Informed Consent for Psychotherapy: A Look at Therapists' Understanding, Opinions, and Practices
Croarkin, Paul, Berg, Jennifer, Spira, James, American Journal of Psychotherapy
Forensic experts agree that the doctrine of informed consent now applies to psychotherapy. The optimum level of detail and content in this interaction remains nebulous. This study examines opinions and practices of therapists. The authors administered a survey regarding this subject to 231 psychotherapists. Six scales were constructed from this survey. High scores on these scales suggest more positive opinions regarding the application of the doctrine of informed consent to psychotherapy. Psychiatrists scored significantly lower on the Informed Consent (p=0.005), Written Consent (p<0.001), and Self-Disclosure (p=0.026) scales than other types of therapists (suggesting a more negative opinion of the application of this doctrine to psychotherapy). Interpersonal therapists scored significantly higher than psychodynamic psychotherapists on the Informed Consent (p=0.003) and Patient (p=0.003) scales. Psychodynamic psychotherapists scored significantly lower than therapists with different modalities on the Written Consent scale. This paper suggests that opinions and practices of informed consent for psychotherapy vary with the characteristics of the therapist. More research in this area could serve as a guide for therapists embarking on the process of informed consent or for professional organizations who wish to establish guidelines.
Sigmund Freud stressed the importance of preparing a potential patient for psychoanalysis. This involved describing the sacrifices inherent in the process, difficulties, costs, and length of treatment. He argued that this process was crucial in protecting against accusations of coercion and for dissuading "unsuitable" patients. However, he also cautioned aspiring psychoanalysts about the perils of "lengthy preliminary discussions before the beginning of treatment (1)." Since Freud's time, there have been other discussions regarding the application of informed consent to psychotherapy. Forensic experts have concluded that this process is necessary for psychotherapy (2-4). What remains nebulous is the optimum content and level of detail in this process.
Some experts argue that informed consent is now advised for psychotherapy. They conclude that this should encompass information relevant to the client's decision. This includes treatment contracting, information about the effectiveness and safety of therapy, as well as alternatives and consequences of no therapy (2). However, applying this doctrine to psychotherapy is challenging due to the diversity of psychotherapists, the myriad of variables inherent in the process of psychotherapy, and to the potential risk of contaminating the process of psychotherapy with this information. There have been strong arguments for and against applying this principle to psychotherapy (5, 6). Much of this was elicited from a court case in the 1980s, Osheroff v. Chestnut Lodge. Osheroff alleged that after a year of psychotherapeutic treatment for depression at an inpatient facility, he left and responded well to antidepressant medications prescribed by an outpatient psychiatrist. He stated that he would have pursued this sooner had he been informed about the psychopharmacologic option at the onset of his treatment. This approach would have possibly saved him from months of misery and a prodigious financial burden. This case settled out of court and did not establish a formal precedent for the issue of informed consent and psychotherapy (7).
Proponents of informed consent for psychotherapy posit that this doctrine protects patients' rights to their best interests, empowers them to exercise control in their treatment, and provides a means for legal recourse should their rights be violated (8). Furthermore, the process may provide psychotherapeutic benefits as well (2). This interactive educational process may hone patients' self-esteem, encourage autonomy, defend against pernicious regression, and establish their active role in the therapeutic process, setting the groundwork for the therapeutic alliance and for effective psychotherapy (9, 10). …