Informed Consent & Multiple Relationships

Question 1

Three components of Informed Consent

Answer 1

1. Capacity
2. Comprehensive
3. Voluntariness

Question 2

What does it mean for the client to have the Capacity for Information Consent?

Answer 2

Capacity—ability to make sound decisions

Over 18 or not/under 18—emancipated minor or not

Question 3

What does it mean for the client to be Comprehensive enough for Informed Consent?

Answer 3

Comprehensive—actual understanding of information

Question 4

What does it mean for the client to have voluntariness in Informed Consent?

Answer 4

Voluntariness—free choice to engage in counseling

Not coerced

Question 5

On which Ethical Principle does Informed Consent most rely?

Answer 5

-Rests primarily on the principle of autonomy: opportunity to make their own decision
-To a lesser degree nonmaleficence and justice
Justice: same informed consent to all, explained in understadble way

Question 6

Which codes cover Informed Consent and what do they include?

Answer 6

ACA Code more detailed; Informed Consent includes:

• -Purpose, goals, technique, and procedures
• -Limitations, risks, and benefits of service
• -Qualifications, credentials of provider
• -Provisions for continuation of service
• -Guarantee clients understand diagnoses, tests, report, fees, bills
• -Share limits of confidentiality (including supervisors access)

APA adds alternative treatments
–Alternatives to therapy, e.g., physician for meds

AAMFT requires informed consent is secured but doesn’t describe it in great detail

Question 7

What are additional considerations for ethical Informed Consent, recommended by “scholars”?

Answer 7

Scholars suggest the Codes are not complete enough

• -Details about logistics (how appointments are made, canceled)
• -Indirect effects of therapy
• -Alternatives to counseling/psychotherapy
• -Disclosing experimental techniques (new skill, invented/innovate technique)
• -Process for lodging grievances, (first talk with me, correct; information about how to make formal complaints)

Question 8

How does one communicate Informed Consent according to ethical codes?

Answer 8

ACA Code: Informed Consent must include written and oral components (oral versus verbal distinction)

APA allows written or oral; must be comprehensive

AAMFT doesn’t specify but must get it.

Question 9

What are the Pros & Cons of Oral vs. Written components of Informed Consent?

Consider Video Consent.

Answer 9

Pros
Documentation, later review, comprehensive, difficult for client to understand or don’t read,

Cons
Adapt to client understanding,
Drawback-proving you did it, may be overwhelming to client, sound weird or disconcerting,
Only the reader knows it, i.e., when parents bring their children in

Question 10

What is HIPAA?

Answer 10

Health Insurance Portability and Accountability Act

• Allows clients to sign one time and allow repeated releases of information to insurance companies for purposes of reimbursement.
• Complying with HIPAA is necessary but not sufficient to meet ethical obligations of informed consent

Question 11

Discuss Consent from Minors

Answer 11

Generally, minors cannot legally give consent for services; parents/guardians must give legal consent

Minors can assent (agree to cooperate/ participate) to therapy

Minors who assent to therapy should be involved as much as possible in the planning and execution of their treatment

Note that assent does not substitute for parental consent

Children can engage therapist without parental consent regarding sexual health and alcohol/drug abuse

Question 12

Discuss Consent when working with Adults with Diminished Capacity

Answer 12

Adults assumed to have capacity until there’s reason to believe they don’t

Adults with diminished capacity don’t have sufficient comprehension to consent; proxy consent from another

Give client as much information and involvement as possible given circumstance

Question 13

Discuss Consent in Mandated Counseling

Answer 13

Judges (and sometimes other authorities) require counseling or give option of counseling or punishment

Question whether consent is truly voluntary and therefore sufficient to proceed

Weigh diminished consent against harm of not (or benefit of) counseling

Question 14

What are the risk factors for Sexual Misconduct of therapist with client?

Answer 14

-Older, male therapists paired with younger, female clients

Question 15

How does Sexual Misconduct by a therapist compromise all five ethical principles?

Answer 15

Autonomy—clients never judged to have given informed, voluntary consent

Beneficence—therapeutic progress tends to stop when sexual relationship is started; focus shifts

Nonmaleficence—sexual relationship generally inflicts significant psychological damage on client

Justice-not treating all the same

Fidelity-not true to code and ethics

Question 16

What do the codes say about sexual contact with former clients?

Answer 16

ACA allows sexual relationships with former clients after 5 years,

APA and AAMFT after 2 years

While not necessarily unethical, relationship with former clients are frowned upon

Common method for evaluating is whether counseling relationship was deeply personal and long lasting

Question 17

What are other therapeutic settings in which sexual contact is prohibited?

Answer 17

Prohibition of sexual relationships with current clients extends to other kinds of relationships due to similar Rationale, e.g., power differential and lack of clarity at end of initial relationship.

• Students
• Supervisees
• Employees
• Research Participants