the truth, even if it may be difficult to hear, please let me know. Some individuals benefit from a softer approach, but for others, complete honesty is essential to their growth. We will establish how much directness you are comfortable with as we progress.
8. Exploration
Therapy is a space for exploration, not only of your feelings and identity but also of the world around you. We will critically examine the cultural and social messages about gender, self-perception, and societal roles. I will support you as you explore these themes and reflect on how they shape your experiences.
9. Growth through Mistakes
Given the complexity and evolving nature of psychological discussions, there will be times when mistakes are made. I may not always use the terms you prefer, or I may offer perspectives that challenge your current understanding of any given concept. These moments are important learning opportunities. I encourage open dialogue if you feel misunderstood or if any language or terminology I use does not sit well with you.
Mistakes are a natural part of the therapeutic process and of life. When mistakes happen, they offer valuable chances for reflection and growth. We will work together to understand why these errors occur and how we can use them to move forward. Whether it’s in therapy or in your daily life, embracing mistakes as learning opportunities is an essential part of growth.
10. Written Contract
By signing this contract, you acknowledge the terms of our therapeutic relationship and agree to engage in the process with an open mind. I, as your therapist, commit to providing a space where we can explore complex and challenging topics with honesty and care. You are free to discontinue therapy at any time if you feel it is no longer serving your needs.
Client Name: _________________________
Parent/Guardian Name (if applicable): _________________________
Date: _________________________
Therapist Name: _________________________
Date: _________________________
This contract is a living document, meaning that as we move through therapy, we may adjust or revisit these terms as needed to ensure the process remains respectful, productive, and affirming of your personal growth.
Wow is your intention to provide this as a potential resource to other clinicians working in the field?
This is brilliant. I would love to hear you discuss different trans-identified patients' responses to it.