Advertisement

Journal of Contemporary Psychotherapy

, Volume 48, Issue 2, pp 69–78 | Cite as

Informed Consent in Psychotherapy: Implications of Evidence-Based Practice

  • Charlotte BleaseEmail author
  • John M. Kelley
  • Manuel Trachsel
Original Paper

Abstract

Evidence-based practice in psychotherapy carries widely unacknowledged consequences for ethical clinical practice. Informed consent to psychological treatments is an ethical imperative in clinical practice, and there is an ethical obligation for psychiatrists, psychotherapists, and clinical psychologists to provide adequate disclosure to patients about treatments. This is codified within the professional guidelines of the American Psychological Association (APA) and the American Medical Association. Given the APA’s commitment to evidence-based practice, the objective of this paper is to argue that the provision of information about how treatments work should be based on evidence-based research on psychotherapeutic treatments. Case-based scenarios are used to illustrate a range of ethical issues pertaining to evidence-based practice and informed consent in psychotherapy. This paper argues that informed consent processes in psychotherapy must be commensurate with the latest integrated findings on empirically—supported treatments; process research into psychological treatments; research into therapist expertise; as well as evidence about individual patients’ characteristics, culture, and preferences. Our conclusions for practice are challenging: standard ethical interpretations of informed consent to psychotherapy must go further. It is not sufficient for therapists only to describe the specific techniques associated with particular treatment modalities, it is also necessary to disclose information about nonspecific factors. There appears to be consensus among therapists and psychotherapy researchers that these factors are relevant to successful treatment outcome. Our paper aims to launch fresh, serious, pragmatic debate in professional psychotherapy about necessary revisions of ethical codes with respect to information disclosure.

Keywords

Clinical ethics Informed consent Common factors Evidence-based practice Empirically-supported treatments 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving Human and Animal Participants

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. American Psychological Association (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285.CrossRefGoogle Scholar
  2. American Psychological Association (2010). Ethical principles of psychologists and code of conduct. Washington, DC: American Psychological Association.Google Scholar
  3. American Psychological Association (2015). Policy statement on evidence-based practice in psychology. Washington, DC: American Psychological Association. Retrieved April 1, 2016 from http://www.apa.org/practice/guidelines/evidence-based-statement.aspx.
  4. Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., … Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111.CrossRefPubMedGoogle Scholar
  5. Barnett, J. E., Wise, E. H., Johnson-Greene, D., & Bucky, S. F. (2007). Informed consent: Too much of a good thing or not enough? Professional Psychology: Research and Practice, 38(2), 179.CrossRefGoogle Scholar
  6. Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. Oxford: Oxford University Press.Google Scholar
  7. Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361.CrossRefGoogle Scholar
  8. Beutler, L. E. (2002). The dodo bird is extinct. Clinical Psychology: Science and Practice, 9, 30–34.Google Scholar
  9. Blease, C., Lilienfeld, S. O., & Kelley, J. M. (2016). Evidence-based practice and psychological treatments: The imperatives of informed consent. Frontiers in Psychology, 68, 7.Google Scholar
  10. Blease, C., Trachsel, M., & grosse Holtforth, M. (2016). Paternalism, placebos, and informed consent in psychotherapy. Verhaltenstherapie, 26(1), 22–30.CrossRefGoogle Scholar
  11. Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6–19.CrossRefPubMedGoogle Scholar
  12. Casarett, D. (2016). The science of choosing wisely—overcoming the therapeutic illusion. New England Journal of Medicine, 374(13), 1203–1205.CrossRefPubMedGoogle Scholar
  13. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52(1), 685–716.Google Scholar
  14. Charlesworth, J. E., Petkovic, G., Kelley, J. M., Hunter, M., Onakpoya, I., Roberts, N., … Howick, J. (2017). Effects of placebos without deception compared with no treatment: A systematic review and meta-analysis. Journal of Evidence-Based Medicine, 10(2), 97–107.CrossRefPubMedGoogle Scholar
  15. Dsubanko-Obermayr, K., & Baumann, U. (1998). Informed consent in psychotherapy: Demands and reality. Psychotherapy Research, 8(3), 231–247.CrossRefGoogle Scholar
  16. Fisher, C. B., & Oransky, M. (2008). Informed consent to psychotherapy: Protecting the dignity and respecting the autonomy of patients. Journal of Clinical Psychology, 64(5), 576–588.CrossRefPubMedGoogle Scholar
  17. Fonagy, P., Rost, F., Carlyle, J.-A., McPherson, S., Thomas, R., Pasco Fearon, R. M., Goldberg, D., & Taylor, D. (2015). Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: The Tavistock Adult Depression Study (TADS). World Psychiatry, 14(3), 312–321.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Gaab, J., Blease, C., Locher, C., & Gerger, H. (2016). Go open: A plea for transparency in psychotherapy. Psychology of Consciousness: Theory, Research, and Practice, 3(2), 175.Google Scholar
  19. Garfield, S. L. (1996). Some problems associated with “validated” forms of psychotherapy. Clinical Psychology: Science and Practice, 3(3), 218–229.Google Scholar
  20. Goddard, A., Murray, C. D., & Simpson, J. (2008). Informed consent and psychotherapy: An interpretative phenomenological analysis of therapists’ views. Psychology and Psychotherapy: Theory, Research and Practice, 81, 177–191.CrossRefGoogle Scholar
  21. Johnson-Greene, D. (2007). Evolving standards for informed consent: Is it time for an individualized and flexible approach? Professional Psychology: Research and Practice, 38(2), 179.CrossRefGoogle Scholar
  22. Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C., & Yanchar, S. C. (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy, 3(4), 249–258.CrossRefGoogle Scholar
  23. Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10(3), 288–301.Google Scholar
  24. Marcus, D. K., O’Connell, D., Norris, A. L., & Sawaqdeh, A. (2014). Is the Dodo bird endangered in the 21st century? A meta-analysis of treatment comparison studies. Clinical Psychology Review, 34(7), 519–530.CrossRefPubMedGoogle Scholar
  25. Messer, S. B. (2004). Evidence-based practice: Beyond empirically supported treatments. Professional Psychology: Research and Practice, 35(6), 580.CrossRefGoogle Scholar
  26. Meyers, D. T. (2005). Decentralizing autonomy. Five faces of selfhood. In J. Anderson & J. Christman (Eds.), Autonomy and the challenges of liberalism: New essays (pp. 27–55). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  27. Miller, S. D., Duncan, B. L., Sorrell, R., & Brown, G. S. (2005). The partners for change outcome management system. Journal of Clinical Psychology, 61(2), 199–208.CrossRefPubMedGoogle Scholar
  28. Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47, 33–41.CrossRefPubMedGoogle Scholar
  29. Rousmaniere, T., Abbass, A., & Frederickson, J. (2014). New developments in technology-assisted supervision and training: A practical overview. Journal of Clinical Psychology, 70(11), 1082–1093.CrossRefPubMedGoogle Scholar
  30. Snyder, T. A., & Barnett, J. E. (2006). Informed consent and the process of psychotherapy. Psychotherapy Bulletin, 41, 37–42.Google Scholar
  31. Somberg, D. R., Stone, G. L., & Claiborn, C. D. (1993). Informed consent: Therapists’ beliefs and practices. Professional Psychology: Research and Practice, 24(2), 153–159.CrossRefGoogle Scholar
  32. Trachsel, M., Grosse Holtforth, M., Biller-Andorno, N., & Appelbaum, P. S. (2015). Informed consent for psychotherapy: Still not routine. The Lancet Psychiatry, 2(9), 75–77.CrossRefGoogle Scholar
  33. Wampold, B. E., Flückiger, C., Del Re, A. C., Yulish, N., Frost, N., Pace, B., … Hilsenroth, M. (2017). In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy. Psychotherapy Research, 27, 14–32.CrossRefPubMedGoogle Scholar
  34. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: Models, methods, and findings (2nd edn.). New York: Routledge.Google Scholar
  35. Whipple, J. M., Lambert M. J., Vermeersch D. A., Smart D. W., Nielsen, S. L., & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology 51(1):59.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.School of PsychologyUniversity College DublinDublin 4Ireland
  2. 2.Program in Placebo Studies; General Medicine and Primary CareBeth Israel Deaconess Medical Center Harvard Medical SchoolBostonUSA
  3. 3.Psychiatry DepartmentMassachusetts General HospitalBostonUSA
  4. 4.Psychology DepartmentEndicott CollegeBeverlyUSA
  5. 5.Institute of Biomedical Ethics and History of Medicine, Faculty of MedicineUniversity of ZurichZurichSwitzerland
  6. 6.Psychiatric Center MunsingenMunsingenSwitzerland

Personalised recommendations