Consent, Latency and Psychotherapy or ‘What am I Letting Myself in For?’

There are inherent difficulties in reconciling concepts of ‘freedom of choice’, ‘autonomy’ and ‘informed consent’ with the idea of unconscious mechanisms. If mechanisms prevent issues being available to consciousness and the possibility of internal or interpersonal dialogue, then what or whom do we believe is giving or withholding consent? In addition to dynamic issues, consideration of maturational processes is essential when making judgements in this arena. There are increased expectations that children should be active participants in making decisions about their own health and welfare: further thought needs to be given to the implications of this for psychotherapy. This paper considers these issues specifically in relation to the latency phase. In therapy, we aim to assist a child in moving from a predominating or seriously distorting reliance on primitive mechanisms. However, before the latency child is sufficiently established in this we may also be faced with developmentally appropriate mechanisms which result in the submergence of experiences which may still be linked with pathological elements. Simultaneously, pathological and healthy processes may lead to resistance in therapy.

Using material from the therapy of a young boy who entered latency during therapy, some dilemmas will be illustrated. He was able to make good use of therapy but conscious and unconscious processes came into play to facilitate or resist the therapeutic aim of making experience conscious and thereby achieving integration. He placed prohibitions on the therapist which the therapist respected while also asserting an awareness of the motivations towards these. Through this means respect was given to his growing desire for autonomy without final surrender to the omnipotence of the world of paranoid-schizoid functioning. The child and the therapist were able to consent to a therapy which met the developmental potential and need at that point without indulging in the self-deceit of ‘cure’.