Our Own View
While our aim in this book is to explore informed consent in the psychoanalytic context and not to advocate for a particular view, it would perhaps make sense for us to lay out, in a preliminary way, our current thinking on the topic. We also briefly discuss the dilemma of the analyst who disagrees with what may be required by informed consent laws.
As a normative matter, we believe that informed consent is necessary and important, but we would like to see a “process view” of informed consent implemented.
Why is informed consent necessary for patients undergoing psychotherapy? Simply put, it shows the patient dignity and respect. It arms her with the information to make an informed choice. And we must presume patients know themselves best and care about themselves most— so they are likely to make the best decision for themselves. It also allies the patient to the treatment from the start and can thus be therapeutic. Indeed, in our survey we found that analysts thought there were many benefits to having an informed consent requirement, even as they were concerned about some risks.
We are also hopeful that a process view will minimize the costs to the therapy—the countertherapeutic effects of an informed consent. We also endorse a process view because, given that analysis is a longterm treatment, benefits, risks, goals, and viable alternatives are likely to change, at which point a new informed consent may be necessary. So, for example, medication may not be an appropriate alternative in the beginning, but if, over time, the patient has depression that has deepened, at that point a disclosure might become imperative.
How would the process view work? More research is needed into the benefits and risks, and into the specific mode of implementation.