Eric Harris, J.D. Ed.D.
Bruce E. Bennett, Ph.D.

This draft psychotherapist-patient contract has been prepared for two reasons. First, it allows the psychologist to comply with the requirement that informed consent must be obtained from his/her patients (Ethical Principles of Psychologists and Code of Conduct, 2002, Standards 10.02, 4.02). Second, it allows the psychologist to establish a legally enforceable business relationship with the patient and avoid risks of such business issues that may become the bases for malpractice suits and ethics or licensing board complaints. Most commentators suggest that full informed consent is both ethically necessary and a good risk management strategy.

This model contract was originally developed as a model long before HIPAA was promulgated. It neither conforms to specific individual state laws nor does it conform to HIPAA requirements. APA and APAIT prepared a comprehensive HIPAA compliance package called HIPAA for Psychologists. HIPAA for Psychologists contains a version of this Agreement that complies with both HIPAA and state law for all US jurisdictions. The major areas of difference between this document and HIPAA/State law compliant forms are in (1) patient access to personal records, and (2) the laws and regulations governing therapeutic confidentiality, testimonial privilege, and exceptions to these protections of the psychotherapist-patient relationship.

This draft was designed for psychotherapy practices. It can and should be modified to include other practice areas such as psychological evaluations, testing, neuropsychological assessment, family therapy, group psychotherapy, etc., if these are a part of a practitioner’s work.

There is a great diversity of business practices among psychologists. You should redraft the contract to fit your business practices rather than adjust your practices to fit the contract. Since regulations and laws governing certain institutions are somewhat different than those governing private practitioners, these forms may also need modification before they can be used in hospitals, clinics, or other institutional settings.

This document includes some general language about the risks and benefits of psychotherapy, but it should be supplemented orally or in writing by the psychologist on a case-by-case basis. This approach was selected because the risks and benefits of therapy can vary considerably from case to case; it is hard to design a single document that is appropriate for all situations. For example, it is probably important to have a more thorough discussion of risks and benefits with patients who are dealing with difficult or risky situations or issues. If the psychologist is a group or family therapist, additional issues may need to be included. The psychologist may orally provide whatever additional information is necessary and make a note in the record about what was said. Of course this will not be as protective as a signed agreement, but in most cases it makes both clinical and risk management sense. It is always important to remember that an informed consent contract is only the beginning of providing informed consent. Important issues contained in this contract or not contained in this contract should be discussed when it is anticipated that they are likely to occur and that the client will feel angry or betrayed when they do.

The reader is strongly advised to have his/her personal attorney review the informed consent document prior to implementation. We recommend that the document you use be in compliance with HIPAA and state and local statutes regulating the practice of psychology and should not include any language that could be interpreted as a guarantee or implied warranty regarding the services rendered.

What follows is specific draft text that you may feel free to adapt for your practice or agency. Sections of the draft where you should insert numbers are designated XX, and sections you may want to add or specially modify are [bracketed].

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