Informed consent

Picture a client signing a form in your waiting room before ever meeting you. That single page is one of the most heavily tested ethics topics on the NCE — because informed consent protects the client's autonomy and is the foundation of an honest counseling relationship.

Informed consent means the client freely agrees to services after receiving enough information to make a knowing choice. The classic required elements: the nature and goals of counseling; the counselor's credentials, training, and theoretical approach; risks and benefits; fees and billing practices; the limits of confidentiality (including duty-to-warn and mandated-reporting exceptions); how records are kept; the use of technology and distance counseling; the right to refuse services or ask questions; the right to be referred; and what happens in an emergency or if the counselor is unavailable. When appropriate, clients are told about diagnosis, testing, and reports sent to third parties.

Three exam-favorite features. First, consent must be given voluntarily and by someone with the capacity to consent — with minors or clients lacking capacity, you obtain assent from the client plus consent from a parent or guardian. Second, informed consent is an ongoing process, not a one-time signature; you revisit it as goals, methods, or circumstances change. Third, use developmentally and culturally appropriate language the client can understand, and provide it in writing and verbally.

Finally, document it. The ACA Code directs counselors to review consent in writing and verbally, document the discussion, and secure the client's understanding. Good documentation of consent is a core risk-management step.

Clinical Pearl: Informed consent is not a form you file once — it is an ongoing process presented in both written and verbal form, and for minors you get the child's assent plus the guardian's consent.