Being Candid and Honest
Chapter Six
Informed Consent
A primary reason clients seek therapy is often because the feel incapable of exercising rational, self-determination of their personal circumstances, emotions, thoughts, and deeds (i.e., nonautonomous).
Therapist who fail to involve the client in the therapeutic decision-making process, by keeping them informed, defeat the very point of therapy.
It would be a violation of respect for client autonomy.
It is a mandatory ethic.
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Informed Consent
Case Study: Withholding Information from a Depressed Client
Was Diana clear enough about Georgia’s definition of child abuse?
Could she have provided client some examples of child about?
Should Carla have share Diana’s diagnosis with her?
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Informed Consent
Case Study: Withholding Information from a Depressed Client
The Informed Consent is not a moment in time.
It is a process that proceeds in a timely fashion throughout the course of therapy as new, pertinent information becomes available.
Informed Consent has rational limits.
E.g., Carla’s belief that disclosing the diagnosis might led to Diana harming herself
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Legal Limits of Informed Consent
State laws typically require therapists to provide copies, or a report of client’s mental health records upon request.
Case law has also established precedent for limiting a client’s access to records.
Canterbury v. Spence (1972) – Practitioner can withhold information if they believe it may cause bodily or psychological harm.
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When is Informed Consent Informed?
Informed Consent
What a reasonable person would want to know
involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it
A shared decision-making process
A powerful clinical, legal, and ethical tool
Requires that the client understands the information presented, gives consent voluntarily, and is competent to give consent to treatment
A process that continues for the duration of the professional relationship as issues and questions arise
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When is Informed Consent Informed?
Informed Consent What is in it?
The therapeutic options and process
Benefits and risks of treatment
Clients are entitled to know about the treatment in question, it’s risk and how comparatively effective it is.
Conventional treatment or experimental treatment?
Qualifications and background of therapist
Honest practitioners do not mislead about their credentials.
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When is Informed Consent Informed?
Informed Consent What is in it?
The nature and purpose of confidentiality
To whom information disclosed in therapy will be shared (e.g., supervisors, consultants, other therapists, office staff, third-party payers etc.)
Sometimes clients do not want a third-party payer to know their diagnosis and therefore choses to pay out of pocket (i.e., Self-pay).
Limits to confidentiality
Fees and costs involved in therapy
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When is Informed Consent Informed?
Informed Consent What is in it?
Length of treatment
May not be possible to provide an accurate estimate
Could be ongoing and in need of periodic updating
How often and length of sessions
Typically once a week (could be every other week or once a month)
Time can vary (e.g., 10, 15, 30, 45, 50 minutes
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When is Informed Consent Informed?
Informed Consent What is in it?
Client role in the therapeutic process
Client should participant in constructing a therapeutic plan.
Client may refuse to participate in any aspect of therapy.
Client should be informed of the consequences of refusing.
Therapist may refuse to accommodate a client when refusing lacks therapeutic value or pose risk of harm to the client.
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When is Informed Consent Informed?
Informed Consent What is in it?
Tape-recording or videotaping sessions
Interruptions in therapy
Therapy termination
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Therapist/Client Relationship
Commonly Assumed by Clients
Counseling is advice giving
Therapist will tell them what to do (client often come feeling powerless)
Some clients think that a therapist is there to show them what to do to change the external or “objective” reality.
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Therapist/Client Relationship
Truth about Counseling
Clients need to solve their own problems and
The therapist is only there to facilitate such constructive change.
It is the client’s “subjective” reality or psychological processes that are primarily the problem.
Counseling will not work unless they are willing to expend the effort.
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Therapist/Client Relationship
Circumstances as Part of Informed Consent
Therapist who reside in small towns are more like to have interactions with clients outside of counseling
Client suggestions about interacting socially outside of counseling
Discuss the potential for problems raised by such outside interactions
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Capacity: A Condition of Informed Consent
Precondition for informed consent is the capacity of the client to give informed consent
Decision-making Capacity Conditions:
1. Ability to make a choice
2. Ability to understand information relevant to the decision at hand
3. Ability to appreciate the consequences of the situation
4. Ability to think rationally and logically in reaching decision
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Capacity: A Condition of Informed Consent
In cases in which a client lacks decision-making capacity, a surrogate is necessary to provide informed consent.
They should know what the client would have likely wanted.
They should know what is in the best interest of the client
Lack of capacity may be temporary
Lack of capacity does not necessarily mean incompetence
Sometimes courts determine incompetence (e.g., financial)
Sometimes clients lack capacity to some degree (i.e., not total capacity lost)
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Capacity: A Condition of Informed Consent
Legally, unless declared personally incompetent by court of law, even a person who is involuntarily hospitalized has a constitutional right to refuse treatment.
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Informed Consent and Termination
Therapy must not be terminated in the absence of client’s informed understanding of the nature and purposes of termination
If premature termination is anticipated, promptly seek transfer or referral
If therapist is leaving an employment setting, inform client of options to continue services.
When a client is no longer benefitting from counseling, but client’s problems persist, inform client and make referral
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Informed Consent and Termination
If counseling appears to have been reasonably successful and therapy is no longer indicated, the therapist provides pretermination therapy and offer occasional “check-ups”.
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Informed Consent in Couples and Family Counseling
It is possible for something to be good for the couple or family and be harmful to the one person in the couple or one family member
Therefore, it is recommended that individuals, not relationships be regarded as the client
Confidentiality is just as important in couple and family therapy as it is in individual therapy.
We respect and guard the confidences of each individual client
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Informed Consent in Couples and Family Counseling
If the therapist wishes to define the client as the couple or family, the therapist needs to include this information as part of the informed consent.
Therefore, it is recommended that individuals, not relationships be regarded as the client
Confidentiality is just as important in couple and family therapy as it is in individual therapy.
We respect and guard the confidences of each individual client
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Informed Consent and Therapist-Client Trust
A therapist cannot always anticipate what may arise in the course of therapy to strain the bond of trust.
Hindsight is, of course, always better than foresight.
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