How many people do you think actually read your informed consent? Like actually sit down and read all the information word for word? Nothing more exhilarating than reading about HIPAA, clients rights, insurance reimbursements, and privacy practices! Am I right?
If your informed consent is anything like mine, clients head straight for the signature portion and move it right along to the other forms and paperwork they need to sign to get this therapy thing a movin!
This is why I believe it is so important to go over a quick verbal informed consent at the start of our time working with children. In the slim chance that parents are reading it, the child certainly isn’t getting in on the action.
Ethically we want to make sure that parents and young people are aware of the therapy process, limitations, and policies even if they choose to pass on wading through all the technical jargon in the informed consent. We want to make sure they receive informed consent on things such as confidentiality and what were to happen if you would see them in public.
And, it’s not only ethical, but I believe that a strong informed consent significantly increases client retention and engagement in the therapy process. If clients (or parents) know how long therapy might take, what types of activities clients and parents might expect, and what the expectations are for parent involvement we manage expectations for what the process will be, thus increasing engagement and communication.
Since I am not a superhuman and do not have the entire informed consent memorized I developed an informed consent checklist that I still have with me every intake session, even though I have been doing this work for over 13 years! It is so easy to forget the little things so this checklist makes it a breeze!
One of the most important things on the checklist is client confidentiality and what you will do if you see a client in public. Even when I lived in a busy metro area I would bump into clients occasionally, but in a more rural area it seems like every trip to Target is a high likelihood that you will see a past or current client.
Without fully explaining confidentiality to a child you are at risk for damaging the relationship should you see them out. If you don’t say hi first they might think you are ignoring them, upset with them, or don’t like them.
Also, while maintaining confidentiality in public is super important, the reality is that most young people see us as just another helper. Like a coach, teacher, or mentor. This is the script I developed to explain confidentiality to children.
“Now, what we do in this office is confidential. That means that I don’t tell anyone outside of here what we do or say in this office like your sister, bus driver, or best friend. However, there are some important people in your life that do need to know what we talk about. Who might that be? (usually they eventually get to naming a parent or guardian). Yes! Your mom/dad/guardian does need to know some of the things we talk about. If there are other people outside of mom/dad/guardian that need to know what we do in here, like a school counselor or doctor I will tell you beforehand and let you know I will be speaking with them and we have to sign some paperwork that lets me talk with them - it is all very official and not a secret or private thing. Now, because what we do in here is confidential, if I were to see you out in public I wouldn’t acknowledge you or say hi first. I want it to be up to you, I want you to decide. You can choose to say hi or wave OR you can choose to pretend you don’t know me and we have never met before - either one is okay! My feelings won’t be hurt. The thing I am most concerned about is that you feel comfortable. Some young people are with friends or someone else and don’t want to explain who I am or that they are in counseling and other young people are excited to say hi and wave. Again, either one is fine - you have the power to choose!”
After that I go into limits to confidentiality and head right on down the checklist. Some things I speak mostly to the parents about (i.e. HIPAA) and other times I am dialoguing with the client about what they were told about coming to therapy and what their expectations are.
Now, how long does the whole verbal informed consent last? Usually for me it takes about 15 minutes. But, because it primes expectations for future sessions and increases client retention, it is likely one of the most important 15 minutes I get with a client.
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I'm Ann Meehan, an LPCC, RPT-S, and EMDR Consultant. I help other therapists grow in their passions as play therapists, trauma therapists,and child and adolescent therapists.