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Being Candid and Honest Chapter SixInformed Consent A primary reason clients seek therapy is often because the feel incapable of

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.

Issues and Ethics

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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?

Issues and Ethics

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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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