Informed Consent in Therapy: What to Say and What to Include
By Kristen McClure, MSW, LCSW | TherapistWorksheet.com
Informed consent is not a form. It is an ongoing process — a continuous conversation about what therapy is, what you offer, what the limits are, and what the client is agreeing to. Most clinicians treat it as a paperwork task. Done well, it is one of the most therapeutically significant things you do in the early sessions.
What Informed Consent Must Cover
Ethically and legally, informed consent must address:
- The nature of the therapeutic services you provide
- Your credentials, theoretical orientation, and treatment approach
- The risks and benefits of treatment
- Alternatives to treatment
- Limits of confidentiality (mandated reporting, duty to warn, court orders)
- Fee structure, cancellation policy, and late fees
- Emergency procedures and how to reach you or a crisis resource between sessions
- How records are stored and who can access them
- Telehealth-specific disclosures if applicable
What to Actually Say
On confidentiality limits
“Everything we talk about is confidential — with a few specific exceptions I want to make sure you know about. If you tell me you are going to seriously harm yourself or someone else, I have a legal obligation to take action to prevent that. If you share information about abuse of a child or vulnerable adult, I am required by law to report that. And if your records are subpoenaed by a court, I may be required to provide them. Outside of those situations, what you share stays here.”
On your approach
“I want to explain a little about how I work so you know what to expect. I tend to work [collaboratively / experientially / with a focus on the relationship between us]. I draw on [CBT / attachment / somatic / IFS — whatever is true for you]. What that looks like in practice is [specific example]. How does that sound as a starting point?”
On the limits of therapy
“Therapy is not a quick fix, and I would not want to oversell it. It tends to be most effective when [you are engaged between sessions / the timing is right in your life / we have enough time together to build something]. I also want you to know what I am not — I am not a crisis service, I am not available by phone during sessions, and if you are in crisis between sessions, the right resource is [988 / your local ER / the crisis line we will write down together].”
On emergency contact
“I want to make sure you know how to reach support if something comes up when we are not meeting. My after-hours policy is [X]. If you are in crisis, please [call 988 / go to the ER / call your crisis line]. We can also build a safety plan together if that would be helpful.”
Informed Consent as an Ongoing Process
Consent obtained in session one is the beginning, not the end. When you introduce a new technique, get consent. When the focus of treatment shifts significantly, revisit it. When a client’s capacity to consent changes (acute psychiatric deterioration, significant substance use), address it directly.
Clients have the right to withdraw consent and terminate at any time. Making this explicit early often makes the therapeutic relationship feel safer, not more fragile.
Documentation
Document that informed consent was obtained, the date, and what was covered. Keep signed consent forms with the client’s record. If you update consent documents, have clients sign the updated version and document that as well.
Frequently Asked Questions
Do I need a separate informed consent form for telehealth?
Yes, in most jurisdictions. Telehealth introduces specific considerations — technology risks, limitations of the medium, emergency procedures across distance — that standard consent forms may not cover. Many licensing boards now require telehealth-specific consent.
What if a client refuses to sign the consent form?
Explore what is behind the refusal before deciding how to respond. Sometimes it reflects genuine concerns about confidentiality or distrust of written agreements. Sometimes it is a symptom of the presentation (paranoia, trauma history with institutions). You are not ethically obligated to proceed without consent; the conversation about why can itself be therapeutic.
How much detail is too much in the informed consent conversation?
Enough that a client could make a genuinely informed decision. The test is not “did they sign?” but “would they say they understood what they were agreeing to?” If your consent process is primarily a signature exercise, it is not meeting the ethical standard.
Do I need to re-consent if I change my fee?
Yes — a fee change is a material change to the service agreement. Clients should be notified in writing with adequate notice and given the opportunity to make a decision about continuing treatment at the new rate.
Kristen McClure, MSW, LCSW is a licensed therapist who creates practical clinical tools to help therapists navigate the hardest moments in their work.