What is Consent?

Shelter Dziya, Ph.D. 

In order to work with me, you must be in consent. What does consent mean? What does consent cover? What is one consenting to? Why wouldn’t someone consent if they came to work with me? And how long does consent last? These are just some of the questions I aim to cover in this installment. 

Consent simply means to be in agreement. When you request to work with me, it seems natural to take it for granted that you are in agreement to change. But I believe that consent is much deeper than that and requires more deliberate and decisive action. Consent is not passive. Consent isn’t just allowing something to happen. Consent is full agreement with the process. 

So, let’s break it down further. What is one consenting to? Consent to treatment means that you agree to let me: 

• Analyze your deepest inner workings

• Come up with a solution/strategy based on my understanding and background

  • So in a sense, you have to be in agreement with my methods, beliefs, and how I view the world

• Employ that strategy in supporting your healing and positive change

• Think about you deeply and spend time processing you and what you are about

  • This creates attachment cords that you must be aware of

• Pray for you – yes, prayer needs consent because we all do not have the authority to petition God/Source/Universe, etc., on someone else’s behalf (parents naturally have this right over their young children, but even then, there are limits). 

This has to do with what you agree to let me do on your behalf in order to support your positive growth and development. 

Consent is also your agreement to:

• Change

• Do things differently

• Become different from who/what you already are 

• Experience the discomfort associated with change

• Break down your defense strategies

• Let me speak into your life about everything (sometimes) I perceive that would be in your best interests

This has to do with what you agree to do because let’s be honest, this is your own process. It’s about you taking personal responsibility and doing the work necessary, and you have to agree to that before we start working. It’s not uncommon for people to consent to the first part (what you agree to let me do) but then withhold consent for the second part (what they agree to do for themselves). And if that is the case, you need to be clear with yourself and clear with me about the state of your consent. Because there are a number of reasons why a person may have difficulty with the second part, and if you are truly ready to change, we can analyze those reasons and determine if you are ready/capable of moving past them in order to move into full consent. 

Why not consent

• Treatment was not your idea/choice – this happens a lot in relationships.  A person will require that another person seek treatment in order to continue the relationship, e.g., substance abuse treatment, anger management treatment, etc. It also occurs when someone is court-mandated to treatment. Treatment that is done grudgingly or under duress rarely works. 

• Loved ones not in agreement with your choice – sometimes you may be in desire for a change, but your loved ones may be resentful or fearful of the changes you are making and thus may sabotage your efforts through snide remarks, withholding money, or downright hostility. They may act in ways that are so awful that it may make change feel like it’s not worth it. 

• Lack of trust in the therapist and what they are about – this is more common when people seek treatment at an organization, and they are assigned a random therapist. There is often a long process of establishing rapport and building trust. This is less common if one seeks out a therapist for their particular expertise and knowledge base. 

• Fear of change – becoming a new person, changing life circumstances, changing relationships- is all fraught with uncertainty, and it can be difficult to anticipate what these changes can mean, and that’s scary.

• Defense mechanisms – we all have these. These are the ways we have adapted ourselves to protect what we are most sensitive or afraid of exposing. For example, a person with low self-esteem may use humor to hide the fact that they don’t feel good about themselves and are secretly jealous of the person they are mocking. 

• Lack of full disclosure of the problem – sometimes a person will withhold consent because they secretly know that they haven’t shared the whole problem. So how can they consent to solving this part of a problem when they know it’s not all there is to it? 

• Lack of awareness of the problem – this harkens back to the first point in this section, particularly if one is court-mandated or forced by a partner. A person may have zero conception or understanding of why their behavior is problematic. Or they may blame all others for the problem. A person may be arrogant and believe they do not have to change. Or a person may harbor such deep shame that it prevents them from even examining the underlying problem. 

Notice I include the words positive in front of anything to do with your change. There are systems and processes out there that have you consenting to harmful things through deception and lies. No wonder why people have a hard time with trust and consent. I believe that people should be upfront in disclosing what sort of power, background or training a person works in the name of. In fact, clients should take personal responsibility and ask this directly. Don’t let a person take a smug attitude and sidestep the question. You have a right to know if what you are consenting to is rooted in the name of light and love or darkness and deception. You have a right to know what a person’s background and training are, e.g., are they master's level, Ph.D. level, or hard-knock level? Are they cognitive-behavioral (CBT) or psychodynamic? We all should be doing this in all our interactions with service providers. Prior to a massage, energy work, plant medicine, coaching, psychotherapy, and even medical attention. 

Finally, I will say that people and organizations often make consent difficult to understand, and I’m not sure I have figured out why. They use complicated words and jargony language that no one can relate to. In addition, consent has an odd, ominous, seemingly veiled threat behind it.  Energetically, that puts a person on the defensive, even if they sign the consent form. But just as a person can consent to some aspects and not others, I believe the language used in consent forms can prevent true consent. It is consent obtained under duress. If one does not sign the document, they will not be seen. The solution is not to do away with consent but to explain it the way I have here, make it easy for people to understand, tell them what they are consenting to, and let a person actually make an active choice to engage or not. And if they are not ready to engage, have an honest conversation about what is preventing them and see if it can be overcome.  What I have attempted to do is lay out consent to make it both understandable and to actually help people move into the consent that will truly help them make positive change. 

Finally, how long does consent last? Until you expressly withdraw your consent. This can be done either verbally or in writing. You simply state that you no longer wish to work with a person and that severs the agreement. It is important to put an end to the consent agreement in the same way you actively entered the consent agreement. However, because sometimes people withdraw consent and fail to inform their practitioner, it may be necessary for the practitioner to regularly check in and determine that consent is still present. Reasons people may withdraw consent prematurely or in the middle of treatment include: 

• Ruptured therapeutic relationship

  • Therapist may have said or done something offensive or hurtful

  • Client may have said or done something offensive or hurtful

  • Misunderstanding or miscommunication

• Change in life circumstances that makes it difficult to continue

• Better understanding of what the treatment process is, and just not wanting that anymore

• Discovering how difficult the process is and not having the capacity to continue

• Misalignment of values – sometimes it takes time for values to be fully realized, and this can be discovered further in the process, which just changes the dynamics

In summary, consent encompasses what you agree to let me do and what you agree to do. There are a number of reasons why people do not consent or why consent can be withdrawn. Knowing this can prevent a lot of time and energy wasted because let’s face it, we have a whole world to change out there. What is the point of working with people who are not in consent, either due to a lack of understanding or who just don’t want the process? I am of the mind that change is a lot easier to obtain and sustain in the context of full consent.