Do Psychiatry Residents Obtain Informed Consent for Psychotherapy?

This study investigated how psychiatry residents conduct the opening phase of treatment with different kinds of patients. Particular attention was paid to whether they obtain informed consent for treatment and whether patient diagnosis or treatment modality affects informed consent discussions.

In psychiatry, as in other fields of medicine, informed consent was first applied to arguably invasive procedures such as electroconvulsive therapy. Only subsequently has its purview been broadened, first to psychopharmacological treatment and, more recently, to psychotherapy (Beahrs and Gutheil 2001). Despite explicit mention in the codes of ethics adopted by the American Psychiatric Association, the American Psychological Association, and the American Psychoanalytic Association, informed consent for psychotherapy is seen as problematic by many clinicians. Recent studies have identified variable attention to informed consent, with psychodynamically oriented clinicians obtaining it for psychotherapy less often than other mental health professionals (Croarkin, Berg, and Spira 2003). Psychoanalysts and psychodynamic psychotherapists may feel that the disclosure entailed by a robust informed consent discussion violates analyst anonymity or disturbs the transference and the psychoanalytic process (Robitscher 1978). Psychiatry residents, given their still incomplete knowledge and uncertain sense of professional authority, may have more difficulty than practicing psychiatrists in obtaining informed consent from their patients.