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

Summary of the components and characteristics of informed consent used with patients.

People cannot receive psychotherapy without explicitly giving their consent. Therapies are not harmless: they have their advantages and disadvantages, and they certainly change people's lives.

Informed consent in psychology is the process by which the patient is provided with information so that he or she can freely decide on any diagnostic and therapeutic intervention of his or her contact with the psychologist.

This tool is fundamental to begin any type of psychological intervention, and it requires that a series of characteristics are fulfilled that, next, we are going to discover.

What is informed consent in psychology?

Informed consent in psychology can be understood as the process in which information is provided, both orally and in writing, to the patient about the treatment he or she wants to receive.. In this way, the patient can freely decide whether or not to initiate therapy, being aware of its potential benefits and also the risks that the treatment may involve.

The origins of this consent lie in the principle of autonomy over the principle of beneficence.. The principle of autonomy is the ethical principle that recognizes the patient's ability to give himself or herself rules or regulations without influence from others, while the principle of beneficence is the obligation of the professional to act in the client's best interest. The principle of autonomy is one of the most important requirements in the performance of professional practice.

After informed consent has been given, the patient, in his or her free, voluntary and conscious conformity, may decide whether or not to accept psychotherapy.. This decision will be taken into account as binding to the extent that the patient shows full use of his faculties after receiving this information, being aware that the decision to accept or reject the therapy will bring him a number of benefits and also disadvantages.

Historical background

It may come as a surprise, but the moral recognition that the patient has the right to be informed about the therapy he or she is going to receive and that it is he or she who can ultimately decide to start and end the therapy is a recent development. Today this right is supported by multiple court decisions and lacks deep historical roots.. It is recognized more for legal aspects than for therapeutic ones.

Since the time of Hippocrates, the patient-therapist relationship was unequal, and was regulated by the paternalistic principle of beneficence: always seek the good of the patient, regardless of his or her consent. Likewise, there were many cases in which this principle was ignored for the sake of knowledge, and sometimes the good of the patient was not a priority either, but rather the expansion of knowledge, even if it harmed him or her.

One of the most important historical antecedents for the elaboration of informed consent in psychology can be found in the decision taken by the German Reich Ministry of Health in 1931, which dictated a regulation on medical therapies and experiments on humans. In that ruling recognized the patient's right to give consent to participate in clinical trials. It was, therefore, a major breakthrough in the recognition of patients' rights.

Ironically, however, it was in that same country that, with the rise of Nazism and the outbreak of World War II, this recognition would be ignored. Human experimentation became fashionable among the bloodthirsty Nazi doctors, who tried all kinds of non-consensual experiments on Jews, gypsies, homosexuals and political prisoners. Much suffering was produced with the intention of expanding science in the German context.

After the defeat of Nazi Germany at the end of the conflict, the Nuremberg trials were held. The tribunal in that city established the basic principles of human experimentation, thus creating the Nuremberg Code.The Nuremberg Code was created. This code has been updated in subsequent revisions, giving rise to the ethical norms of human experimentation, also extrapolated to the field of clinical therapies.

Nowadays, the relationship between therapist and patient has become more horizontal, that is to say, it has become more equal. This does not mean that the relationship between therapist and patient is the same.The therapist, the psychiatrist and, of course, the psychologist are the educated professionals who can guide the therapy with their knowledge, while it is the patient who receives the treatment and decides whether he or she wants it or not. Be that as it may, the paternalistic principle that governed therapies for a long time has been overcome.

What information must be disclosed?

The informed consent form must contain three informative elementsThese will determine the objectives of the communication that will be transferred in writing or orally.

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

Among the information necessary for the patient to understand the health service that is going to be offered, we have:

• The type of therapy
• The alternatives to therapy
• The expected consequences and duration of the therapeutic process
• The right to suspend the treatment of one's own free will
• Legal rights and limitations
• Structure of the sessions
• Fees

Who receives this consent?

Informed consent must be in the form of a written or oral document.. Such a document is signed by the patient if he/she accepts the terms of the psychotherapy. In case it is oral, the patient must explicitly and clearly state that he/she accepts to start the therapy, having recorded it.

Informed consent arises from the right to decide whether or not to receive therapy, i.e., it implies a personal and self-determined decision. It is the patient and not a family member, partner or friend who must give permission for therapy to be initiated.

The patient is the one who must receive the information, although persons related to the patient for different reasons and to the extent that the patient allows it, may also be informed. If the patient has any kind of disability, he/she will also be informed, in a way that is appropriate to his/her possibilities and comprehension, and also informing the person who has a disability. and also informing the person who is the patient's legal representative.

Informed consent by representation

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

For various reasons, the patient may not have sufficient capacity to decide for himself, and it is other people who decide for him. This is referred to as proxy informed consent, which occurs when the subject does not have sufficient capacity for self-determination to know what is best for him or her. This occurs in the following situations:

1. under 12 years of age

In children under 12 years of age, their opinion should be listened to, especially if they are approaching that age. At the very least, their opinion and desire to start therapy should be taken into account, in order to see any possible reluctance the minor may have regarding the treatment. Their consent will not be binding, but they still have the right to know what they will receive..

Minors between 12 and 16 years of age

If the patient is between 12 and 16 years of age, it is important to consider the patient's capacity to make a deeply considered decision. At these ages the individual could be mature enough to be able to decide in a more or less adult way, but each case must be studied professionally. For those over 16 years of age, consent can be accepted.

3. Conflicting situations

If the child or adolescent is in a conflictive situation, such as having divorced parents, both parents must be kept informed and the consent of both must be ensured. Unless there is a judicial authorization or one of the parents has custody, the 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 initiated even if the parents have refused it. This can be agreed upon as follows when the professional considers that the parents' refusal would be detrimental to the childAs long as the authorities have been consulted and there is legal protection, the psychologist can initiate therapy.

Benefits of informed consent in the context of psychotherapy

There are many benefits of informed consent in psychology, both for the patient who is going to receive psychotherapy and for the psychologist who is going to apply it. Among these benefits we can highlight:

1. Protection

By explicitly informing the patient of what is going to be done during the therapy, the clinician is protected, since this informed consent is proof that the psychologist has told the patient what he/she is going to do.. If there was something that was in the consent but the patient did not like it, as he/she was aware of it, he/she should not be able to complain.

In the same way, this consent protects the patient by informing him/her of his/her rights and obligations during the therapy, so that he/she can complain in case the professional has not fulfilled his/her role. The psychologist may err or even act negligently, which entitles the patient to initiate the appropriate legal proceedings.

2. Access to information

This consent allows the patient to have access to validated, coherent and specific information for his or her situation. specific to his or her situation, as well as allowing him or her to understand what the path of the psychotherapy is going to be and what is expected to be treated during the course of the psychotherapy.

Improved quality of the intervention

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

4. Promotes clinical research

Informed consent in psychology promotes clinical research in two ways. One is that in psychotherapy it can be explained to the patient that his or her data can be used for treatment research, whether or not he or she is comfortable with it. If they are, his or her 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 such an experiment. Before they begin, they are given a document specifying what they are going to do, and they can decide to leave the experiment at any time. This type of consent protects the researchers and gives security to the participant.

Criticism of their use

While informed consent is undoubtedly a necessary tool not only in clinical and experimental psychology, but also in other disciplines such as medicine, there are not few people who consider this document to have several disadvantages, more than a few people consider this document to be something that offers several disadvantages..

It must be said that many people who think this way still have a traditional and paternalistic view of how therapy should be applied, very anachronistic for the times we live in. Among these arguments we have:

• The patient cannot adequately understand the information.
• Patients do not want to be informed of bad news.
• The information may scare the patient for no reason and make him reject the treatment.
• Knowing that the therapy may not have good results deprives the patient of the placebo effect, which supplies hope and confidence.

Bibliographic references:

• Del Rio, C. (2010). Informed consent in minors and adolescents: Ethical-legal context and some problematic issues. Informació Psicológica: Universidad de Sevilla, 100, 60-67.
• Ortiz, A., Burdiles, P. (2010). Informed Consent. Revista Médica Clínica Condes, 21 (4), 644-652.
• Beauchamp, T. L. and Childress, J. F. (1999). Principles of biomedical ethics. Barcelona: Masson.
• Law 14/1986, of April 25, 1986, General Health (BOE 29.04.1986).
• Law 41/2002, of November 14, 2002, basic law regulating patient autonomy and rights and obligations regarding clinical information and documentation (BOE 15.11.2002).