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Excerpt from Clinical Practice Today (November 2014)
Below is an excerpt from a recent "Clinical Practice Today" article. NASW Members can view the full article by clicking here (you must be logged in). Not a member? Join NASW

The Art and Science of Prior Informed Consent

Edited by Bet MacArthur, LICSW


Clinical practice in 2014 is evolving rapidly through complex and technical administrative and scientific changes. This column is the place to share questions, controversies, ideas and proposals about clinical work with the NASW community, from beginners to veterans. Communicate with us at

Dear CPT: I am a contracted provider with a medical insurance company which has just asked me to have their subscribers (my patients) fill out a check-box survey describing their therapy issues and progress. Evidently a letter had gone out to all subscribers currently using behavioral health benefits, notifying them of this new procedure in therapy. One client is quite upset that she is being required to describe her therapy experience to her insurance company. Is it permissible for the company suddenly to require this?

—B.R., LICSW, Cape Cod

Dear BR: Your inquiry describes a very common situation these days. The main concerns facing you and your client are:

  1. the procedural matter of prior informed consent (PIC) (which is required under state law in medical and research settings); and
  2. various potential transference snares in the therapy.

Since this is a clinical column, let us take a mostly clinical approach to these issues. Many thanks to attorney (and FOCUS columnist) Barry Mintzer for reviewing the following information, too.

The Public Interest View (or: Why there are PIC laws)

Prior informed consent rules recognize that:

  • it is human nature to be most compliant when under duress or in pain;
  • people ask for help while in, and because of, very vulnerable states; and
  • there is a significant power differential between patients and professionals (such as attorneys, medical providers and therapists).

Since the state’s resources will be tapped to redress injuries caused within such relationships, it has an interest in protecting vulnerable supplicants from harmful exploitation.

So, PIC rules require professionals to introduce to clients, at the very start of care, the full menu of potential demands which might be placed on them – to protect clients’ freedom of choice in relationships with providers. That is why it is called prior informed consent; and why springing some new demand on a patient or research subject ‘midstream’ is usually prohibited...


Full article includes...

  • The Insurer’s View
  • Subscribers’ Relations with Insurers
  • Common Examples
  • Clinical Process and PIC
  • “That was then, this is now.”
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