Barter is the acceptance of services, goods or other non-monetary remuneration from clients in return for psychological services.
Bartering is not inherently unethical, illegal or counter-clinical.
Bartering is common with poor clients who seek or need therapy but do not have the money to pay for it.
Bartering for psychotherapy is also very common in cultures and communities where bartering is an accepted norm for compensation and exchange.
Bartering that is likely to benefit clients can be part of a clinical intervention, negotiated with clients and articulated in the treatment plan.
Bartering can be of goods (chicken, painting, furniture, etc) or of services (automobile repair, plumbing, graphic design, etc.).
Some poor agriculture communities may have more flexible bartering schedules where the arrangement is a chicken and some fresh produce for each session.
Most analytically oriented therapists, consumer protection agencies and risk management experts frown upon bartering. The traditional analysts view bartering as interfering in transference analysis. Licensing boards, ethics committees and risk management experts often view bartering as potentially exploitative and damaging to the therapeutic work.
Most of those who oppose bartering reluctantly acknowledge that bartering can be an acceptable practice with poor people and is a normal and healthy aspect of certain cultures and communities.
Bartering has often been equated, mistakenly, with dual relationships and boundary violation. While bartering of services is, indeed, dual relationships, bartering of goods is generally not. As with many types of dual relationships, bartering of services can be clinically beneficial and ethically sound. All bartering is boundary crossing but not necessary (harmful) boundary violation.
Bartering does not necessarily lead to exploitation, harm or sex. The slippery slope concept that describes how one deviation from rigid guidelines inevitably leads to harm and sex is a fear based, irrational and unproven concept.
Almost all ethical guidelines do not mandate a blanket avoidance of bartering. All ethical guidelines prohibit exploitation of clients.
Bartering arrangements also have tax implications. Consult your tax preparer and make informed decisions regarding your legal, civic and professional responsibilities.
Avoiding all bartering agreements will abandon thousands, or even millions, of people who are in need of therapy but do not have the cash to pay for it.
Most graduate and post graduate education not only instill a fear of licensing agencies and lawsuits, but also deliver inadequate instruction in personal integrity, individual ethics and how to navigate the complex issues of bartering and other boundary issues in therapy.
Clinical and Ethical Considerations:
In planning on entering into a bartering agreement, therapists must take into consideration the welfare of the client, his/her culture, gender, history, condition, wishes, economic status, type of treatment, avoidance of harm and exploitation, conflict of interest and the impairment of clinical judgment. These are the paramount and appropriate concerns.
Make sure that the client involved in the negotiation fully understands and consents, in writing, to the agreement.
Include the bartering arrangement in the document that explains the payment agreement, and have the client sign the appropriate informed consent.
Make sure that your office policies, when appropriate, include the risks and benefits of bartering and that they are fully explained to, read and signed by your clients before you implement them.
The bartering arrangement must be well documented in the clinical notes.
Make sure that the bartering agreement is consistent with and is not in conflict with the treatment plan.
It is important to realize that bartering can be counter-clinical in some situations such as with borderline clients or those who see themselves primarily as victims.
Do not let fear of lawsuits, licensing boards or attorneys determine your fee agreements, treatment plans or clinical interventions. Do not let dogmatic thinking affect your critical thinking. Act with competence and integrity while minimizing risk by following these guidelines.
Remember that you are being paid to provide help and care not to practice risk management.
Differentiate when and what types of bartering are best suitable to each client and situation.
Consult with clinical, ethical or legal experts in complex cases and document the consultations in your clinical notes.
Attend to and be aware of your own needs through supervision and consultations.
At the heart of all ethical and clinical guidelines is the mandate that you act on your client’s behalf and avoid harm. That means you must do what is helpful, including bartering when appropriate.
Keep excellent written records throughout treatment if or when problems and complications arise with regard to the bartering agreement.
Evaluate the effectiveness and appropriateness of the bartering arrangement regularly and change it if necessary through discussion with and, hopefully, consent from your client.
If complications, negative feelings or disagreement arise due to the bartering agreement, discuss it with your client, get consultations and change it in a way that will be most helpful to the client and conducive to therapy.
