When it comes to therapy, informed consent forms refer to the document that a patient fills out at the start of the therapy process. It has an important role in setting some guidelines and the standard procedure regarding how the therapy will go.

This article will look at everything you need to know about an informed consent form: what is it, what information does it typically contain, how do you use it, and what is its role in therapy?

What Is an Informed Consent Form?

Whether you are choosing conventional therapy or a blended care approach, your therapist should provide a physical or digital informed consent form for you to sign. Its purpose is to define and seal the terms of your relationship before you start any treatment.

A Quick Overview

The information contained in the informed consent form depends on the type of patient who is getting therapy or treatment. But, essentially, it lays down definitory information about the therapeutic process that is about to begin.[1]

Examples of such information include:

  • Fees and charging policies
  • Treatment duration
  • Any potential risks and benefits of your treatment
  • How you can make an appointment
  • What outcomes you might expect
  • How a crisis situation will be handled,
  • And more.

With so much responsibility in the hands of mental health practitioners, there is understandably much debate in the healthcare communities over what should be enclosed in an informed consent form. Essentially, such documents are a matter of both ethics and logistics.[2]

As a therapist, providing high-quality care means being able to answer any questions a potential client may have about informed consent.

From a practical standpoint, counselors, therapists, and psychiatrists can now find plenty of informed consent examples and templates online, but they are meant to only give a starting point for a more complex document.

In both conventional healthcare and in teletherapy, practitioners can then adapt these to their own style of work and to each patient, individually.

Related: The Top 5 Therapy Software Solutions in 2020

Before You Sign: Questions To Ask and Answer

As a patient, you have the right to know information about the therapy approach that will be used during your treatment.

As a therapist, providing high-quality care means being able to answer any questions a potential client may have about informed consent. A list of prepared questions and answers can also save you time, while serving as a checklist that you’re constantly up to date with this important document.[3]

Such FAQs typically will cover a few areas, as shown in the table below.

Feature

Key Questions

Logistics and Administration

Not all e-health services are covered by insurance. It’s thus often critical to ask about coverage and fees, to avoid or plan in advance for any potential financial issues.

  • What is the fee for a therapy session?
  • Do you need to pay for missed appointments too?
  • Are the fees expected to rise in the future?

Appointments

Clarity and boundaries around practical issues often help patients and practitioners develop stronger therapeutic alliances, often enhancing engagement.[4]
  • How long is a therapy session?
  • Can a therapy session be prolonged for a bigger fee?
  • What situations can justify missing an appointment? (sickness, weather, etc.)

Type of Therapy

Informed consent guidelines advocate maximum disclosure, especially for telepsychiatry providers.[5] This is particularly important with newer and often less familiar approaches such as video therapy, mobile therapy, and other blended care models.[2]
  • What kind of therapy will be applied?
  • What are the therapist’s qualifications to provide this type of therapy?
  • What is the success rate of the therapist’s method?
  • How long is it expected to last?
  • What are the expected signs of improvement?
  • What are the possible risks that can arise?

Privacy, Confidentiality, and Security

With e-therapy in particular, informed consent issues may center around data storage, HIPAA-compliance, and confidentiality.[6]
  • How do you protect my personal and medical data?
  • What channels of communication can we use?
  • Will you disclose the information you get from me in a certain situation?
  • Will my session and/or medical records be kept? For how long?

What Is the Role of Informed Consent Forms?

Some patients are not sure why they have to sign such a form, especially when it seems long, detailed, and phrased in legal or clinical jargon.

In some cases, a consent form containing too much information can seem like a defense mechanism of an insecure therapist. We’ll cover this more closely in a later section.

A therapist’s role is to make sure the patient is fully aware of the conditions involved, and that they know what signing the form means.

The role of an informed consent form is to make the terms of therapy clear to the patient. Any risks involved should be laid down and explained to the patients both in written form, but also verbally, using a language they will understand.[3] A therapist’s role is to make sure the patient is fully aware of the conditions involved, and that they know what signing the form means.

By signing an informed consent form as a patient, you acknowledge the therapist’s obligations and rights, as well as your own. Just as you would sign a contract before starting a new job, informed consent represents a legal contract between you and your therapist.[7]

Implicit vs. Explicit Consent

One of the most debated things about informed consent forms is what information they should contain.

Some therapists prefer getting into details when creating their consent forms, just to make sure that most situations that may arise during therapy are anticipated. But the truth is, some of the possible situations cannot be predicted.

Implicit Consent

Explicit Consent

Implicit consent will not be confined by the written consent form, as it refers to things that are naturally understood and expected by both the patient and the therapist.[8] For example, an informed consent form may not contain actions like shaking hands at the beginning of a session, something that might occur naturally between the patient and the therapist.[9]

In such situations, consent is implied. This means that it is considered reasonable by most people to act in a certain way (shake hands, calling one another by the first name, etc.)

Explicit consent usually takes into consideration the actions that may be subject to interpretation, or that might have important consequences when misinterpreted. For example, an informed consent form should always include rules about fees, appointments, involved risks, or legal obligations of the therapist.[8]

What Information Do Consent Forms Include?

Putting together everything we know about informed consent so far, we’ll summarize what these important therapeutic documents should contain.

At least 9 key elements emerge.

1. Details about the Provided Mental Health Services

Informed consent forms will briefly describe details of the therapy process, including the name of the used method and the techniques that will be applied to treat a patient’s mental condition. They should clearly name any specific approaches being provided, e.g. Cognitive Behavioral Therapy or Applied Behavior Analysis, along with whether the therapist is licensed and credentialed to implement the models.

2. Information about the Therapist

This type of information can be included in the informed consent form to demonstrate that a client is aware of the therapist’s qualifications to do the job they are doing. This might include:

  • Prior experience – duration, niches, subsectors, or techniques and approaches
  • Credentials, State or Federal license to practicein a teletherapy context, this is particularly salient

3. Procedures for Appointments and Cancellations

The procedures required to make an appointment or to cancel an existing one are important for both patient and therapist, as miscommunication in this area can easily be harmful to the therapeutic relationship.

By signing, patients agree to these procedures and acknowledge that other approaches won’t necessarily be successful. If a patient’s condition involves expected crisis situations, emergency logistics need to be covered and ideally, discussed.

4. Treatment Duration and Number of Expected Sessions

While there is no way of telling exactly how long therapy will last, as it may depend on unknown factors, it is important to set an expected duration, or an estimated number of sessions to be completed before checking the improvement of your condition.

What you will certainly find in the informed consent form is the duration of a single session.

5. Nature of Therapist-Client Relationship

Another important aspect to be included in the informed consent form is what the terms of your relationship are. This means that you agree to only have a professional relationship with your therapist, and not try to pursue other types of relationships.

Personal, business, sexual, or romantic relationships between patient and therapist can compromise the quality and effectiveness of the treatment.

6. Therapy Goals and Milestones

Although this information will be contained in detail in any mental health treatment plan, the important aspects of it such as any assessments, specific tools, and so forth will also be included in an informed consent form.

Patients and mental healthcare providers should discuss an estimated timeline for the former’s therapy process, as well as any milestones and the main goals being pursued. Goals can be defined briefly, or broken into smaller tasks, depending on a specific client or program.

7. Confidentiality

What patients discuss with therapists is protected by a confidentiality agreement. A practitioner’s duty is to protect client information and never disclose it to a third party unless they are required by law to do so.

If you as a patient have any questions about how confidentiality is kept during your treatment, ask your therapist about the measures they have in place, and what constitutes a legal obligation to warn.

Possible information that they are required to disclose may include[10]:

  • Child abuse
  • Sexual abuse,
  • Homicidal or suicidal thoughts
  • Abuse of the disabled
  • Abuse of the elderly
  • Child custody cases
  • Criminal activities
  • A lawsuit filed by the client against the therapist or vice-versa, and
  • AIDS/HIV infection and possible transmission.

8. Duty to Warn

A therapist is required to warn authorities about clients who are a danger to others or to themselves. For the entire duration of the therapy process, they have the authority to act on such dangers and by signing the informed consent form, you are agreeing to it.

The situations when the duty to warn can be applied are suicidal thoughts and intentions, criminal intentions, or hectic, uncontrolled behavior that can lead to dangerous situations.

9. Risk Management

Mental health conditions can often include crisis situations. If you are aware that you might find yourself in such a situation, or if your therapist considers that you might be at risk, your consent form will contain procedures to be followed in case of such a crisis.

For example, making an urgent appointment or applying alternative methods of therapy, like telepsychology, can be mentioned as solutions to crisis situations.

Consent Form Standards and Guidelines

With such heated debate on what a consent form should contain, mental healthcare providers need to agree on some guidelines to be applied for any situation. This set of guidelines is necessary to keep mental health services reliable and interchangeable.

For example, if a patient decides to change therapists, they should know what to expect from a consent form and to know that they are still protected and helped by these regulations.

When To Sign?

One of the rules of signing an informed consent form is to do it as early as possible during the encounters with the therapist. At the same time, a prior discussion would be needed before the consent form is drafted, so that it’s based on your particular situation, and not just a template that skips important issues to your case.

The role of an informed consent form is to provide crucial information to you and to prove that you understood it and it is now acknowledged. Therefore, if any aspect of a consent form is unclear or ambiguous, make sure the issue is addressed before you sign the form.

Should a problem arise later from that part of therapy, your signature will mean that you agreed to it. Filing a suit for such problems is not going to lead to a favorable result if you already consented to it.

Validity of Consent

When it comes to creating an informed consent form, things are quite clear so far. But is signing a document actually sufficient to express true consent of what is going to happen during therapy? The validity of consent is given by a number of factors, as we will show further.

The ability to give valid consent is given by the necessary mental state to comprehend, interpret, and agree to the information included in the document.

For dependent patients such as minor children, or people with certain health conditions and developmental issues, consent can sometimes be obtained from the appropriate guardian (parents, caregivers, legal representatives).

Final Thoughts

An informed consent form represents a written agreement between a patient and their therapist, which outlines the conditions and circumstances of the therapy process. When signing a written consent form, you agree that you have acknowledged, understood, and agreed to the information contained by it.

It is important to read the informed consent form before you sign it and clear out anything that might be interpreted differently. Talk to your therapist about any aspect that needs clarification and only sign a document you fully understand and agree with. Such a precaution will prove crucial in the case of future legal debate and it represents the therapist’s commitment to providing the proper treatment.

If you have not been provided with an informed consent form yet, mention it to the therapist you are working with.

References

  1. ^ Shah, P., Thornton, I., & Hipskind, J,E. Informed Consent. In NCBI, StatPearls. FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430827/
  2. ^ Recupero, P. R., & Rainey, S. E. (2005). Informed consent to e-therapy. American Journal of Psychotherapy, 59(4), 319.
  3. ^ Pomerantz, A. M., & Handelsman, M. M. (2004). Informed consent revisited: An updated written question format. Professional Psychology: Research and Practice, 35(2), 201.
  4. ^ Sexton, H., Littauer, H., Sexton, A., & Tømmerås, E. (2005). Building an alliance: Early therapy process and the client–therapist connection. Psychotherapy Research, 15(1-2), 103.
  5. ^ Schachter, D., & Kleinman, I. (1998). Psychiatrists' documentation of informed consent. Canadian Journal of Psychiatry, 43, 1012
  6. ^ Terry, N.P. (2001). An eHealth diptych: The impact of privacy regulation on medical error and malpractice litigation. American Journal of Law & Medicine, 27(4), 361
  7. ^ WHO. (2003). Mental Health Legislation & Human Rights. World Health Organization. Retrieved from https://www.who.int/mental_health/policy/services/7_legislation%20HR_WEB_07.pdf
  8. ^ Zur, O. (2020). Introduction to Informed Consent In Psychotherapy, Counseling and Assessment. Retrieved from https://www.zurinstitute.com/informed-consent/
  9. ^ Ali, F., Gajera, G., Gowda, G. S., Srinivasa, P., & Gowda, M. (2019). Consent in current psychiatric practice and research: An Indian perspective. Indian Journal of Psychiatry, 61(S4), S667.
  10. ^ APA. (2019). Protecting your privacy - Understanding confidentiality. Retrieved from https://www.apa.org/helpcenter/confidentiality

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