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If you’ve been to a hospital for surgery or to a psychologist for therapy, you would most probably have been given a consent form to sign before treatment begins.
Doctors, as well as mental health professionals such as counselors and therapists, often require clients to sign off an informed consent form. This is to establish that they have been provided with the necessary information about the treatment plan.
Here’s all you need to know about informed consent in counseling and therapy.
What is informed consent in counseling?
Informed consent in counseling is the process of sharing information with a client for them to be able to make informed decisions with regards to his or her participation in the proposed treatment.
Informed consent should be given willingly by the client based on being adequately informed on the treatment or therapy they are about to participate in.
Benefits of informed consent in counseling
Informed consent in counseling offers benefits to both the client and the therapist.
- Providing clients with needed information reduces their dependence on the therapist and empowers them to function autonomously.
- Informed consent promotes collaboration between client and therapist. It helps to foster a positive working relationship in which trust and openness is encouraged.
- As informed consent sets reasonable role expectations and responsibilities, it helps to reduce the risk of exploitation of clients.
- The increased understanding of proposed treatment by clients reduces anxiety and apprehension. This also facilitates an informed decision by the client.
- Informed consent works to promote ethical practices by ensuring that the client has a right to dignity, justice and a sense of autonomy.
- In addition to a strong therapeutic relationship, it offers the therapist a chance to prevent ethical violations and/or legal liability that may occur during the course of treatment.
Many clients who are considering treatment are usually distressed and may be unable to cope with the experience. Hence, it is important that counselors and therapists do their best to help them understand and process the information that is being shared.
Reviews and discussions of relevant information may have to be carried out several times for some clients to ensure that they understand it well enough to make an informed decision.
Process of informed consent in counseling
There are generally three phases when obtaining informed consent. Exchange of information, dialogue between counselor and client are central to the process.
Providing information for the client
The counselor must communicate the nature, benefits and limitations of the treatment or procedure as well as any other eventuality that the client is agreeing to. The counselor or therapist should also provide alternatives to recommended treatment if there are any and ensure that the client is aware of all the options.
Information about likely outcomes of treatment, the release of information, recording of the session should also be presented to the client clearly.
The client should be given an opportunity to ask questions and engage in discussion with the counselor if he or she wants to.
Evaluation of client’s capacity to understand information
Once the information has been provided, the counselor will have to evaluate whether the client is able to understand the information and if he or she is competent to make an informed decision with regards to the treatment.
It is essential for the counselor to ensure that the client is able to comprehend both the risks and benefits of the treatment or procedure.
Obtaining consent from the client
The client will need to acknowledge that he or she has been properly informed and express their consent. A consent form signed by the client is the most common way to document that information has been received, read and understood.
Informed consent should always be obtained before treatment begins.
For situations in which a patient or client is not able to make independent decisions on their own but does not have a designated decision-maker, the court may have to appoint a legal guardian to make the decision.
Written vs. oral informed consent
Informed consent can be obtained through writing or orally.
A written document provides clients with the chance to go through the information at their own pace. It also allows the counselor to keep a hard copy of the signed form as proof of consent.
Oral informed consent is more flexible and allows the counselor or therapist to customize information for their clients. It also helps to facilitate discussion on the treatment.
In reality, a combination of both written and oral consent is the most ideal way. Consent forms should not stand alone and clients should have the opportunity to ask questions or discuss options during the process.
Both written and oral methods should adhere to the applicable laws and professional ethic codes.
Exceptions to informed consent in counseling
There are times when exceptions to obtaining informed consent can or should be made.
For example, it is permitted in many countries and professional codes of ethics to provide treatment and/or assessment during life-threatening emergencies. These include situations where the client is a danger to self or others, as well as when there are serious cases of abuse or neglect.
Exceptions can also be made when the patient is incapacitated or when he or she voluntarily waives consent.
Validity of informed consent in counseling
The issue of competency is central to the ability to give informed consent. Unless proven otherwise, adults are usually presumed competent to give consent for treatment.
Children and other dependent persons can usually be given treatment that their guardians have consented to and to which they have not disagreed to.
For informed consent to be valid, certain standards have to be met.
- Consent from clients must be given voluntarily.
- The client must be legally, cognitively and emotionally competent to give consent.
- The counselor or therapist needs to ensure that the client understands what he or she is consenting to.
- Information shared, agreements and or consent given need to be documented.
Besides this, informed consent should also be an ongoing process. Agreements or forms should be updated when there are changes in the treatment or services that were proposed. As such, it should not be seen as a single event but woven seamlessly into the process of therapy.
Information with regards to treatment should be provided as early as possible and should continue during the therapeutic relationship.
Example of invalid informed consent in counseling
Informed consent can be invalid when it is expressed but not internally given. For example, a client may verbally agree to something out of social pressure or fear, or the client may have difficulty in expressing their true feelings while the person performing the assessment or treatment is honestly unaware of this.
Example of informed consent in counseling
An individual struggling with depression might want to start counseling sessions in place of taking selective serotonin reuptake inhibitors. The therapist would be required to inform the potential client of the risks as well as possible benefits of this decision.
This would include informing the client of the potential relapse when stopping the medication.
Additionally, the therapist should also provide information on alternative treatments that are available, such as group therapy. The client should also be given the chance to ask questions and discuss their treatment options.
Other issues to consider
While informed consent works to safeguard both client and therapist, there are times when it is not straightforward. Here are some issues to consider:
- Competence levels for different individuals vary. As such, some people might be limited in making good judgements about therapy because of unfamiliar medical jargon.
- Clients who are struggling with delusions, dementia, as well as other conditions that influence decision making, may not be able to give informed consent on their own.
- Although the objective is to provide clients with full, complete information, it is quite impossible most of the time. For example, it is unlikely that a client is told of all the risks and side effects of a particular drug.
- It is not possible to predict the exact outcome of treatment in many cases. Information is provided based on studies and statistics but this does not guarantee a similar outcome for all individuals.
- In many mental institutions, patients might not consent to their treatment. Many times, these clients are given the necessary information about the treatment even if they do not consent. This is especially so if the client threatens their safety or that of those who are around them.
Informed consent in counseling is important as it provides a safeguard for both the client and therapist. It allows the client to make informed choices and protects him or her from potential harm.
Additionally, it helps to foster a good therapeutic relationship between client and therapist. However, for it to be valid, all necessary information pertaining to treatment sessions and the available alternatives should be provided.
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