Search terms answered #4: “dbt therapy contract legally binding?”

This is part of a series where I answer interesting questions that come up in my search terms, that are not already clearly answered in this blog.

“dbt therapy contract legally binding?”

DBT contracts can vary in content but a year long commitment agreement is a very common component.

Short answer is no. It’s really more of a social contract or a promise. Same applies for any of the “self-harm” or “no-suicide” contracts.
I’m not a lawyer so I can’t speak to all the details of why it would be legally unenforceable. My understanding though is that a breach of (a real) contract is a civil issue, so monetary compensation would be what was at stake if one party broke the contract. Imagine if any other medical professional tried to do something similar. Can you picture an Oncologist telling their patient that Chemo is a really taxing process and they want to be sure of a patient’s commitment before beginning so they need to sign a contract? No. And that Oncologist certainly would not bring a patient to court (seeking monetary damages) for changing treatment options if they decided some other route was a better idea.

Your treatment is your own to control. Provided you are not in some type of court ordered (or inpatient involuntary) treatment you always have the right to refuse to do anything at any time.

I hate these contracts. Whenever people have presented me with them it’s always been them telling me to sign it or not get treatment with them. I feel bullied by it. Especially in the case of something like a contract to stay in therapy, I don’t think it is fair to always assume that leaving the therapy is a symptom of the problem. Some therapies or practitioners are not a good fit for some people.

Here’s my question for you readers: Is there anyone out there who feels a contract in therapy really helped them in the long run? Did it help you stick things out, in an ultimately helpful treatment, at a time when you were having doubts? Or was it coercive and damaging to add guilt about breaking a “contract” into the already difficult decision to change treatment?

7 thoughts on “Search terms answered #4: “dbt therapy contract legally binding?”

  1. I’m in the middle of this right now. The contract part really freaks me out so much so that makes me uneasy about participating. I feel like it’s a trap– like I’m going to be stuck in something even if I hate it. I’m an adult. I should not have to be made to feel like I have no choice in my treatment. I’m just starting (or in phase one–but that language creeps me out for some reason) but I’m beginning to understand that DBT is a treatment that doesn’t allow for personal freedom, choice, or differences. My therapist says that’s ridiculous and resistance to the treatment. I just don’t get it.

    Reply
      • DBT was built for people with personality disorders who generally have a horrible time with boundaries. I get that DBT tries to force strict boundaries to sort of reign these people in. Force you to sign a contract, force you to stop certain behaviours or be told you can’t come to the next session, force you to accept help if you call during a crisis. I get that people need boundaries and learn how to live within them, but at the same time, what’s the point if you feel dehumanized in the process?

        Reply
        • Good points. I think setting clear boundaries and making sure two people are on the same page about standards of behavior is important, but I don’t think these authoritarian contracts are the solution. People need flexibility and they need a treatment that is personalized to their needs, not some boilerplate contract that is used with everyone.

          Reply

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