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

People cannot receive psychotherapy without giving their explicit consent. Therapies are not harmless: they have their pros and cons, and they certainly change people’s lives.

Informed consent in psychology it is the process by which information is provided to the patient so that he can freely decide, faced with any diagnostic and therapeutic intervention, his contact with the psychologist.

This tool is essential for embarking on any type of psychological intervention, and requires responding to a certain number of characteristics that we will then discover.

    What is informed consent in psychology?

    Informed consent in psychology can be understood as the process by which information is provided, both orally and in writing, to the patient about the treatment they wish to receive. In this way, you will be able to decide freely whether you want to start treatment, being aware of its potential benefits and also of the risks that treatment may involve.

    The origins of this consent are in favor the principle of autonomy over that of charity. The principle of autonomy is the ethical principle in which the capacity of the patient is recognized to give norms or rules without the influence of others, while the principle of charity is the obligation of the professional to act for the benefit of the client. The principle of autonomy is one of the most important requirements in the exercise of professional practice.

    After giving informed consent, the patient, in their free, voluntary and conscious compliance, they can decide whether or not to accept psychotherapy. This decision should be regarded as binding as long as the patient demonstrates the full use of his powers after receiving this information, knowing that the decision to accept or reject the therapy has a number of advantages and, also, of ‘disadvantages.

    Historical context

    It may seem surprising, but the moral recognition that the patient has a right to be informed about the therapy he or she will receive and that it is he or she who can ultimately decide to start and stop therapy is a recent thing. Today, this right is supported by multiple court decisions and has no deep historical roots.. It is more recognized for the legal aspects than for the therapeutic aspects.

    Since Hippocrates, the patient-therapist relationship has been unequal and governed by the paternalistic principle of charity: always seeking the good of the sick, regardless of their consent. Likewise, there were not a few cases where this principle was ignored by the desire to know, and sometimes the good of the patient was not a priority either, but the expansion of knowledge even if it hurt. .

    One of the most important historical antecedents for the development of informed consent in psychology we have in the decision taken by the German Reich Ministry of Health in 1931, in which it dictated a regulation of medical therapies and experiments with humans. In this review the patient’s right to consent to participate in clinical trials has been recognized. It was therefore a great step forward in the recognition of patients’ rights.

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

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

    At present the therapist and patient relation has been horizontalizando, that is to say has been equalized. This does not mean that the relationship between therapist and patient is the same., 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 whether he wants it or not. In any case, the paternalistic principle which has long governed therapy has been overcome.

    What information should be exposed?

    Three pieces of information must be stated in informed consent, Who will determine the objectives of the communication to be transmitted in writing or orally.

    • The facts will be presented in a complete and truthful manner, without offending or dramatizing.
    • A plan will be recommended, also informing of possible alternatives to therapy.
    • Your understanding will be assured.

    In the information necessary for the patient to understand the health service that will be offered, we have:

    • The type of therapy
    • Alternatives to therapy
    • The consequences and duration of the planned therapeutic process
    • Right to voluntarily suspend processing
    • Legal rights and limitations
    • Structure of sessions
    • honorary

    Who receives this consent?

    Informed consent it must be in the form of a written or oral document. Such a document is signed by the patient in case he accepts the conditions of psychotherapy. If it is oral, the patient must say explicitly and clearly that he agrees to start therapy, after having recorded it.

    Informed consent arises from the right to decide whether or not to receive therapy, that is, to make a personal and self-determined decision. It is the patient and not a family member, partner or friend who must authorize the start of therapy.

    The patient should be given the information, although people related to him or her may also be informed for different reasons and to the extent that the patient allows. If the patient has any type of disability will also be informed, in a manner suited to his possibilities of understanding and also informing that person to be their legal representative.

    Informed consent by representation

    Although informed consent in psychology is addressed directly to the patient, it is sometimes not the patient who agrees to receive therapy.

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

    1. Under 12 years old

    In children under 12, their opinion should be heard, especially if they are approaching that age. At least their opinion and desire to start therapy should be taken into account, in order to see any reluctance the child may have towards treatment. Your consent will not be binding, but you always have the right to know what you will receive.

    2. Minors aged 12 to 16

    If the patient is between 12 and 16 years old, it is important to study their ability to make a thoughtful decision. At these ages, the individual may be mature enough to be able to decide more or less into adulthood, but each case should be professionally investigated. In more than 16 years, your consent can be accepted.

    3. Conflict situations

    If the child or adolescent is in a conflict situation, such as having a divorced parent, both parents should be kept informed and the consent of both parents should be sought. Unless there is a court order or one parent is in custody, consent must be given explicitly by both parents..

    4.exception

    There is a special situation in which, although the child cannot decide on the intervention, therapy can be started even if the parents have rejected it. It can be agreed as well when the professional considers that the rejection of the parents is detrimental to the child, And as long as the authorities have been consulted and there is legal protection, the psychologist can begin therapy.

      Benefits of informed consent in the context of psychotherapy

      Informed consent in psychology has many advantages, both for the patient who will receive psychotherapy and for the psychologist who will apply it. Among these advantages we can highlight:

      1. Protection

      By explicitly informing the patient of what will be done during treatment, the clinician is protected because this informed consent is proof that the psychologist told the patient what to do. If there was something in the consent that the patient didn’t like because they were aware of it, they shouldn’t be able to complain.

      Likewise, this consent protects the patient by being informed of his rights and obligations during therapy, in order to be able to take advantage in the event that the professional has not fulfilled his role. The psychologist may be mistaken or even act negligently, which gives the patient the right to initiate appropriate legal action.

      2. Access to information

      this consent allows the consultant to access validated, consistent and specific information for their situation, in addition to allowing them to understand the path that psychotherapy will take and what should be treated in its course.

      3. Better quality of the intervention

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

      4. Promotes clinical research

      Informed consent in psychology promotes clinical research in two ways. The first is that in psychotherapy, the patient can be told that their data can be used for finding treatments, whether or not they agree to whether they are comfortable with it. In case this is the case, his particular 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 voluntary participants who agree to undergo the experiment. Before starting, they receive a document specifying what they are going to do and can decide to leave the experience at any time. Such consents protect researchers and ensure the safety of the participant.

      Reviews of 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 aren’t a few people who view this document as something that has several drawbacks.

      It should be noted that many people who think this way still have a traditional and paternalistic view of how therapy should be applied, which is very anachronistic for the time. Among these arguments we have:

      • The patient does not understand the information correctly.
      • Patients don’t want to be told about bad news.
      • The information can frighten the patient for no reason and cause them to refuse treatment.
      • Knowing that therapy may not work well robs the patient of the placebo effect, which gives them hope and confidence.

      Bibliographical references:

      • De l’Rio, C. (2010). Informed consent among minors and adolescents: ethical and legal context and some problematic issues. Psychological information: University of Seville, 100, 60-67.
      • Ortiz, A., Burdiles, P. (2010). Informed consent. Revista Mèdica Clínica Comtes, 21 (4), 644-652.
      • Beauchamp, TL and Childress, JF (1999). Principles of biomedical ethics. Barcelona: Masson.
      • Law 14/1986, of April 25, general health (BOE 04.29.1986).
      • Law 41/2002, of 14 November, basic regulator of the autonomy of the patient and of the rights and obligations in terms of information and clinical documentation (BOE 15.11.2002).

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