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William Reid July 29th, 2004 07:05 AM

Informed Consent for Psychotherapy
I often run across psychologists (and less commonly counselors) who have an extensive "informed consent" process for their new therapy patients. The rules and disclosures sometimes take two or three pages to describe, and include potential side effects and adverse effects of therapy (or counseling). Other colleagues, particularly ones who have been in practice for years, are far less formal about the process of explaining therapy and the professional relationship to new patients (often simply discussing them orally). What's being taught in training programs currently, and what is the routine for reader-clinicians of different styles & backgrounds?

medumas September 26th, 2004 10:46 AM

Re: Informed Consent for Psychotherapy
I just recently had a client tell me some disturbing information about her husband. He is shaking their infant daughter and I told my client that I must report this. She got visibly upset when I reminded her that in my disclosure statement, it states that this is what I need to do and she stated that she didn't know it said that. I clearly went through my disclosure statement with her and she signed it saying that she understood. She wants to discontinue our therapeautic relationship because I am going to report this incident. What are my LEGAL obligations. What does the law state about what my responsibilities are and where do I go to access that law? I live in Montana.
Thanks for your help!
Melanie Dumas

JustBen October 27th, 2004 11:17 AM

Re: Informed Consent for Psychotherapy
I'm still fairly early in my program, but there does seem to be some emphasis placed on comprehensive informed consent documents accompanied by verbal explanations and an opportunity for the client to ask questions. (My own therapist basically just handed me the document and explained the mandated reporter stuff, though.)

I don't have much experience, obviously, but covering all the bases seems like a good idea given the legal environment. Also, it seems like you'd want to minimize the "surprises". I get the feeling that if you actually have to act on something you've heard and the client doesn't feel that this was ever explained to him or her properly, they're going to feel betrayed.

William Reid October 30th, 2004 08:52 AM

Re: Informed Consent for Psychotherapy
Interesting post. I can't comment on legal obligations, since I'm not a lawyer (much less a Montana lawyer), but if simply shaking an infant is reportable in your state, then it seems to me that you have to do it. Several things come to mind:

1. Most important, if you believe it is likely that an infant is in danger, I wouldn't be very concerned about my therapeutic relationship with the non-shaking parent. For goodness' sake, protect the infant. And don't wait for absolute proof; your good-faith belief that injury seems likely is enough.

2. But: Do you have reason to believe that the shaking is serious? I understand the dangers of shaking a child too vigorously; however, do you believe the shaking is in anger rather than gentle play, and rises to the level of danger (and thus you must do something about it). You may also be dealing with a custody battle (or a future one), a mother who is misrepresenting her husband for some other reason, or a patient who doesn't preceive the "shaking" accurately. In any event, though, protecting the infant from potential significant danger is the top priority. CPS staff -- not you -- are the professionals at determining the facts and acting properly on them. You probably don't have access to all the relevant facts, nor are you in a position to act on them. (One must hope, of course, that CPS is a fair, competent, and reasonably-funded agency in your area; that's not always the case, but they usually try hard.)

3. Regardless of whether or not a patient signs an acknowledgement that the therapist must report things, etc., the therapist is still bound -- ethically in my view, and very probably legally -- to do what is right. It's nice that you went over the initial form with her, but it should not affect what you do about the child (or what you have a duty to do).

4. Finally, a Web forum is not the place to get legal advice. I suggest you contact a (Montana) lawyer if you are not sure about your legal obligations, and a senior counselor with family experience if you're not sure about the practical and ethical ones.

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