What are your thoughts on using written contracts in psychotherapy for managing suicidal behaviors?

In Transference-Focused Psychotherapy (TFP) manuals, there's a strong recommendation to establish a verbal or written contract with patients after evaluation. This contract lays out the limits and responsibilities for treatment, covering things like the importance of going to the ER in case of suicidal ideation, and agreeing not to attend sessions under the influence of substances. TFP considers this a crucial step before diving into treatment, especially for patients with severe personality pathology.

Recently, though, I came across a different perspective in the *Good Psychiatric Management* manual, which suggests that written contracts may imply the clinician’s lack of trust in the patient. They propose that written contracts can undermine the therapeutic alliance, whereas a clear verbal agreement might better maintain trust.

Personally, I’m on the fence. I always discuss treatment responsibilities and limits verbally with patients, but I’ve also used written contracts, especially with challenging cases. My supervisors—who favor the TFP model—recommend them, and I’ve found the tangible document helpful as a reference for boundaries. Still, I question their true utility, as they don’t offer any legal protection (at least where I practice) and may feel defensive, turning the clinical relationship into a pseudo-legal arrangement.

What’s your take? Are written contracts beneficial in managing complex cases, or could they harm the therapeutic relationship?