Imagine this scene: You are near the end of the first or second session with a new client. You have talked with her about how she found you, what issues bring her to therapy, and what she hopes to get from the work. You have talked with her about her previous therapies and what went wrong or right with those. You have taken enough of a history, including her history of trauma, to have a sense of who she is and an approximate idea of her diagnosis. You have talked about your fees, her insurance coverage, and how you deal with insurance in your practice. You have agreed to begin to work regularly and have set up the next meeting.

So you are ready to begin, right? Wrong! You must do an Informed Consent to treatment before you go further. You can have a written document or present it orally; you can ask your client/patient to sign it or not as long as the details of what you have covered are carefully noted in your progress notes for that session. But the ethical standards of all mental health professions, as well as the courts of law, require that this be done. You place yourself at significant risk by not doing it.

The minimum that you must cover:

• Some information about the treatment you offer: what you do, how goals are set, how long sessions usually last, the risks and benefits of the kind of treatment you do (e.g. that trauma treatment can be very painful and occasionally disruptive), alternative treatments that might work for them (e.g. EMDR, medication).
• Fees: What you charge, what happens if someone’s financial circumstances change during treatment or if the insurance runs out, if you charge for telephone contact, how much notice you require for cancellations and if you charge if you do not get adequate notice.
• Insurance coverage: How you handle it, whose responsibility it is (yours or your patient’s), the information that using insurance requires you to provide to the third party payer, the additional information the insurer is entitled to seek.
• Telephone accessibility: Where clients/patients can reach you and when, if you carry a beeper, if you are available for emergencies.
• Record keeping: The fact that you are required by law to keep a record of your work with them.
• Confidentiality: That your work will be kept confidential except when you are obligated by law to take an action that may include breaking confidentiality. For example, if you have reason to believe that a child, an elderly person, or a disabled person is being abused, you must notify the appropriate state agency. If you are led to believe that a client is threatening seriously bodily harm to another or to him- or herself, you must take protective action.
• Consultation with colleagues: Describe any regular consultations you obtain on your work. If you are not yet licensed and your supervisor is legally responsible for the treatment, you must tell your patient her/his name and telephone number. If you are a trainee, you must say so.

Those of us trained more than 15 years ago were not taught to give an Informed Consent and many of us still do not do so. But, for the protection of yourself and the people you work with, you need to begin using Informed Consent procedures.

Over the years of experimenting with this, I have come to use a written document that I go over orally with a new client. I then give them a copy to take home and read, and suggest they raise any questions about it with me the next time we meet. Although my form does have a place for a signature, I do not ask them to sign; it feels too legalistic for the type of relationship I am establishing with my clients. (If you would like a copy of my form, e-mail me at frang@bu.edu or call me at 617-527-6354. You are welcome to use any part of it that works for you.)

Fran Grossman was the chairperson of the Massachusetts Psychological Association Ethics Committee for several years and a member of the American Psychological Association Ethics Committee. She currently teaches the course in professional ethics for the clinical psychology doctoral program at Boston University.