The 'Frame', and the 'Contract'


The FRAME / STRUCTURE

Unlike most other services provided, the 'WORK' is an 'engagement'. Perhaps more like a 'course' (where learning is not only cumulative but progressive, and elliptic too), it is always in a state of 'work in progress' - it grows more ORGANICALLY (more like a tree - in all directions, with changes through the 'seasons', and requiring constant change of all parts) than in a LINEAR, mathematical/industrial fashion.

The client's ENGAGEMENT in the process is CRUCIAL - this includes their COMMITMENT as well as their capacity to ACTIVELY PARTICIPATE in it.

For this to happen an 'AGREEMENT' over a 'FRAME/STRUCTURE' of REGULARITY is necessary. Appointments are on the same day(s) at the same time(s) every week (usually once or twice a week - Psychoanalysis requires attendance 3, 4, 5 or even 6 times a week). They last for 50 minutes and start at the time they are set to start (even if the client is not present yet) and finish at the time they are set to finish (even if the 'material' is interrupted - it can be continued later 'within the frame').

This pattern is usually maintained for about 42 weeks in the year. There are usually 3 (planned) breaks a year: 2 to 3 weeks around the end of the year, 2 to 3 weeks around Easter, and 4 to 5 weeks in the summer (usually August/September). I strive to give every client notice of the dates of such breaks well in advance. These breaks are not just 'holidays' but an important part of the work (as separations are both a disruptive and a potentially constructive element in the process of growth). It would be desirable for clients to plan and arrange for their breaks/absences to coincide with mine, so as to minimise further disruptions or un-necessarily extended breaks in the progress of the work.

Occasionally, it may be necessary for unplanned breaks to be incorporated - either for health reasons or other factors that may necessitate unforeseeable interruptions. Notice of these may not be much advanced.

If the need or wish arises to consider an interruption to the work (of a month or more, or open-ended), it is important to discuss this in the therapy. It can be helpful to try out periods of 'independence', before an ending is agreed.

Endings need to be considered carefully, and time is needed to prepare for and to 'process' them. It is usual to agree a notice of one week per month in therapy, or one month per year in therapy (if more than 2 years). (I would be committed to the same time spans if the initiative to trigger an ending comes from me for whatever reason.)

The AGREEMENT/ CONTRACT

Fees are charged per planned session. These do not include my planned or unplanned breaks, but would include any sessions missed or cancelled by the client. (Sometimes it is possible to re-schedule sessions - to a different day or time during the same week, but this is not desirable and should not become a feature of the pattern of the work. There is no guarantee that this could be practically possible at any point.) If the pattern of attendance needs to be changed, it is desirable that plenty of notice should be given, both for practical reasons, but also because of the impact it is likely to have on the therapeutic relationship and on the 'frame' of the work.

Invoices are presented at the end of every month (for all sessions planned for that month) and payment is expected to be expedient (within a couple of days, by direct debit into my account) or immediate (in cash or by cheque). 

Fees are agreed at the beginning of the work and reviewed every year (usually in September). I operate a 'sliding scale' so as to facilitate affordability according to individuals' financial means. Peak time appointments (early morning, lunchtime, and late afternoon/early evening) command full fees. Fees for Mid-morning and Mid-afternoon appointments are more negotiable.

Assessments, Limitations & Referrals

Psychotherapy is not 'the only option' available for those who would like to enhance their personal development. It is not always the 'best' option either, and in some cases and in some situations it may be counter-indicated.

For this reason an initial 'assessment' is important. It is an opportunity for you to meet your potential therapist and discuss your needs, wishes, and circumstances, and to ask any questions or clarifications and express any concerns. It is an opportunity for me to assess your suitability for what I can offer, and whether my approach and areas of expertise/experience would be your best option. It is also an opportunity for both of us to assess our potential 'match' (for working together).

It is usually conducted over 2, 3, or 4 (weekly) meetings, before we agree to commit to an open-ended contract.  

Some 'presentations' may be better suited to other services/professionals, and if this becomes clear - either in the course of the Assessment or during the work, I shall discuss this with you and endeavour to locate the best pointers for you.

Some more complex presentations may require 'coordinated care' and the input of various professionals. Presentations which include psychotic elements or high risk of suicide or self-harm (including chemical dependencies) usually require an institutional approach, where more and diverse resources and services are in place to 'contain' possible crises. It would not be wise for these presentations to be taken on in Private Practice, and could be detrimental to the client's health in the longer run.

Accessibility - my consulting room is on the 3rd floor without a lift (45 steps up) - please bear this in mind if your mobility is limited.

NB - please note that I do not have a waiting room/area.  I ask clients therefore not to arrive before their agreed appointment times.  There are plenty of cafes and restaurants in the area, should you find yourself arriving considerably before your appointment time. Finsbury Library is open from 9 am to 5 pm every day and until 8 pm on Mondays and Thursdays. 

CONFIDENTIALITY is a crucial part of the work due to the very PRIVATE nature of it.  Material is exclusively discussed with my Clinical Supervisor (who is bound by the same terms of CONFIDENTIALITY).  Case material may occasionally be alluded to in the context of clinical discussions in professional circles, but identifying details are omitted (or changed) to protect the client.  

RISK of HARM - to Self and/or others - is the main factor which legally binds me to take matters outside of the therapeutic relationship.  If the client is at risk I may need to discuss this with your GP or other Psychiatric Services (if and as appropriate).  If there are indications that others may be at risk, I may need to approach Social Services or the Police.  In any case, I shall endeavour to discuss such needs directly with the client, but this is not possible, your consent is assumed.

I do keep handwritten notes of all sessions/contact and these are kept in a secure place which only I have access to. These are records of psychological processes observed during the work for my own reference and largely unintelligible even to other professionals.  I do not keep clinical notes electronically as the risk of confidentiality breaks is higher. ( I do not currently offer either telephone or skype sessions for the same reasons).  Clients are discouraged from sharing personal material or attempting to engage in conversation with me about such matters by any other means (telephone, e-mail, letters, etc.) or in other contexts outside of the 'frame' of the consulting room and agreed session schedule.  The effectiveness of the work depends on the interraction between us and this would be precluded elsewhere or through other media.