Informed Consent and Psychotherapy: The Travails of Consistency (Part I)

The ascendancy of psychological therapy over the last few decades has been phenomenal. During this period, the health care scene has witnessed the continuous proliferation of distinct therapeutic modalities and a marked increase in the demand for psychotherapeutic services. In response, there is now a growing concern as to whether clients who enter therapy do so on an adequately informed basis both as to the range of treatment on offer and what they entail. One movement in this direction has been to call for the adoption of the doctrine of informed consent in this realm. This paper questions the viability of this move. By retracing the doctrine's development to its conception at the dawn of the twentieth century, it will be shown that although the law has undergone three major changes since then, the ‘patient's right to self-determination’ remains the one consistent feature that runs through the doctrine's history and that now, as then, this principle relates primarily to the patient's interest in his bodily integrity. This paper argues that not only are the factors which gave rise to the notion of informed consent peculiar to the medical model, but since psychotherapy does not characteristically involve physical contact, the current law's consequent emphasis on risks-disclosure and freedom from unauthorized bodily intrusions are also generally incompatible with the ethos and reality of psychotherapeutic practice.