Dialectical Behaviour Therapy Agreement

Dialectical Behaviour Therapy Agreement This document outlines the agreement between [Patient’s first name] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a single line.) and Wendy Rossouw (Clinical Psychologist) for participation in Dialectical Behaviour Therapy (DBT). Our Goal We agree to work together as a team to help [Patient’s first name] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a single line.) build a life that is experienced as worth living. The primary goal of this therapy is to help you achieve your own personal goals. This agreement is designed to structure our work so we have the best possible chance of reaching these goals. Client’s Agreements I, [Patient’s first name] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a single line.), agree to: 1. Attend therapy sessions on a weekly basis. In the absence of a DBT skills group, our sessions will alternate between one week of individual therapy and one week of individual skills training. 2. Complete my diary card daily. 3. Make every effort to complete homework tasks as this is the way to generalise skills and become really good at using them. 4. Agree to ultimately stopping any life-threatening behaviours, including all forms of self-harm and suicidal behaviours. 5. Abide by the 24-Hour Rule. This means that if I engage in self-harm, I will not have contact with my therapist for 24 hours following the incident. Reason for this rule: This rule is a standard part of DBT and is not a punishment. It is in place to avoid inadvertently reinforcing self-harm behaviour. Contact and support immediately after self-harm can sometimes act as a reward, which can make the behaviour more likely to happen again. The goal is to learn to use DBT skills to cope with distress instead of resorting to self-harm. You will still be expected to analyse the chain of events leading to the self-harm in our next session. The expectation is to call before attempting self-harm and use skills until I can reach you. 6. Agree to access the necessary medical care should self-harm have occurred. 7. Agree that the 24-hour rule for self-harm applies to phone coaching only. If self-harm has occurred less than 24 hours prior to our scheduled session, the session will still be conducted and a detailed chain analysis will be the focus of the session to try and problem solve the behaviour. 8. Provide at least 24 hours’ notice if I need to cancel or reschedule a session. If I do not provide 24 hours’ notice, I understand I may be charged for the missed session. 9. If I decide to terminate therapy, I will attend at least one final session to discuss this decision in person. 10. Understand that if four consecutive sessions are missed, therapy will be terminated and can only be resumed after a six-month period has lapsed. Therapist’s Agreements I, Wendy Rossouw, agree to: 1. Provide weekly sessions, alternating between individual therapy and skills training as agreed. 2. Make every effort to help [Patient’s first name] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a single line.) achieve their life-worth-living goals. 3. Be available for phone coaching between sessions to provide help with using DBT skills in the moment to manage difficult situations. Phone coaching is brief, focused on skills, and is not a therapy session. There is no charge for phone coaching. 4. Attend to phone coaching calls on the day before 21:00. It is expected that the patient continues using skills until I am able to attend to the call. Joint Agreements We agree that the effectiveness of our therapy work will be formally re-evaluated after six months. This agreement marks the beginning of our work together. It can be reviewed and amended at any time by mutual consent. I am looking forward to going on this journey with you. Signatures _____ [Patient’s first name] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a single line.) Date: [Date of signature] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Use DD/MM/YYYY format.) _____ Mrs. Wendy Rossouw Clinical Psychologist Date: [Date of signature] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Use DD/MM/YYYY format.) (For each section, only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit the section entirely. Never come up with your own patient details, agreements, dates, or signatures. Use only the transcript, contextual notes or clinical note as the source of truth. If any information related to a placeholder has not been explicitly mentioned, do not state that it is missing—simply omit the placeholder or section entirely. Never hallucinate.)