What is informed consent for in psychotherapy?

It is estimated that, worldwide, one in every 4 people has suffered from a mental health problem in their lifetime. This translates into some 700 million patients who require some type of psychological help and, unfortunately, in many cases they do not receive.

However, it is true that the field of psychological help has come a long way in recent decades, despite these disappointing numbers. The problems of an emotional and behavioral nature in the human being are seen less and less as a weakness and, therefore, Therefore, today many people are open to receive help and seek substantial changes in their lives beyond what physical.

Once an individual enters the consultation, a tacit contract is produced between the professional and the patient, in which the latter authorizes, based on his own freedom, the interventions that are to be perform. This pact is not a mere ethereal social construct: we are talking about the explanation of a process with the subsequent filling in of a form. These acts are included in the term known as “informed consent” (IC), and here we will see what it is for and how it works

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What is psychotherapy?

We start with the basics, because talking about informed consent without knowing why it is done can generate more confusion than anything else. Psychotherapy is defined as a scientific treatment (of a psychological nature) that, based on physical or mental manifestations of discomfort in the patient, promotes a series of changes and modifications in her behavior in order to achieve a general state of well-being.

Psychotherapy promotes changes consistent with the goals that the patient wants to achieve. To put it more closely, it provides the individual with a sort of "order in chaos", facilitating the understanding of ideas or actions that previously seemed confusing. By allowing the understanding of the negative elements that surround us, the patient feels relieved, since when end of treatment will be able to face difficult to understand sensations and anxieties that had previously been avoided.

In addition to all this, the techniques that emerge from psychotherapy promote the patient to learn ways different ways of thinking, feeling and acting, thus discarding previously learned behaviors that hinder their wellness. Ultimately, it is not just about fixing the problems that address the life of the individual per se, but about replacing the feeling of discomfort with one of personal domination and control.

On the other hand, in psychological intervention implies the fact that it is necessary to inform the patient about the objectives and procedures of therapy; that's where the informed consent role comes in.

What is informed consent?

For its part, informed consent (IC) is a process by which it is guaranteed that the patient has expressed her willingness to consciously participate in psychotherapeutic research. The regulation of informed consent is set out in Law 41/2002, of November 14, basic regulating of the autonomy of the patient and of rights and obligations regarding information and documentation clinic. Every inhabitant can consult these documents and many more in the Official State Gazette (BOE) of the Government of Spain.

There is a clear confusion in the general population between the verbal process carried out by the professional who is going to perform the therapy and the IC document itself. The psychotherapist must inform the patient about the processes that will be carried out during the treatment, in one or multiple interviews, always in a clear and understandable way. This process is gradual and unique in each case and, therefore, cannot be exemplified on paper in a standardized way.

What the role of informed consent does show is that this transmission of information has taken place between professional and patient. In other words and according to official medical sources: the document is not the information, but the guarantee that it has been produced. So what should a psychotherapist inform the patient of before starting treatment?

Information that must be provided in the informed consent

Although it does not appear in the document itself, every psychotherapist must inform the patient of a minimum, based on their personal inclinations. Some people are very distrustful and want to know a lot about the processes that are going to be carried out, while others tend to hypochondria and, for fear of worrying too much, decide to know what is fair and necessary. Both are respectable positions, so the type and amount of information provided should be tailored to each case.

In any case, there are a number of things that every patient should know when starting a psychotherapy treatment. In this list we show them:

• Nature of the intervention: what it consists of and what procedures will be followed during the treatment.
• Objectives of the intervention: what is the purpose.
• Benefits of the intervention: what improvements are expected to be achieved with the treatment proposed in the patient.
• Risks, discomfort and side effects: the possible effects that derive from not performing the intervention should also be included here.
• Possible options to the proposed intervention.

It is necessary to know that there are multiple models of informed consent in psychotherapy, so it is practically impossible to cover each and every one of them in a few lines. What must be clear, in each and every one of the cases, is that the patient's decision must be respected and how much information he wishes to receive.

The Las Condes Clinical Medical Journal, regarding this issue, makes a more than correct point: the professional's duty to inform the patient does not imply imposing the information that the professional, a scientific society or the administration or management has decided for all cases. The limits are set by you as a patient, and not a standardized process.

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The requirements for an informed consent to be valid

Although the amount of information provided may vary in each case, not all scenarios are valid to consider informed consent as correct and ethical.

The first characteristic that all ICs must meet is the ability of the patient to make decisions, that is, that he can consciously discern whether or not he wants to undergo the proposed treatment.

Beyond this capacity for distinction, there must be a voluntariness. An informed consent is useless if the subject acts on the basis of persuasion. For this reason, the psychotherapeutic approach cannot be proposed by people in authority and it is not valid if it is not granted enough time for the individual to reflect, consult with external agents and finally decide if he wants to be part (or not) of the investigation.

Lastly also two final pillars are necessary that we have already explored: information and understanding. Whatever the amount of information provided, the patient must be able to understand it and be able to act on it, without exceptions. In any case, at this point it is necessary to split a spear in favor of psychotherapists: the patient's freedom does not imply that he can impose on the doctor everything he wants.

As a professional and free entity, the doctor / psychotherapist can decide not to carry out harmful or medically useless interventions on the patient. Beyond this capacity for choice, professionals must actively reject any proposal that involves a harm to the patient, selecting only on the basis of the criteria of knowledge of him the approach that is going to perform.

Resume

As you have seen, informed consent in psychotherapy is not just a role, but a procedure culminating in the signing of a document by the patient. In order for him to decide, he is given a quantity of essential information (to a greater or lesser extent) than informs you of the functionality and objective of the treatment to which you are going to submit in a potential. IC is based on voluntariness and understanding: if the patient is coerced or lacks information, the usefulness of it is nil.

In any case, it is necessary to emphasize that the IC does not serve in any case for the professional to wash his hands if he incurs medical offenses. Nor is it a mere administrative act that remains in the first consultation, but is found current in each and every one of the steps that cement the professional-patient objective that has been raised.