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Get free access to newly published articles. Create a personal account to register for email alerts with links to free full-text articles. Assessment of Psychotherapy : Reflections of a Practitioner.

Assessment in Psychotherapy. Identifying core components in the assessment process

Arch Gen Psychiatry. All Rights Reserved.

The Art and Science of Assessment in Psychotherapy

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Learn more. Save Preferences. Privacy Policy Terms of Use. Sign in to access your subscriptions Sign in to your personal account. Create a free personal account to download free article PDFs, sign up for alerts, and more. Examples of invalid informed consent: A person may verbally agree to something from fear, perceived social pressure, or psychological difficulty in asserting their true feelings, and the person requesting the action may honestly be unaware of this and believe it is genuine and rely upon it.

Consent is expressed but not internally given.


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  5. A person may state they understand the implications of some action, as part of their consent, but in fact not have appreciated the possible consequences fully and later deny the validity of their consent for this reason. Understanding needed for informed consent is stated to be present but is in fact through ignorance not present. A person may move from friendship to sexual contact on the basis of body language and apparent receptivity. However, very few people on dates that result in sexual contact have explicitly asked the other if their consent is informed, if they do in fact fully understand what is implied and all potential conditions or results.

    Informed consent is implied or assumed unless disproved but not stated explicitly. A person below the age of consent may agree to sex and know all the consequences, but their consent is deemed invalid as they are deemed regardless of the reality to be a child unaware of the issues and thus incapable of providing informed consent. In some countries notably United Kingdom , individuals may not consent to injuries inflicted upon them, and so a person practicing sadism and masochism with a consenting partner may be deemed to have caused actual bodily harm without consent, actual consent notwithstanding.

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    Individual is barred from legally giving informed consent, despite what they may feel. Implicit Consent Many experts, professional and lay people alike, mistakenly believe that the only valid way for a client to give consent is by signing on the dotted line of a printed written document. Types of consent: Expressed or Presumed Explicit or Implicit Verifiable or Conjectural Written, Verbal or Non-Verbal Legal or Illegal Ethical or Unethical Definitions Before this paper proceeds to discuss the different forms of consent, following are some basic definitions of some of the above-mentioned terms as identified by Apple Inc.

    Dictionary: Expressed Convey a thought or feeling in words or by gestures and conduct: he expressed complete satisfaction. It is important to remember that neither explicit nor written consent necessarily guarantees that the concern is informed or valid. The notion of implicit consent is rarely discussed in the psychotherapy literature, even though it is probably the most common form of consent given. As a result, the poorly or rarely defined is often misunderstood.

    Consistently, there is little practical guidance as to the extent and depth of explanation that is needed. Needless to say, what is reasonable is highly debatable, and as a result, the degree of implicit consent is not clear and is set by the courts and professional bodies on a case-by-case approach. In these situations one may make the argument that what seems like an affirmative nod was a head bob stemmed from an involuntary muscle spasm or a Tourette twitch. It seems unrealistic and, some may say, ludicrous or counter clinical to have a client sign an informed consent for touch prior to a simple supportive touch on the shoulder.

    Requiring such consent is likely to be detrimental to the therapeutic alliance, as the client will, most probably, view the therapist as rigid and scared rather than supportive and caring. Another example of a consent that is neither explicit, in writing nor verbal is when a client shows up to a session with his or her spouse and tells the therapist that he or she would like the spouse to join them for that session.

    Implied in this situation is that the client authorizes the therapist to reveal, at the very least, confidential information that the therapist uses in treating the client. In this situation it is not clear how much information the therapist is authorized to reveal. The most cited concern is, what if the therapist reveals to the spouse that the client has or had a sexual extramarital affair that the spouse was not aware of.

    While in an ideal world the therapist would have discussed what information he or she is authorized to reveal and whether the affair or other issues should be brought up.

    In some situations it is advisable to have a written consent that summarizes the communication regarding the joint session. However this options is not always possible or realistic. See also Standards 4. See also Standards 2.

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    Assessment in Psychotherapy

    See also Standards 8. Samples of the questions for which a client deserves answers prior to providing informed consent, as articulated by the above authors, appear below: Therapy What is the name of your kind of therapy? How did you learn how to do this therapy?

    How does your kind of therapy work? What are the possible risks involved? In what ways? How do you know? What percentage of clients improve or get worse without this therapy? About how long will it take? Do you do therapy over the phone? Over the Internet? Alternatives What other types of therapy or help are there? What are the risks and benefits of NO therapy?

    How is your type of therapy different from these others? Appointments How are appointments scheduled? How long are sessions? Do I have to pay more for longer ones? How can I reach you in an emergency? Confidentiality What kind of records do you keep? Who has access to them? Under what conditions are you allowed to tell others about the things we discuss?

    How do governmental regulations influence how you handle the confidentiality of my records? Money What is your fee? Do I need to pay for missed sessions? What are your policies about raising fees? If I lose my source of income, can my fee be lowered? What if I switch insurance companies or lose my insurance?

    Or what if you stop accepting my insurance? How would therapy be different if I chose to pay without using insurance? General What is your training and experience? Are you licensed by the state? Board certified? Mixed Format.