Getting Real Consent from Clients
Today I want to talk about something that sounds simple and straightforward, but it’s really not, and that is getting consent from clients.
When we offer an intervention, as in any medical profession, we need to get informed consent. It’s a part of every ethics guideline in any discipline.
It is not enough to get “okay, I’m willing to try it” from a client. We need to see that full-body consent is occurring, or at the very least, that the client is aware of what they are bracing against and why, and is still able to choose to participate in the intervention.
Because clients will say yes when they mean no, or they don’t know what they’re really getting into, and they won’t always tell you that verbally.
The Problem with the Verbal Yes
A verbal yes is a starting point, but it’s not the destination. It lets me know that some part of the client wants to participate, or maybe they are complying, or maybe they want to trust me because they want help, or maybe they’re scared to say no to an authority. As a therapist, you are always an authority, whether you like that characterization or not.
So if you notice any bracing or any hesitation in the yes, slow down. What does that look like? “Hey client, would you like to try a somatic pushing intervention?” And the client goes, “Sure.” I’m exaggerating, but that’s what it looks like: “sure,” with the shoulders coming up slightly and some tension coming into the face.
Ask them: how do you know that’s a yes? What in your body says, “I’m ready to try this”?
If they cannot answer that, or if your asking them slows them down enough to say, “Actually, I’m not sure I want to do that,” then you didn’t have real consent to begin with.
And that is really useful information. It opens us up to exploring how this client orients around consent. How are they organized around consent? Are they even aware of what that is?
What to Do When You Get a No
As soon as a no comes in, whether it’s verbal, or there’s some tightening, or they hesitate and say “yeah?” with a question mark, lean back, slow down, and get curious about it.
“I just heard you say yes, but it’s almost like your body’s saying no. Does that sound right?”
They might say, “Yeah, I guess so. I feel a little nervous about it.”
You say: “Great. What’s scary or uncomfortable about this thing I just offered? What is the hesitation that your verbal yes was trying to override, and I’m also wondering what that yes was doing.”
All of these questions, this curiosity, this openness, if the client can handle it, signals to the client that your agenda isn’t about getting them to do things they’re not ready to do. It’s really about getting to know them and helping them in a way that actually works for them.
And as you explore these yeses and nos, you’re actually going to find your way to the real information that both of you need, information that was outside of your awareness, to find the intervention that’s actually going to work for that person.
A Brief History of Affirmative Consent
I’m going to go off on a little history tangent here, because I think this is fun and I like talking about where things actually come from.
Here is something that most therapists don’t know: the concept of affirmative consent did not come from therapy or academia. It actually came from the kink community.
In 1981, the first formal framework for affirmative consent was developed by members of a New York leather collective. They coined the phrase “safe, sane, and consensual,” a standard that is still used in the kink community today, and that also underpins much of what we in mainstream culture consider the framework of consent.
This framework eventually went on to influence a 2011 letter from the Obama administration sent to college campuses, examining how Title IX investigations around consent and safety were being conducted.
That lineage runs from a New York leather collective to mainstream policy. We owe a great deal to this community, and it doesn’t get enough acknowledgement.
The definition that came out of that tradition is this: consent is the explicit indication, by written or oral statement, that someone is willing to have something done to them, and it can be withdrawn at any point, regardless of what was previously negotiated.
That last part matters clinically. A yes from last week’s session does not carry over into this week’s session. A yes from five minutes ago can change, especially once we start making progress on something and the client’s system begins to signal that it’s not okay with it.
Consent Is Ongoing
What this means practically is that consent is not a checkbox at the beginning of an intervention. It’s something we’re constantly tracking. When my students watch me do demos, it’s almost obnoxious, to some of them not all, how often I check in for consent. But from the client’s perspective, that check-in usually feels less like an interruption and more like staying with them as conditions change. Sometimes it does annoy the client, and just like everything else we talk about, that’s clinical information too.
So it’s not just about getting ongoing verbal yeses, which I definitely want. I’m also paying attention to the voice, the bracing in the body, the stops and starts of the breathing.
The goal is not to get permission or approval from the client. What I am doing is staying in contact with what is unfolding in front of me, because the last thing I want to do is interrupt the client’s process with something that doesn’t work for them and throws us off the flow we’re trying to create in the session.
Every time the body does something different than what the client’s words are doing, that is a sign to slow down. It may not be about anything the therapist is doing. It may just be about the client’s process. But we need to learn how to stay in contact with that process while also paying attention to anything we might be doing that is not in service of it.
Finding the Client’s No
Clients will consent to things that are not right for them because they’re trying to be a good client. They don’t want to disappoint you. Or because they simply don’t have access to their own no.
A big part of your job, especially in the beginning, is to find the client’s no, or help them create it. Otherwise, all of your interventions could be for naught.
That no, whether verbal or nonverbal, is information for you. Our goal as therapists is not to be right. It’s not to get people to comply. Our goal is to deeply understand people so that when we intervene, it actually takes the client into the healing they need.
Real consent is not a single moment. It’s not a single checkbox. It is something we’re tracking for and getting every step of the way.
