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INFORMED CONSENT STATEMENT

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Obtaining informed consent is one of the most fundamental procedures for protecting a client’s rights.  Informed consent means that the potential client has been provided enough information to make a reasonable determination about whether to accept the recommended treatment.  This information includes the procedures and goals of the psychotherapy; the qualifications of and approach used by the therapist; warnings about possible side effects; information about fees, length and frequency of sessions, and likely duration of treatment; alternative therapeutic approaches; and potential sources of help besides psychotherapy.  Essential for informed consent are that the client be able to understand the relevant information and be able to freely choose whether to proceed with the treatment.  Having the client sign a statement early in (or prior to) the treatment is one of the ways that informed consent can be obtained. 

Some practitioners of energy psychology take the position that since details about specific procedures are not usually included in the written informed consent statements used by most clinicians, they are not necessary or appropriate within energy psychology.  Because the treatment techniques are often complex and unfamiliar, they do not always lend themselves well to a brief written statement.  These practitioners obtain informed consent verbally, often while providing hands-on demonstrations of the methods.  Other practitioners do incorporate descriptions of their approach to energy psychology into their written statements.

The following paragraphs may be revised and included in a more comprehensive informed consent statement designed to be signed by the client.  The sample provided here may or may not be applicable within your state and local jurisdiction.  The wording you use should be reviewed by an attorney:
 

Sample Excerpt from a More Comprehensive Informed Consent Statement

I have been advised and understand that a component of the treatment I will receive may utilize a technique called energy checking and involve work with  energy treatment points.

Energy checking is an assessment tool for determining how energy patterns affecting my body and mind may be related to the problems I wish to address in pursuing treatment with my psychotherapist. The technique involves my psychotherapist applying physical pressure that will determine if a specific muscle stays firm or loses strength when I bring to mind a particular thought, emotion, or problem state and resist the pressure.  The outcome, as indicated by the relative firmness maintained by the muscle, provides information to both my therapist and myself about emotional dimensions of my problems that may not be available to me through introspection.  Based partially on this information, my therapist will advise me on which energy points may best be used in helping me achieve my treatment goals.

Energy treatment points, adapted from the practice of acupressure, are located on the surface of the skin throughout the body and can be stimulated for the purpose of correcting disturbed energy patterns that might underlie emotional and psychological problems.  Stimulation may include touching, rubbing, or tapping the point.  In most instances, I will be instructed on how to stimulate the appropriate points myself.  In some instances, my therapist may ask my consent to directly work with specific treatment points.

I understand that the use of energy checking and energy treatment points within the field of psychotherapy is a new development and that at this time there is very little published research in established scientific journals investigating these methods. While clinical reports of successful outcomes using these methods do exist in the published literature of the field known as energy psychology, and the methods are being developed and refined under the auspices of organizations such as the Association for Comprehensive Energy Psychology, I understand that clinical reports do not constitute conclusive scientific evidence.  I further understand that even if the clinical effectiveness of these methods is scientifically established, results will vary from person to person.

I have thoroughly considered all of the above and have obtained whatever additional input and/or professional advice I deemed necessary or appropriate about commencing treatment that utilizes energy checking and energy treatment points.  By my signature below, given freely and without pressure from any person, I consent to the use of these methods in my treatment.