Abstract
Background: Ethical informed consent to psychotherapy has recently been the subject of in-depth analysis among healthcare ethicists.Objective: This study aimed to explore counseling and psychotherapy students' views and understanding about informed consent to psychological treatments.Methods: Two focus groups were conducted with a total of 10 students enrolled in a Masters course in counseling and psychotherapy at a British university. Questions concerned participants' understanding of informed consent including judgments about client capacity; the kinds of information that should be disclosed; how consent might be obtained; and their experiences of informed consent, both as a client and as a therapist. Focus groups were audio-recorded, transcribed, and analyzed using qualitative content analysis. Coding was conducted independently by three authors.Results: Comments were classified into three main themes: (1) the reasons and justifications for informed consent; (2) informed consent processes; and (3) the hidden ethics curriculum. Some trainees expressed significant doubts about the importance of informed consent. However, participants also identified the need to establish the clients' voluntariness and their right to be informed about confidentiality issues. In general, the format and processes pertaining to informed consent raised considerable questions and uncertainties. Participants were unsure about rules surrounding client capacity; expressed misgivings about describing treatment techniques; and strikingly, most trainees were skeptical about the clinical relevance of the evidence-base in psychotherapy. Finally, trainees' experiences as clients within obligatory psychotherapy sessions were suggestive of a “hidden ethics curriculum”—referring to the unintended transmission of norms and practices within training that undermine the explicit guidance expressed in formal professional ethics codes. Some students felt coerced into therapy, and some reported not undergoing informed consent processes. Reflecting on work placements, trainees expressed mixed views, with some unclear about who was responsible for informed consent.Conclusions: This qualitative study presents timely information on psychotherapy students' views about informed consent to psychotherapy. Major gaps in students' ethical, conceptual, and procedural knowledge were identified, and comments suggested the influence of a hidden curriculum in shaping norms of practice.Implications: This exploratory study raises important questions about the preparedness of psychotherapy students to fulfill their ethical obligations.
Highlights
Today the importance of informed consent in counseling and psychotherapy is well-established
The case can be made that prospective clients should be fully informed about their options, regardless; we suggest that the British Association for Counseling and Psychotherapy (BACP), American Psychological Association (APA) and other relevant professional guidelines should provide clear advice to clients and practitioners on best practice pertaining to constraints on choice of psychotherapy relating to costs, access, and insurance coverage
While some trainees displayed a grasp of the importance of disclosing adequate information to clients, many participants in this study were skeptical of the duty to secure ethical informed consent, or were confused about how such processes could be successfully enacted
Summary
Today the importance of informed consent in counseling and psychotherapy is well-established. Despite ethical obligations to respect client autonomy as expressed in professional ethics codes, the question about what informed consent might mean in the practice of counseling and psychotherapy has only recently been the focus of debate [3,4,5,6]. Notwithstanding this growing body of work, much less is known about how practitioners and student therapists view informed consent to psychological treatments. Ethical informed consent to psychotherapy has recently been the subject of in-depth analysis among healthcare ethicists
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