Consenting and Assenting to Psychoanalytic Work

The moment is opportune for a renewed look at what we understand about patient consent to treatment. Until recently, little reference to informed consent could be found in the literature, as though it has never been a preoccupation for psychoanalytic practitioners. Yet several post-Freudian authors offer reasons to suppose the risk of misunderstandings about consent. In fact, the very discovery of transference, replete with unrequited infantile wishes, implies that at some level, at some moment, in every psychoanalytic treatment there will be moments when “consent” will to some extent vacillate. A distinction, justifiable on etymological and intersubjective grounds, is made between patients' consent as a cognitive, somewhat passive, acceptance and patients' assent as an arduous, conflicted, partial disagreement with the symbolically limiting details of analytic work. It is in the discovery and working through of unexpected unconscious responses to aspects of the analytic setting and to the analyst that patients become “informed” of the unique risks to their psychic equilibrium the process poses, as well as its benefits. Instead of a static and unitary contractual event, informed consent in psychoanalysis is more properly conceived as a multilayered, repetitively posed, and necessarily ambivalent process of good-enough assenting over time.