Confrontation of the Contract

The therapeutic contract as a framework of seriousness

Just as in a doctor's office it is assumed that the patient will cooperate with the treatment (take medication, rest), couple therapy requires an implicit contract of collaboration.

When a couple attends sessions but consistently refuses to follow directions, sabotages exercises, or maintains a destructive hostile attitude, they are violating this basic contract of help.

It is helpful to remember the medical analogy: if you go to the doctor for an infection but refuse to take antibiotics and yell at the doctor, the service cannot be rendered.

The therapist must internalize his or her professional authority to point out that the therapeutic process has minimum conditions of respect and participation to be viable.

This is not authoritarianism, it is the establishment of a safe and professional framework.

Direct confrontation of non-compliance

When resistance becomes chronic and obstructive (e.g., constant absences, not doing homework, verbal aggression in session), a direct confrontation of the setting is necessary.

The therapist should pause the content work (the couple's problems) and focus on the process: "What is going on here? We agreed to work to improve the relationship, but every intervention is rejected. How should we interpret this?".

This confrontation, sometimes called "contract challenge," seeks to bring hidden ambivalence to light.

One may ask, "Are you coming here to change or to show that you are beyond repair?"

This brutal, if risky, honesty often shakes up the system and forces the couple to re-decide their commitment to therapy, moving them from passive complaint to an active position.

The option of ethically terminating therapy

If after confrontation and attempts at re-framing the couple continues to sabotage the process or use it to harm each other, the ethical decision may be to end treatment.

Continuing ineffective therapy validates the dysfunction and may give the false impression that they are "doing something" when in fact they are stuck.

The therapist can approach therapeutic dismissal in a constructive manner: "At this time, I do not believe that joint therapy is helpful because the necessary conditions of safety/collaboration are not in place.

I suggest that you take some time to reflect on whether you want to continue under these new conditions or seek other help."

Sometimes, this withdrawal of the therapist acts as