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There are no universal rules for psychotherapy, but there is a code of conduct for the therapist, setting boundaries, and a therapeutic contract.

Here are some of these rules:

  • The therapist enters into a therapeutic contract with the client and provides assistance exclusively in the context of this agreement. The contract defines the therapeutic relationship based on a mutual desire, in which the professional knowledge and skills of the therapist will be used to understand the conscious and unconscious motives of the client's behavior in the interests of solving his/her problems.

  • The primary contract includes an agreement on the duration and frequency of sessions, their cost and method of payment, time and place of their holding. Other aspects of the contract are discussed as necessary during the treatment process (for example, conditions for canceling sessions, paying for absence, etc.)

  • The price for the consultation should be set by the therapist during the first meeting (conversation) with the client. The consultation fee cannot be replaced by any work or service from the client.

  • The psychologist (or psychotherapist) must act in the interests of the client and take him/her into account in the first place. If the client’s condition is beyond the therapist's area of expertise, the therapist should refer him/her to the appropriate specialist.

  • If the psychologist is in any personal (or kin) relationship with the client or the client's friend or relative, it will be better if the psychologist sends him/her to another specialist. This is necessary, since established personal relationships (outside the therapeutic context) may introduce biases to the process. In order to help the client, the therapist should strive to be the most objective, which can be hindered by existing informal relationships. Often in the process of psychotherapy, the client expresses his/her feelings and begins to idealize the therapist more and more, projecting on him/her all the best that is in himself, in his past life. As a result, the patient may even fall in love with the therapist. Freud called this phenomenon "transference." In such cases of "transference", the therapist tries to continue working with the patient, leading him/her to the realization of what is really happening. The psychologist does not have the right to under any circumstances enter into an intimate relationship with the client. Professional ethics does not allow any form of customer use in the interests of the analyst. Physical contact of an aggressive or sexual nature on the part of a specialist or candidate cannot be considered ethical even with the consent of the client.

  • The psychologist guarantees his patient strict confidentiality regarding the information received during the meetings, even if the client reports on the committed illegal actions.

  • If the client reports forthcoming illegal actions (for example, planned for a future murder or suicide), then he has the right to report this information to law enforcement agencies or a psychiatrist. The client is notified beforehand. The psychologist has the right to violate confidentiality if he is a witness in court, which is also reported to the client.

  • The professional behavior of a specialist is determined by the interests of the client, the safety of society and the therapist. The most important basis of psychotherapeutic work is the awareness and voluntary participation of the client in the analytical process.

  • If the client misses the consultation and does not warn the therapist about it at least 24 hours in advance, without a good reason, the client must pay for the missed session. Also, if the patient is inclined for a long time (more than 15 minutes) to discuss his problems with the therapist over the phone, then the specialist has the right to appoint a fee for the time spent. In turn, the psychologist warns the client in advance by phone if the consultation is postponed for any reason.

  • In psychotherapeutic practice, the therapist receives payment from the client only for the services rendered to him and the time spent on work. The amount of pay is determined on the basis of an open discussion with the client and should be acceptable to both parties. The client pays for the session at least 24 hours in advance, unless decided otherwise. The client is liable for missing sessions. The therapist does not pay or receive commissions when transferring or referring clients to other specialists. In all other cases, payment issues are decided in accordance with the legal law of Sweden.

  • The number of meetings depends on the client’s request, and may not always be accurately predicted in advance. The client decides to end therapy after discussing this with the therapist.

Alexander Lebedev MD PhD, psychiatrist, analyst.

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