2.1 Informed Consent and Assessing Capacity

Ethics in IEMT Practice: Lesson 2.1

Informed Consent and Assessing Capacity

Welcome

In this lesson, we focus on informed consent—a cornerstone of ethical therapeutic practice—and how to assess a client’s capacity to give that consent. This is especially relevant in IEMT, where sessions can be brief, emotionally impactful, and client-led.

Learning Objectives

By the end of this lesson, you will be able to:

  • Define informed consent and explain its ethical significance.
  • Identify the components of valid consent.
  • Understand how to assess and support client capacity.
  • Apply these principles in both adult and youth contexts.

What is Informed Consent?

The ethical imperative of informed consent in IEMT practice hinges on its role as a mechanism for safeguarding client autonomy within a therapeutic framework that is both brief and emotionally intensive.

Given IEMT’s potential to elicit rapid shifts in emotional states, the process of securing consent must transcend a perfunctory exchange, evolving into a dynamic dialogue that empowers clients to actively participate in their care.

This necessitates a practitioner’s ability to distil complex therapeutic concepts into accessible terms without sacrificing accuracy, ensuring that clients grasp not only the procedural aspects of IEMT but also its psychological implications.

By framing consent as an ongoing negotiation rather than a static agreement, practitioners reinforce the ethical principle of autonomy, acknowledging the client’s right to adapt their participation as the session unfolds.

Informed consent means that the client:

  1. Has the capacity to make a decision.
  2. Receives sufficient information about the therapy.
  3. Makes the decision voluntarily, without coercion or undue influence.

Consent is not a one-off event. It is a continuous process that must be revisited as therapy progresses or changes.

Key Elements of Valid Consent

1. Capacity

The client must be mentally and emotionally capable of understanding and deciding. Factors like age, mental state, and cognitive ability may affect this.

As a foundational element of valid consent, assessing capacity introduces additional layers of complexity in the context of IEMT, where emotional vulnerability may temporarily obscure a client’s decision-making ability.

Capacity is not a monolithic trait but a fluid construct influenced by factors such as stress, trauma, or cognitive impairment, all of which may surface during IEMT’s targeted interventions.

Practitioners must, therefore, develop a nuanced approach to evaluation, attuned to subtle indicators—such as hesitancy, confusion, or emotional overwhelm—that might signal a need to pause and reassess.

This process demands clinical acumen and ethical sensitivity, as an overzealous pursuit of therapeutic progress could inadvertently override a client’s diminished capacity to consent.

By prioritising this assessment, IEMT practitioners uphold their duty to protect vulnerable individuals while fostering a respectful therapeutic environment.

2. Information

You must clearly explain:An infographic with four sections: What IEMT is and how it works; Potential outcomes and limitations, especially for trauma and PTSD; The nature and length of sessions; Their right to pause or stop at any time. Each section features an icon.

3. Voluntariness

The requirement of voluntariness in consent takes on particular significance in IEMT, where the brevity of sessions and the practitioner’s role as a facilitator might inadvertently introduce subtle pressures.

Clients, especially those in paid arrangements or influenced by external parties such as family members, may feel an implicit obligation to proceed, undermining the authenticity of their agreement.

Therefore, practitioners must remain vigilant for signs of overt or covert coercion and cultivate a practice that explicitly counters these dynamics. This might involve reiterating the client’s right to withdraw at any stage or creating space for reflection before commencing work, particularly when emotional stakes are high.

Such measures not only align with the ethical mandate of justice but also enhance the therapeutic alliance by reinforcing the client’s agency within the process.

Clients must choose freely, without pressure. Be cautious of:

  • Implied obligation in paid settings.
  • Family or partner pressure.
  • Subtle therapist influence.

Consent with Adult Clients

  • Use plain language and check for understanding.
  • Document that consent was given (verbally and/or in writing).
  • Reconfirm consent before starting each session, especially if the content or goal has shifted.

Consent and Capacity in Children and Young People

When working with children and young people, the intersection of consent and capacity in IEMT practice requires a tailored approach that balances developmental considerations with legal and ethical obligations.

For instance, applying the Gillick competence framework demands a sophisticated evaluation of a young person’s maturity and understanding, particularly given IEMT’s capacity to engage with emotionally charged material.

Practitioners must navigate the tension between respecting a minor’s autonomy and ensuring adequate safeguarding, a task complicated by the potential for rapid emotional shifts that may outpace a young client’s ability to process them.

Involving parents or guardians, while often necessary, must be carefully calibrated to avoid undermining a competent minor’s voice, highlighting the need for IEMT practitioners to integrate ethical reasoning with practical judgement.

This dual focus ensures that therapeutic interventions remain both developmentally appropriate and ethically defensible.

Children Under 16:

  • Apply the Gillick competence test: does the young person have enough understanding and maturity to make decisions about their care?
  • Involve parents or guardians unless the child meets Gillick criteria and refuses parental involvement.

Aged 16–17:

  • Presumed to have capacity, but still consider family context and emotional maturity.
  • Include parents where appropriate, especially for safeguarding.

Always ensure safeguarding policies are followed when working with minors.

Use this checklist to ensure ethical consent in every IEMT session.

An infographic titled Practitioners’ Ethical Steps outlines eight steps for trauma care—such as Verify Capacity and Prioritise Safety—ideal for EMDR or PTSD contexts, with icons illustrating each step.

Self-Reflection Exercise

Think about your current process for obtaining consent.

  • How do you explain IEMT to new clients?
  • Do you check for understanding, or assume they understand?
  • What changes could you make to improve clarity and empowerment in your process?

Write a short action plan based on your reflections.

Key Takeaways

  • Informed consent is ongoing, not a one-time form.
  • Capacity, clarity of information, and voluntariness are essential.
  • Children and young people require extra attention to consent and safeguarding procedures.

Next Steps

In Lesson 2.2, we will explore boundaries and dual relationships—how to maintain professionalism while creating a supportive and ethical therapeutic alliance.

This ethics series is produced by The Association for IEMT Practitioners and is intended for professional development purposes. Always adhere to local laws, safeguarding requirements, and your professional judgement when applying ethical principles in practice.

PreviousNext