Framing and Contracting

Establishing the rules of the game

The "contrating" or establishment of the therapeutic contract is the administrative and ethical basis on which therapy is built.

Before delving into the emotional problems, it is vital to clarify the logistics: the estimated duration of the treatment (which in couples is usually short, around 10 sessions), the frequency and place of the meetings. A critical point is the cancellation policy.

It should be clearly stated how much notice is required to cancel an appointment without cost (e.g., 48 hours).

If these rules are not explicit from the outset, situations such as last-minute non-attendance can lead to disputes over payment, damaging the therapeutic relationship and diverting the focus of treatment.

Confidentiality and its limits in the system

Confidentiality is the cornerstone of trust, but it is not absolute. It is imperative to inform the partner of legal and ethical exceptions before beginning.

This includes situations of imminent risk to the life of either partner or third parties (safeguarding), legal obligations such as court orders requiring records, or mandatory reporting laws in cases of child abuse.

In addition, mention should be made of the clinical supervision process, where the therapist may discuss the case with a supervisor to ensure quality of service.

In the context of family and systemic therapy, "reflective teams" or one-way mirrors are sometimes used; if these techniques are employed, the couple must be informed and consent that there is a team working on their case, which, far from violating privacy, expands the available resources for help.

Exclusion criteria for joint treatment

Not all couples are suitable candidates for conjoint therapy at any given time. There are clear contraindications.

First, couple therapy does not cure serious mental illness; if one partner suffers from a decompensated psychiatric pathology, he or she should receive priority or parallel individual treatment.

Secondly, willingness is non-negotiable; you cannot do therapy with an empty chair or with someone who flatly refuses to be there.

Finally, if the complaint is exclusively a sexual dysfunction (such as premature ejaculation or vaginismus) and the affective and communicative relationship is otherwise excellent, the correct referral is to specific psychosexual therapy, not general couples counseling, as the tools are different.

Summary

The contract establishes the logistical and ethical basis through clear rules on duration and frequency. Defining the cancellation policy avoids administrative conflicts by unnecessarily diverting the focus of therapeutic treatment.

Confidentiality is not absolute, and there are legal limits to imminent risks or detected child abuse. Clinical supervision and the mandatory use of external reflective equipment should also be reported.

Exclusion criteria include severe psychiatric pathologies or unwillingness to attend therapy. Pure sexual dysfunctions require specific referral to expert psychosexual treatment rather than general counseling.