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#15 Consent in Counselling, When do we have enough?

This time I will be looking through the client centered lens as well as the psychdynamic one to consider when do we have enough consent to carry on and potentially deepen the counselling process.

As counsellors we are all familiar with the informed consent documents to be reviewed and signed by client at the start of our counselling process. In it we list the limits to confidentiality, rights of the client within the counselling relationship and other specific details about how the process will proceed. So this articulates the client's consent to engage in the counselling process. Does that cover all that needs to be covered as the process unfolds? It is not intended to, but sometimes we do not go back to the fundamentals of ensuring we continue to have informed consent as difficult emotional issues may arise. I think of this as a second layer of consent that I refer to as a 'rolling consent' that is specifically used to confirm that the client is still willing to carry on in the conversation when it may become more daunting for them. If we see a reaction from the client registering some level of caution or hesitation immediately after an issue is identified or emerges, and we deliberately pause the process to inquire into their comfort level with whether to continue with that subject or reaction, this second level consent is an opportunity to again confirm the client is ready to go deeper.

Caution: It may also be a personal safety boundary for both the client, counsellor and the helping contract, between doing supportive work or a decison to go deeper potentially into trauma work. By our asking this consent question at that time, they get to say, yes I want to continue, or no stop, or lets pause and go slower. It can set up a kind of a green light, yellow light or red light framework as a convenient reference to keep clear the on-going consent and not unintentionally taking someone into their trauma without that being a very explicit decision.

Why would this be needed if we have the original consent already? Because the first consent was conceptual, ahead of when their life was actually in view. Re-confirming that the client is still OK to proceed within this particular content helps to builds trust within the counselling relationship as the client has proof that they are being heard and considered in an on-going way. This, in turn, also builds the level of psychological safety so the client may proceed, if desired, at a pace they can have an active say about in real time. There are three important by-products of using this rolling consent as we notice clients begin to disengage or show any reservations to emerging feelings or content. 1/ It keeps the process more manageable for the client by showing them how carefully we are attending to their reactions and adjusting our actions accordingly. 2/ The more emotionally charged an issue manifests itself, using this process, we can stay in sync with our client on a moment to moment basis during difficult moments in sessions and support the client's participating in their own decision making at emotionally critical times in sessions. 3/ This can also increase their confidence through being able to exercize their own agency to a greater degree in session.

So how would this work in a session? Lets say a client just began to tear up after a question or reflection was offered concerning a tender part of their life. C'or reflection: "I am just noticing you are tearing up after what we just said." Then we would interject "Could we pause here for just a moment? I want to check in with you to see if you are OK to carry on here given your tears just now?" Then we would wait for their response to our question, Carry on or ... ? "because if you wanted to continue, I would just give you some space to feel it and explore what comes up for you as you let your tears emerge." Then, their consent is truly in that specific moment, informed. They know they have options and what we would do if they decided to carry on with their tears.

If they want to slow their emotional experience down or not follow it, we would of course respect their wish and ask them "what they would prefer to do at that moment?" and then follow their lead, perhaps offering a cognitive consideration rather than a more feeling oriented focus for example.

In my clinical practice when I am teaching clients ways to get more in touch with their emotional selves by doing various grounding and breathing exercises, I will also teach them ways to close down their emotional experience too. Because this gives them more agency and options at times when they become disregulated or overwhelmed, whether in session or not in session. Just reversing the grounding or breath exercizes can often achieve this, or things like clench their muscles, hold their breath or staring at something with a hard eye focus.

This rolling consent option may be used multiple times in a session if there is a lot of newly emerging or uncomfortable emotional experiences coming up for the client. This could also be useful in a supervision session where potentially difficult issues arise within that dynamic. It is a strategy combining personal transparency and emotional attentiveness together in a powerful way. I find it to be quite effective at allowing the counselling process the option to deepen with the client's consent and at a pace they are invited into setting and adjusting as needed. I hope you find some part of these strategies useful to you in your practice.

That's it for me this time, I will be doing one more this December, then taking the next three months off as I have a heavy teaching load this winter, but please check in at new years and see if my ideas, building on this rolling consent process fine tuning the ways to follow clients' leads can support them going deeper into their work. Ciao, David

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