Informed consent for psychotherapy: Ethical illusion or clinical reality? A survey about psychotherapists' attitudes and practices in Germany

Abstract

Objective This study aimed to assess clinicians' attitudes and their current clinical practices regarding informed consent for psychotherapy. Method A convenience sample of N = 530 clinicians in Germany (n = 418 licensed psychotherapists and n = 112 postgraduate psychotherapy trainees) took part in an online survey. Results Most clinicians (84%) reported obtaining informed consent for psychotherapy in their daily routine. However, many psychotherapists felt unsure about satisfactorily fulfilling the legal (63%) and ethical obligations (52%). The two most frequently reported components of information disclosure related to explaining the terms and conditions of psychotherapy (96%) and the psychotherapeutic approach (91%). Providing information about mechanisms of psychotherapy (33%) and the role of expectations (30%) were least practiced. One in five psychotherapists reported not informing clients about potential risks and side effects. A considerable proportion reported concern about inducing anxiety in patients by disclosing information about risks and side effects (52%). Conclusions Although obtaining informed consent for psychotherapy seems to be the rule rather than the exception in clinical practice, the quality of its implementation in terms of legal, ethical and clinical demands remains questionable. Training psychotherapists in providing comprehensive informed consent enables informed decision‐making and might have a positive influence on treatment expectations and outcomes.

Informed Consent for Psychotherapy: The Moderating Role of Therapeutic Alliance, Prior Knowledge and Autonomous Motivation on Decision‐Making and Treatment Expectation

“…The present findings on the moderation effects indicate that especially patients with rather little prior knowledge about psychotherapy and/or lower autonomous treatment motivation may benefit the most from an OIC. In such cases, we highly recommend the implementation of an individualized and positively framed OIC in clinical practice to address otherwise often neglected topics such as potential side effects of psychotherapy or treatment alternatives (Dsubanko‐Obermayr and Baumann 1998; Gerke, Meyrose, and Nestoriuc 2023), thus likely optimizing treatment outcomes (Beahrs and Gutheil 2001; Gerke, Pauls, et al. 2023).…”

Optimizing treatment expectations and decision making through informed consent for psychotherapy: A randomized controlled trial.

“…In preliminary consultations prior to any treatment, patients should be informed of all circumstances essential to consent (German Civil Code, 2013). In clinical practice, information about expected benefits, common factors, or risks of psychotherapy is rarely disclosed while organizational aspects seem overrepresented (Dsubanko-Obermayr & Baumann, 1998; Gerke, Meyrose, et al, 2022). Consequently, patients might not acquire realistic treatment expectations, which in turn, weakens therapeutic alliance (Barber et al, 2014; Johansson et al, 2011; Zilcha-Mano & Fisher, 2022) and leads to poorer psychotherapy outcome (Constantino et al, 2018; Seligman et al, 2009).…”