Informed consent in Psychology: what it is, parts and functions

People cannot receive psychotherapy without explicit consent. Therapies are not harmless: they have their advantages and disadvantages, and without a doubt they change people's lives.

Informed consent in psychology It is the process by which information is provided to the patient so that he or she can decide freely before any diagnostic and therapeutic intervention from her contact with the psychologist.

This tool is essential to start any type of psychological intervention, and requires that a series of characteristics be met that we are going to discover below.

• Related article: "The 8 benefits of going to psychological therapy"

What is informed consent in psychology?

Informed consent in psychology can be understood as the process in which information is provided, both orally and in writing, to the patient about the treatment she wants to receive. In this way, he will be able to freely decide whether or not to start the therapy, being aware of its potential benefits and also the risks that the treatment may imply.

The origins of this consent are in put the principle of autonomy above that of beneficence. The principle of autonomy is the ethical principle that recognizes the patient's ability to give himself standards or rules without influences of other people, while the principle of beneficence is the obligation of the professional to act for the benefit of the customer. The principle of autonomy is one of the most important requirements in the performance of professional practice.

After giving informed consent, the patient in her free, voluntary and conscious conformity, he can decide or not to accept psychotherapy. This decision will be taken into account as something binding to the extent that the patient shows full use of its faculties after receiving this decision. information, being aware that the decision to accept or reject therapy will bring you a series of benefits and, also, disadvantages.

Historical background

It may surprise you, but the moral recognition that the patient has the right to be informed about the therapy that is going to receive and that he or she is the one who can decide, ultimately, to start and end the therapy, is something recent. Today this right is supported by multiple judicial decisions and lacks deep historical roots.. It is recognized more for legal aspects than for therapeutic ones.

Since the time of Hippocrates, the patient-therapist relationship was unequal, and was regulated by the paternalistic principle of beneficence: always look for the good of the patient, regardless of their consent from him. Likewise, there were not a few cases in which this principle was ignored due to the desire to know, and Sometimes the good of the patient was not a priority either, but the expansion of knowledge even if it was done damage.

One of the most important historical antecedents for the development of informed consent in psychology is found in the decision taken by the German Reich Ministry of Health in 1931, in which it issued a regulation on medical therapies and human experiments. In that opinion the right of the patient to give her consent to participate in clinical trials was recognized. It was, therefore, a great advance in the recognition of the rights of patients.

But ironically it was in that same country where, with the rise of Nazism and the start of World War II, this recognition would be ignored. Human experimentation became fashionable among bloodthirsty Nazi doctors, who tried all kinds of non-consensual experiments on Jews, Gypsies, homosexuals, and political prisoners. There was a lot of suffering produced with the intention of expanding science in the German context.

After the defeat of Nazi Germany at the end of the conflict, the Nuremberg trials were held. The court of that city established the basic principles in human experimentation, thus creating the Nuremberg code. This code has been updated in subsequent revisions, giving rise to ethical standards for human experimentation, also extrapolated to the field of clinical therapies.

At present, the therapist-patient relationship has been horizontalizing, that is, it has been equalizing. This does not mean that the relationship between therapist and patient is equal., since the doctor, the psychiatrist and, of course, the psychologist are the professionals with studies who can guide the therapy with their knowledge, while it is the patient who receives the treatment and decides if it is he wants or not Be that as it may, the paternalistic principle that governed therapies for a long time has been overcome.

What information should be exposed?

In the informed consent, three informative elements must be exposed, which will be the ones that determine the objectives of the communication that will be transferred by written or oral means.

• The facts will be exposed completely and truthfully, without offending or dramatizing.
• A plan will be recommended, also informing of possible alternatives to therapy.
• It will ensure understanding of him.

Among the information necessary for the patient to understand the health service that is going to be offered, we have:

• The type of therapy
• alternatives to therapy
• The expected consequences and duration of the therapeutic process
• Right to suspend treatment at your own will
• Legal rights and limitations
• Session structure
• Fee

Who receives this consent?

informed consent must be in the form of a written or oral document. Such a document is signed by the patient in case he agrees to the terms of psychotherapy. In the event that it is oral, the patient must say explicitly and clearly that he does agree to start the therapy, having recorded it.

Informed consent arises from the right to be able to decide whether or not to receive therapy, that is, it implies making a personal and self-determined decision. It is the patient and not a family member, partner or friend who must give permission for therapy to start.

The person who should receive the information is the patient, although people related to him may also be informed for different reasons and to the extent that the patient allows it to be so. If the patient has some type of disability, he will also be informed, in a way that is appropriate to his understanding possibilities. and also informing that person who is his legal representative.

Informed consent by proxy

Despite the fact that informed consent in psychology is directed directly to the patient, sometimes he is not the one who consents to receive the therapy.

Due to different reasons, the patient may not have enough capacity to decide for himself, and other people decide for him. This is called proxy informed consent, which occurs when the subject does not have enough self-determination capacity to know what is best for him. This happens in the following situations:

1. Under 12 years

In children under 12 years of age, their opinion must be heard, especially if they are close to that age. At least their opinion and desire to start therapy should be taken into account, in order to see the possible reluctance that the minor may have regarding the treatment. His consent will not be binding, but he also has the right to know what he is going to receive.

2. Minors between 12 and 16 years

If the patient is between the ages of 12 and 16, it is important to study their ability to make a deeply thoughtful decision. At these ages, the individual could be mature enough to be able to decide in a more or less adult way, but each case must be studied professionally. In more than 16 years, you can accept her consent.

3. Conflict situations

If the child or adolescent is in a conflictive situation, such as having divorced parents, both parents must be kept informed and the consent of both must be ensured. Unless there is a judicial authorization or one of the parents has custody, consent must be given explicitly by both parents..

4. Exception

There is a special situation in which, although the minor cannot decide on the intervention, therapy can be started even if the parents have rejected it. This can be arranged like this when the professional considers that the rejection of the parents is detrimental to the minor, and as long as the authorities have been consulted and there is legal protection, the psychologist can start the therapy.

• You may be interested in: "The 4 exceptions to the psychologist's professional secrecy"

Benefits of informed consent in the context of psychotherapy

There are many benefits of informed consent in psychology, both for the patient who is going to receive psychotherapy and for the psychologist who is going to apply it. Among these benefits we can highlight:

1. Protection

Explicitly informing the patient of what is to be done during therapy protects the clinician, since This informed consent is proof that the psychologist has told the patient what he was going to do. If there has been something that was in the consent but that the patient did not like, since he was aware of it, he should not be able to complain.

In the same way, this consent protects the patient by being informed of her rights and obligations during therapy, in order to be able to claim in case the professional has not complied with her role. The psychologist can err or even act negligently, which gives the patient the right to initiate legal processes that pertain.

2. Access to information

This consent allows the consultant access to validated, coherent and specific information for her situation, in addition to allowing her to understand what the path that psychotherapy will follow will be and what is expected to be treated during it.

3. Better quality of the intervention

The informed relationship and joint therapist-patient decision-making allows for greater commitment. By understanding the meaning of the actions that the psychologist is going to carry out, the patient can have a more or less clear idea of ​​what he is going to receive during the treatment.

4. Promotes clinical research

Informed consent in psychology promotes clinical research in two ways. One is that in psychotherapy you can explain to the patient that his data can be used for treatment research, accepting or not if he is comfortable with it. In case it is, your specific case can be used to improve treatments and help more people like him or her.

The other way is directly with laboratory research. In psychology, as in other sciences, laboratory experiments require volunteer participants who agree to undergo such an experiment. Before starting they are given a document specifying what they are going to do, as well as being able to decide to leave the experiment at any time. This type of consent protects the researchers and gives security to the participant.

Criticism about its use

While there is no doubt that informed consent is a necessary tool not only in clinical and experimental psychology, but also in other disciplines such as medicine, there are not few people who consider that this document is something that offers several disadvantages.

It should be said that many people who think like this continue to have a traditional and paternalistic view of how therapy should be applied, very anachronistic for these times. Among these arguments we have:

• The patient cannot adequately understand the information.
• Patients do not want to be informed of bad news.
• The information can scare the patient for no reason and cause him to refuse treatment.
• Knowing that therapy may not have good results deprives the patient of the placebo effect, which provides hope and confidence.

Bibliographic references:

• Del Rio, C. (2010). Informed consent in minors and adolescents: Ethical-legal context and some problematic issues. Psychological Information: University of Seville, 100, 60-67.
• Ortiz, A., Burdiles, P. (2010). Informed consent. Clínica Condes Medical Journal, 21 (4), 644-652.
• Beauchamp, T. L. and Childress, J. F. (1999). Principles of biomedical ethics. Barcelona: Masson.
• Law 14/1986, of April 25, General Health (BOE 04.29.1986).
• Law 41/2002, of November 14, basic regulation of patient autonomy and rights and obligations in terms of clinical information and documentation (BOE 11.15.2002).