Paternalism, Placebos, and Informed Consent in Psychotherapy

From a legal as well as ethical point of view, healthcare professionals are nowadays obliged to obtain informed consent (IC) of patients. Consequently, paternalism is eschewed in most ethical codes of practice and IC. But what should IC mean in psychotherapy? With respect to this question, the claim that psychotherapy may be a placebo may raise grave concerns for its ethical practice. Indeed, almost since the inception of psychotherapy some scholars have claimed that psychotherapy is a sham and/or it may work as a placebo. However, we argue that in clinical biomedicine there is still much conceptual confusion about the terms ‘placebo’ and ‘placebo effect’; moreover, we contend that the term ‘placebo’, when applied to psychotherapy, may invite more questions than it can easily resolve. Nonetheless, we assert that the core moral debate about clinical placebos raises important themes that are transferable to a psychotherapy context: namely: Are therapists providing adequate information to patients about how psychotherapy works? In light of ongoing empirical research into psychotherapy we argue that therapists may be failing to mention key features (so-called common factors) that are relevant to the process of therapeutic change. We assert that current psychotherapy practice appears to exhibit misplaced paternalism in failing to provide patients with this information. We conclude that any justification for paternalism on the grounds of beneficence is unfounded and that adequate disclosure policies are likely to enhance rather than undermine the therapeutic process