Educational and reflective resource. You can use this resource independently or discuss it with a practitioner. It does not provide an individual assessment or establish a therapy relationship.
- For
- A client who is disabled, or living with a disability or long-term condition, and their therapist, together
- Time
- Five minutes for the quick version; part of the first one or two sessions for the full one
- Format
- Guide, five-question quick version and nine-part agreement
- Prints
- Yes, or download as Word
- Evidence
- This site’s own tool, shaped by what disabled clients report about therapy
Access as part of the therapy, agreed together.
A short agreement a client and therapist fill in together, early in therapy. It puts access in the therapy contract, next to confidentiality, fees and cancellations, so it’s part of how the work is set up rather than a favour asked for later.
The key idea: access isn’t an extra. How sessions run, how you communicate, what happens on a bad day and how a cancellation is handled are all part of the therapy frame, and they can be agreed like the rest of it.
Who leads: the client says what helps. The therapist says honestly what they can offer, and what they can’t.
Low on energy? Start with the five-question quick version. The full agreement can wait.
How it fits: Before Your First Session helps you prepare. This agreement is the standing arrangement. The Session Card covers how you are on a particular day.
Where are you right now?
I’m the client
You can bring this to your first session, or ask to fill it in together.
I’m the therapist
You can offer this to every client, not only those who mention disability.
Where this fits
This site has tools for each stage of therapy. The agreement is the piece that holds them together.
- BeforeBefore Your First Session: prepare what you want and need
- Early onThis agreement: the standing arrangement, agreed together
- Each sessionSession Card: how today is
- Every so oftenIs This Working for Me?
- If neededRaising a Problem in Therapy
Why put access in the contract
Disabled clients have reported spending sessions educating their therapist about disability, and having physical symptoms explained as psychological. In a study of 24 US adults with physical disabilities, about a third said a therapist had attributed physical symptoms to psychological causes. Agreeing access at the start helps prevent both: the therapist knows what matters before it becomes a problem, and practical needs are less likely to be read as resistance.
There is also wider evidence that taking clients’ preferences seriously matters. A meta-analysis found that clients whose preferences about therapy were accommodated were less likely to drop out, and did somewhat better. Access preferences are a kind of preference that is easy to agree and easy to overlook.
Five principles
- The client leads on what helps. Their words go on the sheet.
- No diagnosis needed. Describe what helps, not what’s wrong.
- The therapist is honest about limits. If something can’t be offered, they say so, and look at alternatives together, including another service if that would suit better.
- Access isn’t interpreted without asking. Arriving late, needing to stop early or asking for a change isn’t treated as resistance or avoidance unless the client wants to explore it that way. See When Disability Gets Misread as Psychology.
- It changes when needs change. It’s reviewed at agreed points, and either person can ask to revisit it at any time.
If asking feels hard
Early in therapy, it can feel risky to ask for anything. You might worry about seeming difficult, or about what the therapist will think. You might be used to managing without, or to people doubting you. All of that is common, and none of it means you shouldn’t ask.
- You can fill it in on your own first, and bring it when you’re ready.
- You don’t have to do it all at once. The quick version below covers the essentials.
- You don’t have to explain why. What helps is enough.
Some ways to raise it:
“There are a few practical things that help me get the most out of sessions. Could we talk about them?”
“I found an access agreement online that I’d like to fill in with you. Is that OK?”
“Some weeks are harder than others for me. Could we agree what happens if I can’t make it in person?”
Signs of a poor response
- Doubting that you really need it
- Asking for proof or a diagnosis before agreeing something simple
- Interpreting the request, for example as resistance or wanting special treatment
- Agreeing, then not following through, more than once
If this happens, you can name it, using Raising a Problem in Therapy or the Self-Advocacy Scripts. You can also decide this therapist isn’t right for you. Looking for someone else isn’t failing at therapy.
Quick version · Five questions · About five minutes
The essentials
For a first session, a low-energy day, or if the full agreement feels like too much. You can add the rest later. It’s also page one of the Word download.
The full agreement · Nine parts
Our therapy access agreement
Fill this in together. Parts marked client are written by, or in the words of, the client. You can type into the boxes and print the page, or use the Word version.
1How sessions run
Client, then agreed together
2Communication
3Energy, pain and bad days
4Cancellations and missed sessions
Therapist sets out their usual policy; then agreed together
For disability-related cancellations at short notice, we agree:
5Disability in the work
Client decides
6Other people
7When something isn’t working
8Longer breaks and between sessions
9What the therapist can offer, and review
Therapist
This agreement sits alongside your usual therapy contract. It doesn’t replace it, and it isn’t a legal document. Either of you can ask to change it at any time.
Does this weaken the therapy frame?
Some therapists, particularly in psychodynamic and integrative traditions, worry that changing session length, format or cancellation rules for one client weakens the frame, or gratifies the client in a way that gets in the way of the work. It’s a fair question, and it deserves a straight answer.
- An agreed adjustment is the frame. The frame is the set of reliable, explicit arrangements that make the work safe. An access arrangement agreed at the start and kept consistently is part of that frame, made to fit this client. It isn’t a departure from it.
- What harms the frame is inconsistency and the unspoken. Ad hoc exceptions, resentment that isn’t named, or a client quietly struggling to fit a structure that doesn’t work for their body are more of a risk than a clear agreement.
- A standard frame isn’t neutral. A 50-minute in-person hour, a flight of stairs or a strict late-cancellation fee assumes a particular kind of body. Applying it unchanged can tell a disabled client their needs don’t fit.
- Meaning can still be explored, if the client wants. What it’s like to ask, to need help, or to have a body that doesn’t follow the timetable can be rich material. But it’s explored with the client, after the need has been met, not used as a reason not to meet it.
For more on how neutrality and the frame look from a disability perspective, see Beyond Neutrality.
When access goes wrong in the room
Even with a good agreement, things will go wrong. A therapist speaks before the client has finished typing, books an in-person session on a day agreed as online, or reads tiredness as avoidance. Handled well, a slip like this can strengthen the relationship rather than end it.
For the therapist
- Name it simply: “I booked you in person when we’d agreed online. That was my mistake.”
- Ask what’s needed now, and what would help next time.
- Update the agreement if something needs to change.
- Keep the apology short. The client shouldn’t end up reassuring you.
- Take the pattern to supervision if it happens more than once.
For the client
- You can name it in the moment, at the end, or by message afterwards.
- You don’t have to protect the therapist’s feelings.
- One slip isn’t a reason to give up. A pattern that doesn’t change might be.
- See Rupture and Repair for more.
Longer breaks, changing needs and endings
- Planned or unplanned breaks. A hospital stay, surgery or a long flare-up can interrupt therapy for weeks. Agree in advance how you’ll keep in touch, if at all, whether the client’s place is kept, and how you’ll restart. Coming back after a break can need its own conversation.
- Changing or progressive conditions. If needs are likely to change over time, review the agreement more often. Changes in access needs can carry a lot of feeling, and the client decides whether to bring that into the work.
- Endings that aren’t chosen. If therapy has to end because of health, money, a move or the therapist’s own circumstances, aim to end well where you can: a final session, a summary, and help finding someone else if wanted.
- Getting help between sessions. Not everyone can use the phone in a crisis. Agree which options suit the client. In Ireland, 50808 is a free text service available any time; in the UK, you can text SHOUT to 85258. In both countries, people who can’t make voice calls can register to contact emergency services by text. In an emergency, contact emergency services.
Keeping the agreement private
A completed agreement can hold sensitive information about health and daily life. Agree where it’s kept and who can see it. Usually that means the therapist’s secure client records, not shared with anyone else without the client’s agreement. The client should have their own copy, and can ask for it to be updated or for parts to be removed. The usual data protection rules apply.
For therapists: offering it well
- Offer it to everyone. Many clients don’t disclose disability early, or don’t use the word. Offering it routinely, as part of contracting, means nobody has to justify asking.
- Don’t ask for proof. You don’t need a diagnosis to agree a break, a shorter session or an online option.
- Be honest about your limits. If your room isn’t accessible or you can’t offer text-based sessions, say so early. Discuss alternatives, including a referral if another service would suit the client better.
- Look again at your cancellation policy. A fixed late-cancellation fee can fall hardest on clients whose conditions fluctuate. Switching format, shortening a session or waiving the fee are all options.
- Record arrangements, not symptoms. In your notes, write down what was agreed. Keep the client’s own description of their needs, not an interpretation of them.
- Revisit it. Needs change, and so does the work. A short check every few months, or when something shifts, keeps it alive.
- Know your duties. Equality law in Ireland and the UK applies to private therapy services. See Reasonable Adjustments for the law in brief.
Two worked examples
Maeve is 41, autistic, and lives with chronic pain. She is starting therapy for low mood after a change at work. Her therapist offers the access agreement in the first session as part of contracting. Maeve does the quick version then, and the full agreement the following week.
- How sessions run: in person on most weeks, online on high-pain days. A seat with arm rests, and the overhead light off.
- Communication: Maeve likes a little time to answer, and a two-line written summary after each session.
- Bad days: her signal for a pause is to hold up her hand. On harder days she might want a 30-minute session.
- Cancellations: the therapist’s usual policy is a full fee within 24 hours. They agree that for pain-related cancellations they’ll switch to online or phone first, and there’s no fee if that isn’t possible.
- Disability in the work: Maeve ticks “only when I bring it up”. She asks that her looking away during sessions isn’t read as withdrawal.
- A slip: in week five, the therapist comments that Maeve “seems far away today”. Maeve reminds her about looking away. The therapist thanks her, says she’d forgotten, and adds it to her session notes.
- Three months later: at the review, Maeve says the written summaries help most. She now wants to talk about how being autistic shapes her work stress, and changes her answer in part 5.
Dara uses a wheelchair and contacts a therapist he found online. Her practice room is on the second floor of an old building with no lift.
- What the therapist says: before booking, she tells Dara plainly that the room isn’t accessible. She offers online sessions, and names a colleague with a ground-floor room who works in a similar way.
- What she doesn’t do: she doesn’t suggest he could “manage the stairs with help”, and she doesn’t leave him to discover the problem on the day.
- What Dara decides: he wants in-person therapy, so he contacts the colleague. He says later that the honest, quick answer made him more willing to keep looking.
- What the therapist does next: she adds an access statement to her website, so the next person doesn’t have to ask.
Evidence & sources
- ResearchConner, K. J., Acosta, V. M., Nouri, R., Tyler von Wrangel, M., Gramillo, E., & Conner, A. (2023). Psychotherapy experiences of U.S. adults with physical disabilities: Recommendations for affirmative practice. The Counseling Psychologist, 51(7), 970–1004. doi:10.1177/00110000231186824
- ResearchSwift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis. Journal of Clinical Psychology, 74(11), 1924–1937.
- Clinical guidanceOlkin, R. (1999). What Psychotherapists Should Know About Disability. Guilford Press.
- Support services50808, Ireland’s free 24/7 text support service; Shout 85258, the UK’s free 24/7 text support service. Checked November 2026.
- Our frameworkThe agreement, the quick version, the five principles and the guidance on the frame and repair are this site’s own. They haven’t been formally tested.
- Fictional examplesMaeve and Dara are invented for teaching. They are not real people.
Summaries are this site’s own wording. For every source cited across the site, see Sources and Bibliography.
Last reviewed: November 2026.
How to cite this page: Donaghey, C. (2026). Therapy Access Agreement. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/for-disabled-people/therapy-access-agreement/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with extra permissions for teaching, supervision and therapy. Credit the site. See Reusing This Material.