Corey, G., Corey, M., & Callanan, P. (2011.). The client’s right to give informed consent. In Issues and ethics in the helping profession (8th ed.), (pp. 160-162). Cengage Learning.
The first step in protecting the rights of clients is the informed consent document. Informed consent involves the right of clients to be informed about their therapy and make autonomous decisions pertaining to it. Informed consent is a shared decision-making process in which a practitioner provides adequate information so that a potential client can make an informed decision about participating in the professional relationship (Barnett, Wise, et al., 2007). One benefit of informed consent is that it increases the chances that clients will become involved, educated, and willing participants in their therapy. Mental health professionals are required by their ethics codes to disclose to clients the risks, benefits and alternatives to proposed treatment. The intent of an informed consent document is to define boundaries and clarify the nature of the basic counseling relationship between the counselor and the client. Although informed consent has both legal and ethical dimensions, it is best viewed “as an integral aspect of the psychotherapy process that is essential for its success” (Snyder & Barnett, 2006, p. 40). Informed consent for treatment is a powerful clinical, legal, and ethical tool (Wheeler & Bertram, 2008).
Informed consent entails a balance between telling clients too much and telling them too little. Most professionals agree that it is crucial to provide clients with information about the therapeutic relationship, but the manner in which this is done in practice varies considerably among therapists. It is a mistake to overwhelm clients with too much detailed information at once, but it is also a mistake to withhold important information that clients need if they are to make wise choices about their therapy. Studies of practitioners’ informed practices have found considerable variability in the breadth and depth of the informed consent given to clients (Barnett, Wise, et al., 2007).
Professionals have a responsibility to their clients to make reasonable disclosure of all significant facts, the nature of the procedure, and some of the more probable consequences and difficulties. Clients have the right to have treatment explained to them. The process of therapy is not so mysterious that it cannot be explained in a way that clients can comprehend how it works. For instance, most residential addictions treatment programs require that patients accept the existence of a power higher than themselves. This “higher power” is defined by the patient, not by the treatment program. Before patients agree to entering treatment, they have a right to know this requirement. It is important that clients give their consent with understanding. It is the responsibility of professionals to assess the client’s level of understanding and to promote the client’s free choice. Professionals need to avoid subtly coercing clients to cooperate with a therapy program to which they are not freely consenting.
Generally, informed consent requires that the client understands the information presented, gives consent voluntarily, and is competent to give consent to treatment (Barnett, Wise, et al., 2007; Wheeler & Bertram, 2008). Therapists must give clients information in a clear way and check to see that they understand it. Disclosures should be given in plain language in a culturally sensitive manner and must be understandable to clients, including minors and people with impaired cognitive functioning (Goodwin, 2009a). To give valid consent, it is necessary for clients to have adequate information about both the therapy procedures and the possible consequences.
A good foundation for a therapeutic alliance is for therapists to employ an educative approach, encouraging clients’ questions about assessment or treatment and offering useful feedback as the treatment process progresses. Here are some questions therapists and clients could address at the outset of the therapeutic relationship:
- What are the goals of the therapeutic endeavour?
- What services will the counselor provide?
- What is expected of the client?
- What are the risks and benefits of therapy?
- What are the qualifications of the provider of services?
- What are the financial considerations?
- To what extent can the duration of therapy be predicted?
- What are the limitations of confidentiality?
- What information about the counselor’s values should be provided in the informed consent document so that clients can choose whether they want to enter a professional relationship with this counselor?
- In what situations does the practitioner have mandatory reporting requirements?
- If the person is referred for an assessment or for therapy from the court or from an employer, who is the client?
A basic part of the informed consent process involves giving clients an opportunity to raise questions and to explore their expectations of counseling. We recommend viewing clients as partners with their therapists in the sense that they are involved as fully as possible in each aspect of their therapy. Practitioners cannot assume that clients clearly understand what they are told initially about the therapeutic process. Furthermore, informed consent is not easily completed within the initial session by asking clients to sign forms. The Canadian Code of Ethics for Psychologists (CPA, 2000) states that informed consent involves a process of reaching an agreement to work collaboratively rather than simply having a consent form signed (Section 1.17).
Informed consent is a collaborative process that helps to establish and enhance the therapeutic relationship (Snyder & Barnett, 2006). The more clients know about how therapy works, including the roles of both client and therapist, the more clients will benefit from the therapeutic experience. Educating clients about the therapeutic process is an ongoing endeavour. Informed consent is not a single event; rather, it is best viewed as a process that continues for the duration of the professional relationship as issues and questions arise (Barnett, Wise, et al., 2007; Barnett & Johnson, 2010; Goodwin, 2009a; Snyder and Barnett, 2006; Wheeler and Bertram, 2008).
The informed consent process is a way of engaging the full participation of the client; it is a means of empowering the client, giving it clinical as well as ethical significance. Especially in the case of clients who have been victimized, issues of power and control can be central in the therapy process. The process of informing clients about therapy increases the chances that the client-therapist relationship will become a collaborative partnership.
Practitioners are ethically bound to offer the best quality of service available, and clients have a right to know that managed care programs, with their focus on constant containment, may have adverse effects on the quality of care available. Clinicians are expected to provide prospective clients with clear information about the benefits to which they are entitled and the limits of treatment.
