Informed consent and psychotherapy: An interpretative phenomenological analysis of therapists' views

Abstract

This research has been valuable in identifying therapists' views and experiences of how the issue of informed consent is addressed in therapeutic practice. In the light of the findings of this research, future investigation would benefit from more detailed examination of the process of providing informed consent, examining whether, and how often, consent issues are revisited by therapists. More research focusing on the views and need of clients are also warranted.

Clinical psychology service users' experiences of confidentiality and informed consent: A qualitative analysis

“…In line with Pomerantz (2005, p. 356) who noted that 'informed consent to psychotherapy : : : should constitute an ongoing process between therapist and client' some participants emphasized the growth of understanding choices, and active participation in decision-making, emerging over time. This research also supports the recommendations of Marzillier (1993) and Goddard et al (2008) in relation to the need for ongoing and repeated conversations about consent in therapy in the context of acknowledging 'the need to consent to the unknowingness of therapeutic approaches' (Goddard et al, 2008, p. 189) and adds to our understanding of how to increase the meaningfulness of the processes from a user perspective. Meaningfulness is underpinned by the centrality of an individuality of approach, and can be achieved by offering a process of repeated opportunities for discussion; acknowledgement of and sensitivity to the emotional state of the individual; paying attention to the individual's preferences regarding how they process information and discussion; updating users on developments in the NHS, for example electronic records, as needed.…”

“…Being mindful of how acquiescent some users may feel, psychologists may need to continue to broach these issues even when it appears they have been covered. Attending to and acknowledging the difference in power within the working relationship and providing opportunities for honest discussion about how this feels (Hagan & Smail, 1997) will help.…”

“…It is interesting to consider how the results of this study compare with research concerning therapists' views regarding confidentiality and informed consent. Goddard et al (2008) found that psychodynamic practitioners had concerns about whether giving information and holding discussion were sufficient to secure informed consent, with most practitioners wishing to provide 'a trial experience of therapy during the assessment stage as a way of informing them about the process of therapy' (p. 184) as the practitioners were conscious that the decision to proceed or not with therapy is ultimately a 'balance of probabilities'. Psychodynamic practitioners and psychological therapy users emphasize a need to deconstruct what is meant by 'risk', and reflect on the centrality of the relationship made -some therapists described perceiving that 'clients considered consent to the therapist as more important than to a theoretical approach' (p. 186), a view partially echoed by participants in this study who emphasized the qualities of trust and collaboration as seminal to the working relationship and its outcomes.…”

“…In addition, the theme of the promotion of user autonomy within the therapeutic relationship and the responsibility of users and psychologists to strive for this position is found in both studies, with users describing an awareness that it could be difficult to assert their views, and psychodynamic practitioners expressing a wish for the active involvement of the user in the work, and clear goals. Goddard et al (2008) focused solely on psychodynamic practitioners to ensure homogeneity of sample whilst this study encompassed participants who had worked with clinical psychologists working within a cognitive analytic therapy or cognitive behavioural therapy (CAT or CBT) conceptual model; Somberg, Stone, and Claiborn (1993) surveyed 324 American psychologists and reported that therapists of a CBT orientation indicated that they considered it more important than therapists working within other conceptual frameworks to discuss consent issues regarding methods, communication and process with clients.…”

“…In the UK, Goddard, Murray, and Simpson (2008) studied the views of psychodynamic therapists in relation to informed consent. They conclude that in psychodynamic practice, the experiential component of therapy may be seen by therapists as more informative than other methods of information sharing, and emphasize that research investigating the views and needs of users is needed.…”