Informed Consent

Content of Informed Consent Procedures

What information should counselors and psychotherapists include during the informed consent process? Ethical codes and legal regulations typically offer little guidance regarding the specific topics to cover or particular details to address. In the absence of unambiguous guidelines, counselors and psychotherapists have developed and employed a wide variety of approaches to informed consent.

A number of topics have traditionally been included in the informed consent process. Prospective clients are generally informed about the nature of the counseling or therapy being proposed. This includes what the therapeutic approach is called, how it usually works, what activities it may involve, and how long it may last. They are also typically informed about the effectiveness of the proposed treatment, as well as potential risks and alternative treatments. Of course, the pragmatics of the treatment arrangement are also usually covered: how appointments are scheduled, where and how often sessions will take place, payment arrangements and responsibilities, and emergency contact information. Finally, informed consent procedures have customarily included confidentiality policies, including situations in which the counselor or therapist may need to break confidentiality without the permission of the client (e.g., when the therapist becomes aware of a legal duty to warn a third party of potential danger).

In addition to these essentials, a number of additional topics may merit inclusion in the present-day informed consent process. Recently, numerous authors have identified contemporary issues in the counseling or therapy field about which the client may have a right to be informed. For example, the increasing involvement of insurance companies, managed care organizations, and other third-party payers has had a widespread and well-documented influence on the counseling and psychotherapy professions, and some members of these professions believe this topic merits inclusion in their informed consent procedures. Similarly, therapy manuals (or empirically supported therapies, or best practices guidelines) have resulted in many clients in recent years receiving treatment that is to some extent predetermined or preplanned according to a diagnostic category or presenting problem. Informing prospective clients about their use by a counselor or therapist may be another relatively new addition to the informed consent procedure.

Timing of Informed Consent

When should counselors and therapists obtain informed consent? Ethical codes and legal regulations generally suggest that informed consent be obtained as early as possible in the therapeutic relationship. The rationale behind this suggestion is clear: Clients should have the opportunity to choose whether to proceed with counseling or therapy before finding themselves immersed in it. However, counseling and psychotherapy are fundamentally different from other practices that utilize informed consent procedures. Consider, for example, a physician who obtains informed consent from potential patients facing the same medical procedure. The procedure is assumed to be essentially similar for all patients, and to be a one-time event, so the physician can provide a uniform informed consent document to all potential patients at the outset.

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