Informed Consent In Therapy

document-428335_640A provider of any service is ethically and, in some cases, legally obligated to inform customers of how they do business, their business policies and the limitations of their services.

The nature of mental health services and, specifically, psychotherapy is so unique that informing the consumers about how those services work and what can and cannot be expected is absolutely crucial, it is more important than in any other industry. Yet, many therapists don’t provide their prospective clients with enough information for them to be able to make an informed decision about hiring a therapist. What’s more, they actually give much less information about their services than other service providers.

Normally, what you may see on the therapist’s informed consent form is their business policies in regards to payments, appointment cancellation, no shows, the lengths and the frequency of sessions and other logistics.

On that form you will rarely see an adequate explanation of what psychotherapy is, now it works, what its limits, benefits, risks and potential downsides are, what can and can’t be expected from, as well as an adequate explanation of how this or that particular therapist practices in terms of their philosophy, approach, methods and the justification behind them. Sometimes, there are vague general statements on the consent form about how the therapy process might be difficult at times because it may bring some dark emotions to the surface and that such occurrences are normal in therapy. There is a cliche statement therapists often use to explain this: “Sometimes you get worse before you get better.”

Other than a vague reference to the fact that psychotherapy may be a difficult process to go through, not much else is explained about how it works and this is unfair to you as a consumer.

The main reason why therapists don’t explain therapy process in detail is because psychotherapy is very different from other medical services even though our healthcare industry tries to equate them. Unlike general medicine, there are no precise procedures in psychotherapy with clear objectives and predicted measurable outcomes. As I’ve mentioned many times throughout this blog, psychotherapy is not a precise medical practice that operates with objective data derived from tests. Therefore, many psychotherapy theories and methods are largely speculative and belief-based rather than fact-based, which makes it difficult for therapists to describe precisely what they are doing. This, however, makes it crucial for professionals to be upfront about the limits of their factual knowledge before they begin to work with each client.

In addition, due to the unique nature of psychotherapy work, informed consent in psychotherapy cannot be limited to the initial general information that therapist puts on the form. What is put on the paper is just a basic contract the client accepts thus confirming their basic understanding of what they sign up for. Since psychotherapy is not a precise practice that operates with objective data, the results of psychotherapy work are always fluid and unpredictable. Therefore, there has to be a continuous revision of where things stand and where to go next. Honest conversations about the process itself and how well it is working or not working for each individual client should take place in therapy routinely. Both sides, therapist and client, learn something from those conversations, as the process goes on. Thus getting informed and consenting to what you, as a client, are informed about is not a single one-time decision, it is a continuing process.

There is a number of things therapists are generally suggested to include in their informed consent forms, but in that list of items the point or the spirit of the informed consent gets lost, and that spirit is the transparency about what the therapist can and cannot deliver. Most therapists, unfortunately, fail to understand and to integrate the spirit of honesty and transparency into their contracts with clients and into their entire practices, which often leads to clients’ hurts, disappointments and even traumas due to unmet expectations.

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2 Comments  comments 

2 Responses

  1. anonymous

    Since I worked with several psychiatrists (with an MD) many years ago, I did a search and found the AMA Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry 2013 edition. This document seems to me to indicate (in Section 8, Part 4 that psychiatrists have an obligation to inform patients of all treatment options. Also, in Section 5, part 5, guidance is given about how the psychiatrist should proceed when the patient requests a consultation.) There is other information about ethical expectations that may be of interest.

    It might be helpful for patients to read guidelines from associations such as this and/ or from state licensing boards so that they know what information their therapist is expected to provide.

    The rules of the boards and associations may not be comprehensive enough, but they provide some guidance.

    • Marina Tonkonogy

      Good point. People usually don’t research ethical guidelines of professional organizations and professional laws and that’s a big mistake. It is also true that this information is not always clear and not consumer oriented but there is still some helpful information on licensing boards and professional organizations websites. This website attempts to translate this information into a consumer-friendly, laymen language that appeals to regular therapy clients because it reflects their experiences.

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