Informed Consent in Counselling: What Are You Actually Agreeing To?

Description:

What are you actually agreeing to when you sit down with a counsellor? Informed consent is about much more than signing a form. This article looks at what clients should understand before counselling begins, why they have the right to ask questions and say they are not ready, and why consent remains part of the counselling relationship.

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When you go to a counsellor for the first time, you may be given a form to read and sign before the session begins. It might explain confidentiality, fees, appointments, record keeping and what you can expect from the counselling process.

You sign it, and the counselling begins.

But informed consent is about much more than signing a form.

It is about understanding what you are agreeing to, knowing what you can expect, having the opportunity to ask questions and being able to make your own decision about participating in counselling. In other words, you should not have to guess what you have agreed to.

IT IS NOT JUST PAPERWORK

Imagine you make an appointment because you have been feeling overwhelmed for months. You arrive, sit down and the counsellor immediately starts asking very personal questions.

You answer because you think, “Well, I am here for counselling. I suppose this is what I am supposed to do.”

But did anyone explain how the counselling would work? Did you know that you could ask questions? Did you know that you could say, “I am not ready to talk about that yet”? Did you understand what would remain confidential and what the limits of confidentiality were?

These things matter.

Informed consent means that the client is given information in a way they can actually understand before agreeing to the work. Professional guidance consistently emphasises that consent should be based on understanding and should not be reduced to a ritual of signing paperwork. 

“BUT I SIGNED THE FORM.”

A signature does not automatically mean that someone understands what they have agreed to.

Imagine being handed a six-page document filled with professional language. You read the first page, become overwhelmed, sign at the bottom and hand it back.

There is a signature.

But was there really an informed decision?

This is why the way a counsellor explains things matters.

Instead of saying, “Your information will remain confidential subject to statutory and safeguarding limitations,” a counsellor might say:

“What you tell me is private. There are some situations where I may need to share information, particularly if there is a serious safety concern or I am legally required to do so. I will explain those limits to you before we begin.”

The second explanation is easier to understand without making it less professional.

YOU CAN SAY, “I AM NOT READY.”

Going to counselling does not mean that you have agreed to every question, exercise or intervention a counsellor might suggest.

Imagine a client says, “I know we have been talking about my childhood, but I do not feel ready to go there today.”

That matters.

The counsellor may need to slow down, ask what is making the client uncomfortable, explain why they thought that area might be useful to explore, or simply work somewhere else for the time being.

The point is not that the client dictates every aspect of counselling. The point is that the client is a participant in the process.

Consent is closely connected to autonomy: the person's right to understand what is happening and have a say in decisions concerning their care. 

CONSENT CAN CHANGE

Another common misunderstanding is that consent happens once, at the beginning, and then disappears into a file.

Consider a client who originally comes to counselling because of stress at work. Over several sessions, it becomes clear that difficulties within the family are also affecting the situation.

The direction of the counselling may now be changing.

A counsellor might say, “We started by looking at what has been happening at work. Some of what you have shared has also brought us towards your family relationships. Would you be comfortable exploring that?”

That small conversation matters.

It gives the client an opportunity to understand why the focus is changing and to decide whether they are comfortable continuing in that direction.

Consent should therefore be understood as an ongoing part of counselling, especially when the nature or focus of the work changes. 

THE CLIENT SHOULD NOT HAVE TO BE AN EXPERT

Clients are not expected to know counselling terminology.

If a counsellor talks about confidentiality, boundaries, safeguarding, records, referrals or therapeutic approaches, the responsibility is on the professional to explain what those things mean.

A client should be able to ask:

“What does that mean?”

“Who will have access to my information?”

“What happens if I want to stop?”

“Why are we doing this?”

Those are reasonable questions.

In fact, being able to ask them is part of what makes consent meaningful.

WHY THIS MATTERS FOR COUNSELLORS IN TRAINING

For trainee counsellors, informed consent can easily become something they learn to complete rather than something they learn to communicate.

A trainee might know exactly what needs to appear on a consent form. But sitting in front of a real client and explaining confidentiality, boundaries and the client's rights in ordinary language is a different skill.

That skill needs practice.

The difference might be as simple as saying:

“Before we start, I want to explain how these sessions work, what you can expect from me, and the limits of confidentiality. Please stop me if anything is unclear or if you have questions.”

That is not simply administrative procedure.

It is part of establishing the professional relationship.

SO, WHAT ARE YOU ACTUALLY AGREEING TO?

You are agreeing to participate in a professional relationship based on an understanding of what the counselling involves.

You should know what to expect.

You should understand the boundaries.

You should know the limits of confidentiality.

You should be able to ask questions.

And when the nature of the work changes, the conversation about consent may need to change too.

That is why informed consent is much more than a signature on a page.

It is part of how a counsellor respects the person sitting in front of them.

If you have been to counselling before, did you feel you understood what you were agreeing to when you first walked into the room? What do you remember most about your first experience?