Berlin , date………………….




A therapeutic contract concluded between …………………………………………………………

and Agata Slezak  - a therapist, includes the following principles:

  • Ttherapeutic sessions are preceded by a psychological consultation - assessment (1-2 meetings), as a result of which the client's problems, the purpose of work, the intensity and probable duration of psychotherapy and the applicable rules of cooperation are determined.
  • The tools of therapy are dialogue and observation. These tools come from the trend psychodynamic psychotherapy. They require the patient's spontaneous activity - his commitment and willingness to participate in the therapy process is a condition for the effectiveness of the therapy. Depending on the type of problem, a behavioral-cognitive and Integrative approach will be used, taking into account techniques from this trend of psychotherapy.
  • a psychotherapy session lasts 50 minutes
  • sessions will be held once a week with the possibility of increasing their frequency
  • the cost of one psychotherapy session is: 80 EUR, payable after each session in cash or by bank transfer in accordance with the joint arrangement of the form of payment for sessions
  • the patient pays for all sessions, except for:

- sessions canceled by the psychotherapist

- sessions canceled at least 24h by the patient

- sessions canceled due to hospitalization or physical illness of the patient

  • if the patient cancels the session on the same day it was scheduled or does not appear at the session without information, undertakes to pay for this session
  • Patient's absence from the session without any information will be treated as resignation from further session psychotherapy
  • in case of doubts or the desire to change the date of the session, the patient can contact us by phone and the psychotherapist promises to call him back if she can't answer the phone
  • the psychotherapist undertakes to inform the patient in advance about her own planned and unplanned absences
  • Between sessions, the patient has the right to contact the psychotherapist in justified situations (SMS, telephone, e-mail), respecting the psychotherapist's privacy and undertakes not to abuse this right.
  • The goals of therapy are set each time individually in dialogue with the patient, their achievement depends to the same extent on the commitment of the patient and the psychotherapist. The goal of therapy during its course may change. This should be discussed by the patient and psychotherapist.
  • the psychotherapist is not responsible for whether, how and with what effect the patient will apply the new knowledge gained in the process of psychotherapy in his life
  • the patient has been informed about the possibility of deterioration of psychophysical condition during therapy - which may be the result of changes occurring in the patient during therapy
  • the psychotherapist may suggest to the patient a psychiatric or other consultation specialist, if he considers it necessary in the process of therapeutic treatment
  • the psychotherapist has the right to suspend the therapeutic process if undertaken by the patient's actions or behavior will harm or threaten his life or health
  • psychotherapy can be resumed if the patient discontinues or significantly reduces the above behavior (also with the help of other specialists) - on mutually agreed terms
  • in cases of life-threatening emergencies, the patient agrees to be contacted psychotherapist with his family or relevant services
  • the patient undertakes to be honest with the psychotherapist and actively participate in the process of psychotherapy
  • the psychotherapist undertakes to treat the patient in accordance with the professional code psychotherapist and using their psychotherapeutic experience and knowledge
  • the psychotherapist is bound by professional secrecy in the scope of providing information about treatment of the patient; except when the patient authorizes relatives in writing to information about his treatment
  • the exception to professional secrecy are situations when: life is at risk or health of the patient or other persons, or on waiving secrecy are provided for by other laws
  • the patient has the right to end the therapy before the mutually agreed date if he/she considers it appropriate necessary; he is then asked to inform about this decision in advance psychotherapist - preferably during a therapeutic session and having at least one session closing the process of psychotherapy
  • the psychotherapist has the right to resign from conducting psychotherapy of the patient only important reasons, but informs the patient about it beforehand and recommends another psychotherapist
  • the therapeutic contract is concluded for an indefinite period
  • changes to the therapeutic contract require the preparation of an annex to the contract


I am aware of the above rules, understand and accept them





Signature of the psychotherapist                                                                               Signature of the patient