Informed Consent in Therapy

[Mary S]

Today I looked up Kenneth Pope's web page on informed consent in therapy . The page includes several references, with excerpts from each. Here are a couple having excerpts that I think are particularly worthwhile (in large part because they bring up points that are important but infrequently discussed):

Medical Choices, Medical Chances by Harold J. Bursztajn, Richard I. Feinbloom, Robert M. Hamm, and Archie Brodsky. San Jose, CA: iUniversity Press, 2000.

Excerpt: "The term informed consent is used to describe the requirement that a doctor inform the patient (within reason) of the available options and the risks of each. The weakness of this concept lies in the word consent, which implies a passive consumer accepting options that the doctor (like a car dealer) presents, rather than participating in creating the options. The words informed choice better describe the scientific gambling that patients and doctors...must do together."

 "Managing Uncertainty: The Therapeutic Alliance, Informed Consent, and Liability" by Thomas G. Gutheil, Harold J. Bursztajn, Archie Brodsky, and Victoria Alexandra, in Decision-Making in Psychiatry and the Law edited by Thomas G. Gutheil, Harold J. Bursztajn, Archie Brodsky, and Victoria Alexandra. Baltimore, MD: Williams & Wilkins, 1991.

Excerpt: "The most serious problem with the consent form, however, is not its language, the response it elicits from the patient, or the circumstances in which it is proffered and signed. The overriding danger of the form is that it tempts the clinician to treat the transaction as a discrete task that is accomplished, and thus terminated, once the patient has signed the form. This unfortunate misuse of the form defeats the very purpose of informed consent, which is to foster and sustain an ongoing dialogue between patient and physician, as part of the process of joint decision making. Ideally, informed consent is never over. At any point along the way, the patient should feel free to ask questions about the impact of the treatment...."

Edited June 11, 2019 by Mary S

[disequilibrium1]

My therapy relationships were the opposite of informed consent. We only discussed appointment and payment policy. After that I plunged into a game that was never explained with no understanding of the risks or offer of choices. Therapists knew best.  Though cynically, I'm unsure how therapists can explain risks if they don't understand them themselves. I've never seen a satisfactorily concrete explanation of how therapy works.

[April]

Honestly, I've been to multiple therapists and I can only count a couple times that could vaguely be considered informed consent.  Even with those, they did not explain any risks or the probability of treatment failure.  They made it seem like something that could not fail if you just put enough time/effort/money into it.  

[Mary S]

2 hours ago, April said:

Honestly, I've been to multiple therapists and I can only count a couple times that could vaguely be considered informed consent.  Even with those, they did not explain any risks or the probability of treatment failure. 

Yes, I also encountered very little informed consent. I think it was the fourth therapist I tried who was the first to have an informed consent form. But it only covered fees, lengths of appointments, and cancellation policies. Nothing about the content, goals, processes, etc. IN addition, when I asked therapists why they were doing what they did (e.g., asking why they were asking a particular question), I got responses like, "I have my reasons," "Because that's what you need," "Are you sure you're not trying to second guess me?', "Do you realize you're asking me to give up my control? Those to me are all unprofessional responses.

There was one who had a fairly lengthy informed consent form. I read it over, and said I wasn't willing to sign it, because it seemed to be signing away my right to informed consent. He lost his cool a little, and said, "Where does it say that?" and I replied with something like, "It doesn't say that explicitly -- but right here it says that you will ask a lot of questions, and I'm not willing to give blanket consent to your asking questions -- I only consent to your asking questions that you have a good reason to know the answer to, and that are accompanied by that reason-- and if you respect my right not to answer if I don't think your reason is good enough." To his credit, he accepted my objection, and I signed an altered form adding something like my right to be given reasons and to refuse to answer if I did not consider the reason good enough.

[Mary S]

Today I did some more browsing on informed consent in therapy. One side I found (http://www.drlaurabrown.com/media/PsychotherapyConsentForm.pdf ) had something that I don't think I ever saw in therapist informed consent forms before, but that sounds like something that should be included:

"IV. Other Rights You have the right to ask questions about anything that happens in therapy. I'm always willing to discuss how and why I've decided to do what I'm doing, and to look at alternatives that might work better. You can feel free to ask me to try something that you think will be helpful. You can ask me about my training for working with your concerns, and can request that I refer you to someone else if you decide I'm not the right therapist for you. You are free to leave therapy at any time. "

This seems to express a therapist perspective that is unlike most of my experience with therapy (as described in my preceding post in this thread.)