Informed Consent

Informed consent is a foundation in the ethical practice of counseling. Not only does informed consent provide the groundwork for matters that affect the [Page 486]entire course and direction of the counseling relationship, it guides the practice of client autonomy. Informed consent refers to the freedom of choice a client has regarding whether or not to enter into a counseling relationship, the right to understand the nature of the counseling process, and relevant information concerning the counselor.

Due to the significant amount of information contained in the informed consent, both verbal communication and written communication are necessary. Any discussions of informed consent are to be documented by the counselor and, when appropriate, signed by the client. The informed consent process is used as a means to continuously monitor the goals and strategies of counseling. Rather than a onetime event at the onset of the counseling relationship, informed consent is an ongoing, collaborative process between the client and the counselor for the duration of the counseling process.

Underlying issues related to informed consent include the roles, rights, and responsibilities of the client and the counselor, as well as all parties involved. Topics that, at minimum, are included in the informed consent document are referenced in the Code of Ethics provided by the American Counseling Association (ACA), NAADAC (the Association for Addiction Professionals), as well as individual state certification or licensure boards. The following subject matter is typically included in this process, although this is not an all-inclusive list.

In clinical practice, the informed consent document includes a description of the client's right to confidentiality, program procedures that safeguard them, and exceptions imposed by federal, state, or agency regulations. An explanation of the counselor's background—that is, expertise, training, credentials, and theoretical orientation—is provided. Clients have a right to know which treatment modalities are to be employed and the expected benefits and potential risks of the services. Typical approaches to addiction counseling include individual, group, and couples and family therapy, in addition to medication management, support group attendance, and drug testing. Alternative approaches that might be available to the client should also be presented. Information about the anticipated duration of treatment and any situation potentially resulting in premature termination of treatment or circumstances in which a referral may be necessary are discussed. An explanation of client's rights in regard to an organization's policy and procedures and means to resolve disputes are included. Financial responsibility, payment options, and any other monetary obligations of the counseling relationship need to be clearly explained.

Informed consent is also utilized in research initiatives. The investigator is responsible to ensure participants are informed of any associated risks and provide them with relevant information necessary to make decisions about participation in the research project. An institutional review board oversees the research process to ensure all necessary information is provided in an comprehensible manner to participants.

Ethical considerations for the informed consent process are particularly relevant to substance abuse counseling. Individuals enter treatment with varying levels of cognitive abilities, particularly if they have recently been under the influence of drugs, alcohol, or both. In the case of detoxification, clients may actually be under the influence of substances when they agree to engage in the process. Additional factors to consider are the client's motivation for entering treatment, medical and emotional condition, and legal constraints. Such factors can significantly impair the client's autonomy and ability to provide informed consent. Once clients have initially entered treatment and are stabilized, particularly if they have gone through detoxification, information pertaining to the counseling process outlined in the informed consent is again reviewed. Under all circumstances, counselors need to respect the client's autonomy and right to consent or withdraw, of their own accord, from treatment.

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