There is a legend which talks of an old Parisian artist who was so poor that he could not afford any canvases. Feeling in his heart he had a masterpiece to create, he searched for old paintings which he could clean off and use. One day, having found an old daub, he diligently worked to remove layer upon layer of paint. Halfway through he was amazed to discover what looked like a very fine painting. He submitted it to the experts and found, much to his delight, a lost Carot. His days of poverty were over.
For those of you who are wondering how this relates to counseling and informed consent, this story reveals the curious path of exploration and discovery. Similar to the starving artist who uncovered the lost Carot, counselors work diligently with clients to investigate the masterpiece which lies within. In the counseling field this journey begins with informed consent.
I believe, as do many counselors, that the spiritual dimension can play an important role in the therapeutic process. At the onset of counseling when I talk with clients about my therapeutic approach and start the intake process, I mention that discussion of spiritual and/or religious belief systems may become a part of counseling. I also state that referral to both traditional and non-traditional persons or activities may be suggested if the client is interested. I talk about therapy having potential risks, not the least of which is approaching feelings, thoughts, or belief systems which can be daunting or scary. I also talk about making changes in behavior, which can be challenging. While explaining the nature of my services I try to communicate (both written and verbally) in ways that are developmentally and culturally appropriate for the client. I also consider the client’s spiritual and/or religious belief system, if known, and inform the client they have a right to decline anything. Finally, since the informed consent process is a continuous part of counseling, these issues are revisited in an effort to ensure that the services provided are meeting the needs of the client. Spirituality, like disclosure of my qualifications and experience, is simply a part of the process.
When I review my approach with clients, I find it becomes relatively clear whether spirituality will be a part of the initial counseling process. The client will either express an interest in spiritual and/or religious issues or reveal that they do not feel these issues play a significant role in their life. For those clients who do wish to relate counseling to spiritual matters, this initial discussion opens the door. For those who do not, I now know this is not an avenue they wish to explore. Of course there are many instances where client’s do not feel spirituality and/or religion have anything to do with the presentation problem and, for that reason, do not want to address these issues. Regardless, including spiritual matters in the informed consent process lays the groundwork to discuss (or not discuss) spiritual concerns. It also educates the client that these issues can be addressed in counseling. This is important because some clients simply do not know it is appropriate to talk about spiritual and/or religious issues with a counselor. When the counselor takes the first step, the client often feels more at ease. Just remember, providing information regarding your approach to counseling is not only important in establishing a positive working alliance but is also a requirement for ethical clinical practice.
Stephanie Dailey is a counselor, adjunct faculty and doctoral candidate at Argosy University-Washington, D.C.