No Fine Print-Part One: The Basics of a Group Contract

by Marc G. Schramm, Psy.D., C.G.P.

Group contracts are a popular therapeutic tool, used to help communicate and clarify ground rules, guidelines, and boundaries (contracting around treatment goals is a separate issue, not dealt with here). Typically the contract is a written one. The patient population, level-of-functioning, and orientation of the therapist tend to influence how contracting is used, but certain elements are almost always included.

The basic elements in a contract are:

1) Regular and punctual attendance.

A contract may state this (and other such guidelines) with explanations of its importance for a successful group. The parameters of such guidelines (e.g. notification about absences) are included.

2) Confidentiality

The mutuality inherent in this clause is often stressed. In my experience, this rule and #4 below are the ground rules least often breached, and I have never bothered with a discussion of consequences for its violation.

3) Participation

The new member is assured that they can "join in" at their own pace, provided only that they accept that therapy happens through participation, not just listening. The contract (or verbal gloss on it) might note the impact nonparticipation can have on group process.

4) Prohibition of physical aggression

This is rarely a concern for most groups, but I have found that many prospective members are reassured by this ground rule because of their private fantasies about what could happen in groups when anger arises.

5) Responsibility for payment

This ground rule can help therapists deal with what is often a difficult issue for them. (Of course the structure provided by the contract is almost always important to both therapist and group-members.)

6) Extra-group boundaries

Some contracts "forbid" contact between members outside group. Even so, it is unusual for a group to have no (planned) extra-group contacts. Except in more extreme cases, there is unlikely to be any leader-directed consequences other than exploring the non-compliance. But a too-strongly worded rule typically leads to the rest of the group--or at least the therapist!--being kept in the dark indefinitely so that concomitant problems in the group process cannot be resolved. Thus many contracts only advise against such contacts, explaining why, but adding that if and when such contacts do occur, members are expected to share this in the next group session.

7) Completion of therapy

A contract should state a minimum time commitment to group, since if honored, it can prevent early dropouts by providing a structure to stay in group while acclimating to it. Accomplished group leaders usually ask their members to remain in group until they have completed their therapy. Except among highly motivated populations, I fear this might potentially daunt those with ambivalence towards groups therapy. When I have worked with clinic populations I have requested a much more modest commitment. In addition, the contract I use asks members to announce their intention to "graduate" from group with four sessions notice. This allows for working through termination issues, both for the individual and the members he or she is leaving behind. It may also prevent premature termination due to the time available for processing the planned departure.

Other ground rules for a contract are of course possible. My groups sometimes used to experience focus on the "here and now" process as a distraction from historical content. This was rarely the case after the contract included a clause noting the relevance of "here and now" work. The rules of group in Modern Psychoanalysis (Ormont, 1968) disallow any physical contact between members (when it occurs, the only "consequence" is to explore the need to express oneself through touch rather than only verbally).

In closing, I want to direct your attention to a suggestion by Rice and Rutan (1987). They advise that for inpatient groups (whose contracts would differ from the above in a number of ways) there be a second contract for the outer boundary--between group and the hospital administration. Such contracts are not always possible, but we do well to remember that there is always some sort of outer boundary to cope with.

In Part Two we will look at a sample group contract.

Suggested Reading:

Ormont, L. (1968) Group resistance and the therapeutic contract. International Journal of Group Psychotherapy, 18, 147-154.

Rice, C.A., & Rutan, J.S. (1987). Inpatient Group Psychotherapy: A Psychodynamic Perspective. New York: Macmillan.

Rutan, J.S., & Stone, W.N. (1984). Psychodynamic Group Psychotherapy. New York: MacMillan.

Vannicelli, M. (1989). Group Psychotherapy With Adult Children of Alcoholics. New York: Guilford Press.

4/17/98

Marc G. Schramm, Psy.D., is a Founding Certificant of the National Registry of Certified Group Psychotherapists, a clinical member of the American Group Psychotherapy Association, and President of the Tri-State Group Psychotherapy Society. He is currently Cincinnati-Dayton Regional Director for Counseling Consultants, Inc. Call Dr. Schramm at 513-984-9222

 

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