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Negotiating Consent in Psychotherapy

Negotiating Consent in Psychotherapy

Copyright Date: 1998
Published by: NYU Press
Pages: 200
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  • Book Info
    Negotiating Consent in Psychotherapy
    Book Description:

    Psychotherapists have an ethical requirement to inform clients about their treatment methods, alternative treatment options, and alternative conceptions of their problem. While accepting the basis for this "informed consent" requirement, therapists have traditionally resisted giving too much information, arguing that exposure to alternative therapies could cause confusion and distress. The raging debates over false/recovered memory syndrome and the larger move towards medical disclosure have pushed the question to the fore: how much information therapists should provide to their clients? In Negotiating Consent in Psychotherapy, Patrick O'Neill provides an in-depth study of the ways in which therapists and clients negotiate consent. Based on interviews with 100 therapists and clients in the areas of eating disorders and sexual abuse, the book explores the tangle of issues that make informed consent so difficult for therapists, including what therapists believe should be part of consent and why; how they decide when consent should be renegotiated; and how clients experience this process of negotiation and renegotiation.

    eISBN: 978-0-8147-6978-2
    Subjects: Psychology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Introduction: Therapy as Narrative Structure
    (pp. 1-9)

    When client meets therapist, they begin the construction of a therapy narrative, with a beginning, a middle, and an end. The beginning is a conception of where the problem came from. The middle is an understanding of what will happen in therapy. The end is an idea about what the result will be, how the client will function when therapy has run its course.

    The therapy narrative is a product of separate narratives that client and therapist bring to the enterprise. Each is an expert in a different domain. Clients are experts on their own lives and on the sorts...

  5. 1 Informed Consent as a Challenge for Psychotherapists
    (pp. 10-26)

    HIPPOCRATES and his followers had no interest in the sort of informed consent we now consider essential in health care. The father of medical ethics, who lived and worked around 400 b.c., is remembered for his oath, which emphasized the physician’s obligation to do no harm and to maintain confidentiality. But there is nothing in the writing of Hippocrates and his followers to indicate that patients should have meaningful input into treatment decisions. On the contrary, inDecorum,attributed to Hippocrates, apprentice physicians are given this advice about bedside manner:

    Perform all this calmly and adroitly, concealing most things from...

  6. 2 Asking Questions
    (pp. 27-39)

    HERE IS A QUESTION asked in one of our interviews. It came a third of the way through a one-hour interview conducted in a prison with a psychologist who treats sex offenders. The inmates volunteer for such treatment, the psychologist has just said, and they cannot be made to participate against their will.

    Interviewer:I guess one of the obvious questions is the difference between a client who is participating with free will because they have chosen to pursue a therapeutic intervention and incarcerated persons who are in need of therapy but the choice is no longer theirs. [Mutual acquaintance]...

  7. 3 Making Meaning
    (pp. 40-52)

    WE ASKED a psychologist who worked with sex offenders in prison was asked what “uncoerced consent” means for inmates who volunteer for his program. I began chapter 2 with the question; I begin this one with his answer. It will serve as a starting point for a discussion of the approach to qualitative analysis taken in this book.

    It’s a question of how much freedom, free choice do you have in that kind of an environment. [Offenders] are in the context of a prison. They have, in that context, freedom of choice to say “I’m not gonna do this” or...

  8. 4 Clients with Eating Disorders
    (pp. 53-92)

    THIS CHAPTER focuses on therapy with clients who suffer from eating disorders—primarily anorexia or bulimia. Interview material from therapists and clients concerns the negotiating process in therapy, the presentation and control of treatment options, and the discussion between therapist and client of underlying factors in the disorder.

    To provide a context for how therapists handle these issues, I have chosen to start with a sketch of two clients and their experience of various therapeutic approaches. These clients, whom I call Marie and Deborah, both suffered from eating disorders but were also victims of sexual abuse when they were children....

  9. 5 Survivors of Sexual Abuse
    (pp. 93-135)

    THE HERO of Victor Hugo’sLes Misérables, Jean Valjean, stole a loaf of break to feed his sister’s starving children. This petty crime shaped the hero’s whole life. It was an early event that haunted him no matter how he tried to change his circumstances.

    There is some parallel with the situation of survivors of sexual abuse. Although what has happened to them is by no means petty or minor, the parallel is the shaping force of a past event whose consequences continue to reappear at various stages of one’s life—no matter how much one tries to forget, and...

  10. 6 Sex Offenders
    (pp. 136-163)

    NOW WE TURN from survivors of abuse to sex offenders. In doing so, we move into a treatment area in which room for negotiating consent, or anything else, is extremely limited. Most therapists who deal with offenders work within a framework established by the legal system. That framework puts serious limits on the freedom of the adult offender to select type of treatment, type of therapist, and so on.

    I begin with a portrait of an offender, using his own words. We interviewed two clients for this chapter, referred to by the pseudonyms Jake and Morgan. Jake was an incest...

  11. 7 Conclusion: Therapy as Negotiated Transition
    (pp. 164-176)

    WE ARE CAUGHT in the middle of our lives trying to anchor the present in a dimly perceived past and an uncertain future. In Emerson’s words, “We wake and find ourselves on a stair; there are stairs below us, which we seem to have ascended; there are stairs above us, many a one, which go upward and out of sight” (1969/1844, p. 141).

    Our lives, when we reflect, seem to be made up of a series of transitions. Often those moments did not seem so as we lived them and take on that significance only in retrospect. But there are...

  12. References
    (pp. 177-184)
  13. Index
    (pp. 185-188)
  14. About the Author
    (pp. 189-190)