PACFA Research Forum: Confidentiality and Informed Consent

PACFA’s Research Committee hosted a very successful webinar in September 2018 exploring the issue of confidentiality and informed consent, the topic of a recent systematic literature review commissioned by PACFA. The forum was a great success, with fifty participants joining us online for stimulating presentations and discussions .

The webinar is available for download for $15 at the PACFA Portal.  PACFA members are encouraged to view the webinar as this is such an important topic for all counsellors and psychotherapists.

The Panel for the Research Forum is made up of the authors of the Literature Review, Andrea Lamont-Mills and Steven Christensen, and Crystal Lockard from the PACFA Research Committee.

The webinar looks at the major findings of the literature review:

  • Confidentiality (C) and Informed Consent (IC) are considered by therapists to be context and culturally specific;
  • Consideration needs to be given to clients from different cultural backgrounds and how they understand and treat confidentiality;
  • There has not been any Australian research on the client’s understanding of, and how a therapist knows that a client “actually understands” confidentiality and informed consent.

The webinar gives participants much food for thought about conducting research on how therapists obtain consent from their clients, and how they know that this is informed. It’s important to observe what therapists actually do in practice, not just what they say they do.

A key issue is the fact that therapists need to be sure that clients are truly consenting to the process. The use of forms for confidentiality and informed consent is discussed and compared to the task of signing a consent form for a research project that many people don’t read closely.  Participants are asked to think how often they really read all of the conditions of use on websites before they click ‘accept’. Even for the webinar, how many participants had actually read the conditions? By clicking ‘accept’ we give informed consent that we agree to all of these conditions. This highlights the fact that many people do not read these terms and conditions and the complexity that is involved, especially in the context of the first session of counselling or psychotherapy, when anxiety is higher for clients than subsequent sessions.

The webinar discusses ideas for how our practice around IC and C could be tightened up to become more explicit to ensure there is a clear understanding of what and how our clients understand about IC and C.

The studies examined in PACFA’s literature review indicate that pro forma documents for IC and C might not necessarily solve the problem given that they could be used blindly and not actually obtain the explicit consent that was needed. Questions are raised about sending a consent form to a client prior to the first session and suggested good practice focusses on the form being used collaboratively within the therapeutic alliance.

The webinar is also an opportunity to hear from Crystal Lockard about PACFA’s updated Code of Ethics. It raises the dilemma of being prescriptive vs. encouraging of practitioners to be thoughtful and mindful of ethics (including IC and C) which can be a grey area. In practice, there will almost certainly be an exception to any rules applied to ethics. It is challenging to incorporate these ideas into the PACFA Code of Ethics which needs to be a living document that can be updated regularly to stay current and reflect emerging research.

Confidentiality when providing services via Skype and other forms of technology is also covered in the webinar. It is considered best practice that the therapist reads the consent form to the client and that it is worked through verbally via the technology to support a shared and clear understanding of consent and confidentiality.

The PACFA Ethics Committee is developing a set of tools for members which will include some of the information from the Research Forum and from the literature review.

Gina O’Neill
PACFA Research Committee

About the Presenters

Andrea Lamont Mills is an Associate Professor of Psychology in the Faculty of Health, Engineering and Science at the University of Southern Queensland. Andrea has been involved with the professional training of psychologists for over 15 years and has a strong commitment to ensuring that psychology students are exposed to a wide range of research approaches and experiences. Andrea is also a registered psychologist who has been involved with the Ipswich Suicide Prevention Network as former Deputy Chair.  Her research interests focus on how peers provide support to each in real-world contexts.   She is currently researching how those experiencing suicidal ideation come to understand each other as being suicidal and how they provide support to each other in online spaces.

Steven Christensen is a registered psychologist, registered teacher, and lecturer in the School of Psychology and Counselling at the University of Southern Queensland. He is a full member of the Australian Psychological Society, a member of the Australian Psychological Society College of Sport and Exercise Psychologists, and is an active researcher using qualitative research methodologies to examine how psychotherapy is embodied in therapist-client interactions. He is a former mathematics, science, and physical education teacher with the Education Department in SA and currently teaches courses in motivation, emotion, and sport psychology at USQ.

Crystal Lockard is a member of the PACFA Ethics Committee. She has worked in the health and welfare sector for more than 25 years, including managing her own family and relationship counselling practice since 1999. A long with being a trainer and educator, Crystal has worked as a clinical supervisor for over 15 years. She is a past coordinator of the Mental Health Professionals Network, a past Board member of CAPA NSW and the Cancer Counselling Professionals.