Therapeutic Contract Negotiation — The Bruges Model

Unlike directive approaches, the goal of treatment — including the choice between abstinence and controlled use — is formulated together with the client, not set by the program. The client's participation in choosing the goal increases adherence and self-efficacy. The contract is not a legal document but a living agreement, reviewed as changes happen. This is a key element distinguishing the Bruges Model from traditional programs such as the "12 Steps".

Step-by-step guide

Ask the client: "What is your goal regarding use?"
Inquire into both options (abstinence or controlled use) without preference
Discuss the realism of the goal in light of previous attempts
Lock in the goal in concrete, observable terms
Agree on intermediate review points for the contract

When to use

First and second session — before the main work begins
On any relapse or need to review the course of treatment
When the client expresses ambivalence about the goal
Under pressure from third parties (family, court, employer)

Key phrases

What is your goal — full abstinence or learning to drink differently?

What does "controlling the use" mean for you? What will it look like, concretely?

Follow-up questions

If in a month you say you are moving in the right direction — what will have changed?

How will you know that you have reached your goal?

When we meet again, by what signs will we know that we are moving where we need to?

Alternative phrasings

What of what you tried before fit — even partially?

If there were no constraints — what would you want for yourself?

Warnings

⚠️ Do not impose abstinence as the only correct goal even with medical indications — inform, but not directively
⚠️ With medical contraindications to use, provide information while keeping the right of choice with the client
⚠️ Review the contract when new data appear — it is living, not final

Source: De Shazer & Isebaert, 2003; Isebaert, 2016; González Suitt et al. 2019