Health professionals, including psychologists are expected to solicit the consent of the person they are going to work with. A conversation about consent opens the opportunity for the client to decide whether to go ahead with the proposed psychological service and treatment. In this article, we will discuss a variety of life circumstances in which informed consent may vary somewhat. However, before that, it is important to understand a little history: informed consent is not like the Hippocratic Oath which has been around over 2400 years (Hulkover, 2010). On the contrary, the term consent form emerged in the 1950s, and became a more significant topic of discussion in the early 1970s (Beauchamp, 2011). The post World War II era has brought about a surge of exploration and research in Medicine and Psychology. This has led to many infamous studies, such as Solomon Asch’s (1955) ‘Line Experiment’, Stanley Milgram’s (1961) ‘electric shock experiment’, and Philip Zimbardo’s (1971) ‘prison experiment’.
For example, Zimbardo’s (1971) prison experiment, set out to investigate the psychological impact of powerlessness and authority due to rampant prison brutality at the time. Many people applied to take part in the experiment, but only the most well-adjusted and psychologically mature young men were chosen. Some were given the role of prison guard and some the role of prisoner. The ‘prisoner’ participants were placed in a mock prison at Stanford University, and the ‘guard’ participants took turns to keep guard over them. The experiment had to be terminated after 6 days, due to the unexpected tyranny and cruelty of the ‘guards’ and the depression and disorientation of the ‘prisoners’ (Britannica, 2023). This and many other past experiments have been heavily criticised due to significant ethical considerations.
Nevertheless, Zimbardo’s prison experiment and other similarly controversial experiments have provided incredible insight into human behaviour and made a huge contribution to the Science of Psychology. Yet the proposition of such studies today would horrify any ethical committees. In fact, the accumulative impact of these studies has led to the dialogue about the necessity of informed consent.
Let’s now consider the nitty-gritty of what a consent should include and the various life circumstances in which they differ: Psychologists are to provide prospective clients necessary information about the service they are about to engage in. This in turn will allow clients to decide whether they consent to participate in this service. This is informed consent.
The process of obtaining informed consent:
- The psychologist is to explain what the proposed psychological treatment entails
- The psychologist is to discuss any alternative assessment or treatment options
- The psychologist is to explain possible risks, such as the possibility of feeling worse for a while before improving
- The psychologist is to discuss benefits, risk and costs of engaging or not engaging the service
- The psychologist is to explain the client’s right to withdraw from the service and their consent at any time
Consent to involve others
In some cases, the psychologists and prospective clients may need to discuss whether the client would wish to inform anyone of their treatment and assessment, such as their employer, court, or other health professional.
Psychologists are to explain the boundaries of professional confidentiality, such as limitations of sharing information collected during the provision of services.
Consent relating to record-keeping
In some cases, especially in research and university psychology clinics where students practice under supervision, consent may be needed for the use of one-way screens, and audio or video recordings. For such, explicit consent is required, including an explanation of its purpose.
Court related informed consent
It is important to note that when a psychologist is summoned by the court to provide evidence, the psychologist is responsible to the court, not to any other parties.
Obtaining informed consent from children and adolescents
Regardless of the age of a child or young person, the psychologist must seek their consent, irrespective of who initiated the service i.e. (parent/guardian, child or government body). In case of a minor, the psychologist aims to:
- Provide age-appropriate explanation of the prospective service
- Discuss what it may involve working with a psychologist
- Age-appropriate explanation of the work of the psychologist
- Discuss confidentiality, how information is recorded and shared, and the possibility of denying consent in case the young person is ‘Gillick competent’ (Gillick competency refers to when a child is found to be a ‘mature minor’. This is usually the case from about 14-15 years old, in which case the young person is given the right to provide their own informed consent).
- Review how the young person is to be kept safe
- Affirm the young person that their consent can be withdrawn at any point
People who may not have capacity
When an individual has dementia, or brain injury, intellectual disability or severe mental health issues, the psychologist will need to determine whether the person has capacity to give informed consent. As far as it is reasonable to do so, the psychologist will aim to obtain the person’s consent. In this process, a special emphasis will be given to ensure that the information required to make an informed decision without duress is communicated to the individual in a manner that suits their physical and intellectual capacity to process the information (APS, 2018).
It is not unusual for third parties, such as employers and insurance companies to be involved as a funding agency in the client’s assessment and treatment. As the third party pays for the service, they usually expect information from the psychologist. In such cases, the aim of the psychologist is to share only that which is necessary for the third party to know. It is only natural that during the process of an assessment or treatment personal information will be shared with the psychologist which may be unrelated to the original purpose of the service. Should this information be freely shared with the funding third party, it may lead to discrimination against the employee. To avoid such circumstances, the psychologist will endeavour to discuss with the client what they feel comfortable sharing, and what the psychologist must share with the third party. To learn more, read my article called ‘Confidentiality’, which explores this topic further.
Co-Author: Sharyn Jones, B Psych (Hons).
Sharyn Jones is a Brisbane psychologist with 10 years of experience working with adults, adolescents, children and their parents.
To make an appointment with Sharyn try Online Booking. Alternatively, you can call Vision Psychology Wishart on (07) 3088 5422 or M1 Psychology Loganholme on (07) 3067 9129.
Co-Author: Katalin Mezei, BA (Hons) Psych & Crim, G. Dip Psych, MSc Health Psych
Katalin Mezei is a Provisional Psychologist now based in Brisbane, having completed my undergraduate and Master’s training in the United Kingdom. My aim is to help people identify my clients’ core values and help them live according to them.
To make an appointment with Katalin, you can Book Online, or call Vision Psychology Wishart on (07) 3088 5422 or M1 Psychology Loganholme on (07) 3067 9129.
Australian Psychological Society (2018). Testing and disability: Current key themes. https://psychology.org.au/getmedia/c30b3c3a-9212-4656-8c47-9f8be82e4133/testing-disability-current-themes-2013.pdf
Australian Government Australian Law Reform Commission (2013). Capacity and decision-making https://www.alrc.gov.au/publication/equality-capacity-and-disability-in-commonwealth-laws-ip-44/equality-capacity-and-disability-in-commonwealth-laws/capacity-and-decision-making/
Beauchamp, T. L. (2011). Informed Consent: Its History, Meaning, and Present Challenges. Cambridge University Press: online 16/08/2011. https://www.cambridge.org/core/journals/cambridge-quarterly-of-healthcare-ethics/article/abs/informed-consent-its-history-meaning-and-present-challenges/27E8171706F09D53D5702137B3DEA168
Britannica, The Editors of Encyclopaedia. “Stanford Prison Experiment”. Encyclopaedia Britannica, 25 Dec. 2023, https://www.britannica.com/event/Stanford-Prison-Experiment. Accessed 21 January 2024. British Psychological Society https://explore.bps.org.uk/content/report-guideline/bpsrep.2017.inf115/chapter/bpsrep.2017.inf115.8 Encyclopaedia https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/informed-consent-i-history-informed-consent
Hulkover, R. (2010). The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant. The Einstein Journal of Biology and Medicine. https://www.einsteinmed.edu/uploadedFiles/EJBM/page41_page44.pdf Hippocrates https://www.nlm.nih.gov/hmd/topics/greek-medicine/index.html#case1