What is informed consent for in psychotherapy?

Informed consent is an indispensable process in any intervention with patients.

It is estimated that, worldwide, one out of every four people has suffered some kind of mental health problem during their lifetime. This translates into some 700 million patients who require some kind of psychological help and who, unfortunately, in many cases do not receive it.

However, it is true that the field of psychological help has come a long way in recent decades, despite these discouraging figures. Emotional and behavioral problems in human beings are seen less and less as a weakness and, therefore, many people are now open to receive help and seek substantial changes in their lives beyond the physical.

Once an individual enters a consultation, there is a tacit contract between professional and patient, in which the latter authorizes, on the basis of his or her own freedom, the interventions to be performed on him or her. This pact is not a mere ethereal social construct: we are talking about the explanation of a process with the subsequent completion of a form. These acts are encompassed in the term known as "informed consent" (IC), and here we will see what it is for and how it works..

What is psychotherapy?

Let's 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 psychological manifestations of discomfort in the patient, promotes a series of changes and modifications in their behavior in order to achieve a general state of well-being..

Psychotherapy promotes changes congruent with the patient's desired goals. To put it in a more general way, it provides the individual with a sort of "order in the chaos", facilitating the understanding of ideas or acts that before seemed confusing. By allowing the understanding of the negative elements that surround us, the patient feels relieved, since at the end of the treatment he/she will be able to face sensations and anxieties that were difficult to understand and that had been avoided before.

In addition to all this, the techniques that emerge from psychotherapy promote the patient to learn different ways of thinking, feeling and acting, thus discarding previously learned behaviors that hinder their well-being. In short, it is not just a matter of fixing the problems that address the individual's life per se, but of replacing the feeling of discomfort with one of mastery and personal control.

On the other hand, implicit in psychological intervention is implicit in the fact that it is necessary to inform the patient about the goals and procedures of the therapy.This is where the role of informed consent comes into play.

What is informed consent?

Informed Consent (IC) is a process by which ensures that the patient has expressed his or her willingness to consciously participate in psychotherapeutic research.. The regulation of informed consent is contained in Law 41/2002, of November 14, 2002, the basic law regulating patient autonomy and the rights and obligations regarding clinical information and documentation. 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 to 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 paper does show, however, is that part of the informed consent is that this transmission of information has taken place between practitioner and patient.. In other words, and according to official medical sources: the document is not the information, but the guarantee that this has taken place. So, what should a psychotherapist inform the patient about before beginning treatment?

Information that should be provided in the informed consent form

Even if it does not appear in the document itself, every psychotherapist should inform the patient of some minimums, based on his or her personal inclinations. Some people are very suspicious and want to know a lot about the processes to be performed, while others tend to hypochondria and, for fear of worrying too much, decide to know just what is necessary. Both are respectable positions, so the type and amount of information provided must be adjusted 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 to you:

• Nature of the intervention: what it consists of and what procedures will be followed during treatment.
• Objectives of the intervention: what is the purpose.
• Benefits of the intervention: what improvements are expected to be achieved with the proposed treatment in the patient.
• Risks, discomfort and side effects: this should also include the possible effects of not carrying out the intervention.
• 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 all of them.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 case, is that the patient's decision and the amount of information he/she wishes to receive must be respected.

The Revista Médica Clínica Las Condes, in relation to this issue, makes a more than accurate 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 the patient, and not by a standardized process.

The requirements for an informed consent to be valid

Although the amount of information provided may be variable in each case, not all scenarios are valid for an informed consent to be considered correct and ethical.

The first characteristic that all ICs must meet is the patient's capacity to make decisions, i.e., that he/she is able to discern the patient's needs.The first characteristic that all ICs must meet is the patient's capacity to make decisions, i.e., that the patient can consciously discern whether or not he or she wants to undergo the proposed treatment.

Beyond this ability to distinguish, there must be voluntariness. Informed consent is useless if the subject acts on the basis of persuasion. Thus, a psychotherapeutic approach cannot be proposed by persons in a position of authority and is not valid if the individual is not given sufficient time to reflect, consult with external agents and finally decide whether he/she wants to take part (or not) in the research.

Finally, two final two final pillars that we have already explored are also necessary: 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 exception. In any case, at this point it is necessary to make a spear in favor of psychotherapists: the patient's freedom does not mean that he/she can impose everything he/she wants on the physician.

As a professional and free entity, the physician/psychotherapist can decide not to perform harmful or medically useless interventions on the patient. Beyond this ability to choose, professionals must actively reject any proposal that would be harmful to the patient, selecting only on the basis of their knowledge criteria the approach to be taken.

Summary

As you have seen, informed consent in psychotherapy is not only a piece of paper, but a procedure that culminates that culminates with the patient's signature on a written document. In order for the patient to be able to decide, he/she is given a certain amount of essential information (to a greater or lesser extent) that makes him/her aware of the functionality and objective of the treatment to which he/she is potentially going to be subjected. IC is based on voluntariness and understanding: if the patient is coerced or lacks information, its usefulness is null.

In any case, it is necessary to emphasize that the IC does not serve in any case to wash the professional's hands if he/she commits medical faults. Nor is it a mere administrative act that remains in the first consultation, but is in force in each and every one of the steps that cement the professional-patient objective that has been set.