Informed consent is a vital component of any treatment or care provided, whether it’s medical or mental, online or in-person. It’s how you ensure that your client is informed about the treatment they are receiving and that you have their full agreement to proceed as planned.
This article defines informed consent for therapy, with practical examples and templates that you can use to create your own documents.
Informed Consent for Therapy
According to the American Medical Association:
The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention.
The American College of Obstetricians and Gynecologists focuses on why informed consent is so important for the patient:
Although informed consent has both legal and ethical implications, its purpose is primarily ethical in nature. As an ethical doctrine, informed consent is a process of communication whereby a patient is enabled to make an informed and voluntary decision about accepting or declining medical care.
This highlights the real driving force behind the Informed Consent form and process—not just to protect the therapist or e-therapist from legal woes, but to empower the client or patient with the ability to make their own decisions about what’s best for them.
Although the two passages above come from the medical side of treatment, they form an excellent basis for understanding the basics of and implementing informed consent for any type of care.
“Informed consent is a process that involves the psychotherapist sharing sufficient information with the client or prospective client so the client can make an informed decision about participation in the proposed course of treatment. The client provides her or his informed consent based on being adequately informed about what they are considering participating in.”
Basically, the informed consent form is a way to make sure you and your client are on the same page about what the goals are, what format the treatment will be provided in, and what you can expect from one another in the course of the therapeutic relationship.
A Word on Ethics & Informed Consent
You know that informed consent is mandatory in any therapeutic relationship, but it can be helpful to go over why it’s so important.
Informed consent isn’t merely a box to be checked or a formality to get out of the way before the real work can begin. It opens a dialogue between you and your client, one that lays the groundwork for an effective relationship. It does this through:
- Empowering the client with information, thus reducing their dependence on the therapist and promoting autonomous function.
- Fostering collaboration between the therapist and client and setting a positive, open, trusting tone.
- Reducing the risk of exploitation or harm of clients by informing them of reasonable expectations.
- Improving the therapeutic relationship by increasing the client’s understanding of the proposed treatment.
- Promoting ethical practices through respecting the client’s right to dignity, autonomy, justice, and integrity.
When viewed through this lens, it’s easy to see why having a good informed consent form is part of any healthy, ethical practice.
A Look at Consents in Online Therapy & Research
If you’re already in practice and have an informed consent form that you regularly use, you may be tempted to use the same form for online therapy. We get it. It’s easier to reuse the same form rather than coming up with something new!
However, given the different risks and benefits and the added layer of physical separation between you and your client, it’s a good idea to address those differences. Your client should understand what they’re getting into, how it will differ from in-person therapy, and what they can expect—especially if this is their first time doing online therapy sessions.
According to Dr. Marie Fang, there are 4 benefits, risks, and other things of note regarding online counseling that you should point out to your clients:
- Confidentiality. There are unique confidentiality risks to online therapy, including people nearby your client overhearing the session or unauthorized persons gaining access to the video sessions, phone calls, or even electronic messages between you and your client.
- Clinical limitations. Some things are more difficult to observe or to target in online counseling, including facial expressions and body language.
- Transmission difficulties. Sometimes calls drop, and the internet goes down—it’s a common issue! Ensure your clients are aware of this risk and know what to do if something interrupts the session (e.g., try to call back, wait for you to get in touch, reschedule the session).
- Ability to respond to emergencies. Ensure your clients know when you are available remotely, what they should do if they can’t get in touch with you during an emergency, and what you will do during the session if you believe they are in immediate danger.
- Insurance coverage. It doesn’t hurt to point out that your client’s insurance provider may have different coverage when it comes to online therapy. Also note what your policy is if their provider does not cover online therapy.
- Online platform and HIPAA. Identify which virtual counseling platform you plan to use, along with the tools your clients must have access to attend sessions (e.g., computer with a webcam, an app, a smartphone).
- Discretion of appropriateness of teletherapy. Make sure you inform your client that you may at any point determine that online therapy is no longer appropriate and change the nature of your therapeutic relationship accordingly.
2 Practical Examples
This informed consent from the Genesis Counseling Center provides a good example of a form that is customized for online therapy.
It’s a great example because it:
- Defines online therapy. It states, “Online therapy includes the practice of psychological health care delivery, diagnosis, consultation, treatment, referral to resources, education, and the transfer of medical and clinical data.”
- Identifies some of the risks of online therapy vs. in-person therapy. The form states some of the risks of online therapy, including disruption in the transmission of personal information, failure of electronic storage of information, etc.
- Acknowledges that the client’s needs may change. The form includes an acknowledgment that the client’s counselor has determined that online therapy will likely be effective for the client, but notes that “…if my counselor believes I would be better served by another form of intervention (e.g., face-to-face services), I will be referred to a mental health professional that can provide such services in my area.”
- Identifies when online therapy is not appropriate. This informed consent contains instructions on what to do when video conferencing may not be feasible, effective, or appropriate: “If I am in crisis or in an emergency, I should immediately call 9-1-1 or seek help from a hospital or crisis-oriented health care facility in my immediate area.”
Another good example comes from the Clinical Care Consultants. This sample informed consent covers several important aspects of online counseling, including:
- Who it’s for (adults, not minors)
- Identify verification (how clients will verify their identity)
- Technology used
- A backup plan for disconnection problems
- Prohibition on recordings of sessions
- Risks of harm in online therapy
- Confidentiality restrictions
- Record maintenance
- No-Show and Late Cancellation Policies
Both of these forms provide good examples of what your informed consent should look like. However, there are also several resources you can check out if you want to use more specific guidelines or a quick and easy template you can customize for your own practice.
Guidelines & Templates for Your Online Practice
If you’d like to create your own informed consent form from scratch, the components below are great for guiding you in this endeavor.
Doctors Daniel E. Hall, Allan V. Prochazka, and Aaron S. Fink offer these four components that you must touch on for truly informed consent to be obtained:
- The client must have the capacity to make decisions (or have a guardian who has the capacity to make decisions).
- The care provider must disclose sufficient details for the decision-maker to make an informed choice.
- The decision-maker should show his or her understanding of the disclosed information.
- The decision-maker should freely authorize the treatment plan.
These guidelines were developed for medical treatment, but they make sense for mental health treatment as well.
In terms of ensuring your informed consent also covers the unique realities of online practice, add the information we touched on above (e.g., confidentiality, insurance, disconnection policies) to component #2.
This information is part of the “sufficient details” that the decision-maker needs to make a fully informed decision.
4 Templates for Individual and Group Therapy Sessions
If you prefer to use a ready-made template and simplify customize it for your purposes, there are several resources available.
See the table below for sample templates.
|Center for Ethical Practice||Informed Consent for Individual Adult Therapy Services||https://centerforethicalpractice.org/ethical-legal-resources/practice-resources/sample-handouts/informed-consent-for-therapy-services-adult/|
|JotForm||Informed Consent for Individual Online Therapy||https://www.jotform.com/pdf-templates/online-therapy-consent-template|
|Lyra Health||Informed Consent for Video Therapy Session||https://www.lyrahealth.com/wp-content/uploads/2018/05/Sample-Video-Therapy-Informed-Consent.pdf|
|Steven Greenwood (via JotForm)||Telehealth Consent Form||https://www.jotform.com/form-templates/telehealth-consent-form|
The informed consent is something that must be checked off the to-do list before you can begin the important work you do with clients. It’s probably not something you look forward to doing, but make sure to give it some serious thought.
It sets the tone for your relationship with your clients and ensures you are both on the same page, as well as providing cover in case any sticky legal or ethical issues arise. It pays to get it right the first time!
- ^ AMA. (2021). Informed Consent. Retrieved from https://www.ama-assn.org/delivering-care/ethics/informed-consent
- ^ ACOG. (2009). Informed Consent. Retrieved from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2009/08/informed-consent
- ^ Barnett, J. E. (n.d.). Informed consent in clinical practice: The basics and beyond. Society for the Advancement of Psychotherapy. Retrieved from https://societyforpsychotherapy.org/informed-consent-in-clinical-practice-the-basics-and-beyond/
- ^ Fang, M. (2020). Informed consent for online therapy. Private Practice Skills. Retrieved from https://privatepracticeskills.com/informed-consent-online-therapy/
- ^ Genesis Counseling Center. (n.d.). Genesis informed consent for Online Therapy Services. Retrieved from http://genesiscounselingcenter.com/wp-content/uploads/2019/11/Genesis-INFORMED-CONSENT-FOR-ONLINE-THERAPY-SERVICES-1.pdf
- ^ Hall, D. E., Prochazka, A. V., & Fink, A. S. (2012). Informed consent for clinical treatment. CMAJ 184, 533.