Couples Therapy Agreement

Couples Therapy Agreement

_____________________________ (hereafter "Individual 1") and _______________________ (hereafter "Individual 2," collectively "The Couple") hereby agree to the following terms and conditions set down by __________________ (hereafter "Therapist"):

The Couple will meet with the Therapist every {frequency} at the Therapist's office at {address} from {start time} to {end time} at a rate of {monetary amount} per session.

The Couple acknowledges the role of therapy as an opportunity to acquire and learn new tools for creating and maintaining healthy relationships and attachment styles, to promote emotional honesty and clear communication, to repair damage to the relationship, and to enforce respectful dialogue and reasonable boundaries.

The Couple understands that the goal of therapy is not to focus on either individual's personal happiness but rather the health and safety of both parties. If the therapy sessions reveal that the Couple might be better apart, the focus of the sessions may pivot to work on an amicable separation.

The Couple agrees to set goals as individuals and as a couple in the first session and use therapy as an opportunity to work toward those goals together and apart.

There is no set number of sessions. The Couple may continue therapy as long as they wish, and they may discontinue therapy at any time. Any cancelled or deferred sessions require {amount of time} advance notice or the Couple will be charged {fee}.

Both members of the Couple will attend each session. If both parties cannot attend, the session will be rescheduled to accommodate. The Couple may also schedule individual sessions with the therapist, to be determined by the individual and the Therapist.

During individual sessions, sensitive and personal information may come up. Each individual will be granted full privacy for what they share in individual sessions. However, the individual will be expected to share the following information during the Couple's sessions, as they can greatly impact the Couple and their relationship:

• Affairs (emotional and/or physical), emotional attachments and romantic intimacies with others outside the Couple.
• Arrests, trials, probation, jail time, records and other legal issues.
• Medical issues that affect the other individual (specifically STIs).
• Financial difficulties, including debts, liabilities and creditors.
• Addiction of any kind (drugs, alcohol, gambling, etc.).
• Instances of physical, verbal or emotional abuse.

The Couple swear and attest that they will not subpoena testimony from or require the court presence of the Therapist for any reason, including divorce proceedings or child custody hearings. As such, both individuals agree not to use any information imparted during the therapy sessions against each other in a civil, criminal or circuit court.

In witness to their agreement to the terms of this contract, the parties affix their signatures below:

_____________________________________
(Individual 1 signature and date)

_____________________________________
(Individual 2 signature and date)

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