As a psychologist I strive to explain concepts as simply as possible. I take this very seriously, as I believe that clients’ informed consent is an essential component for a successful therapeutic process. I understand and define informed consent as:

• A process: as new objectives come to light consent needs to be re-checked.
• It ensures that the person with whom the psychologist is working with, has the opportunity to become knowledgeable about the activities in which they may participate;
• It facilitates an educated decision.
• Affords individuals the opportunity to refuse to consent if they so choose.

Informed consent essentially ensures that therapy is truly a collaboration between the therapist and the client. As such, therapy is tailored to the person increasing its success and benefits. This is enabled by being able to reach decisions by knowing the potential benefits and costs of any path. Decisions are necessary in almost any given time or situation. Imagine that decisions are somewhat like a cross road. Where do you opt to go? Left, right, straight on? Are you opting to get off the main road and go west? South maybe? Or north?

Exploring the possible costs of a decision is a very personal journey. What one might consider a cost, another might not. The costs and their significance are determined by the individual. To do this, one needs information. The information is initially shared by the therapist. In this case, myself. The client can also ask for clarifications, more information i.e. reading material, and could potentially conduct indepent research.

Such information might include what research argues to be the best approach to use when striving to achieve your goals. This infers to the framework which will be used to plan your treatment. Each therapeutic intervention is based on a theory, which is often validated by research. Each theory predicts possible barriers for change, that occur under certain circumstances. We will not get into these now, as your therapist can go over them with you.

As a therapist I also try to highlight that change can be emotionally challenging, as an introduction to the process of therapy. This is in line with professional ethics guidelines and standards, highlighting the importance of informed consent to therapy. The American Psychological Association stresses that psychologists must inform clients as early as feasible in the therapeutic relationship about the nature and anticipated course of therapy, while providing sufficient opportunity for the client to ask questions and receive answers. Thus, the client can opt in or out of a proposed intervention, or have a conversation with their therapist for an alternative method of action.

Thereby, in the spirit of professional transparency and informed consent I strive to explain that therapy can have “side effects”. It can feel difficult and may give rise to negative emotions.  One might get upset during an intervention. Things can get difficult and unpleasant. At times, it is challenging to describe the experience of self-development, primarily because it differs from individual to individual, and secondly because the formal and scientific language of psychology aims to stay as objective as possible. As a result, formal and jargon filled phrases can at times feel dry or lacking emotional essence. Thereby, at times I find inspiration in literature, poetry, and elements from cultures other than my own. 

I came across this excerpt by Bridges (Book: Transitions, Making sense of life’s changes) which does an excellent job in exemplifying the felt experience of self development by using the metaphor of initiation:

His face and body are whitened with clay, and he is no longer recognizable as the youth who left his village two months before.  The wounds of his ordeal-a circumcision and the parallel scars across his cheeks-are healed now. But they will always bear witness to what he has suffered. They mark him as one who has crossed the boundary of childhood and has put that life behind him.

He is alone. More than simply out of contact with his peers and his elders, he is absolutely and radically alone. During this time (or time-out) in his life, he is out of relation with all others. There is no map to which one could point and say, “There he is”. There is no there, because he inhabits for this time a nonplace.

He is beyond the mediating power of roles and relationships and social mores. Armed only with the rituals and chants taught him by an initiation master, he wanders free and unattached through the universe. Beyond the meaning-making powers of his everyday realities, he stands face-to-face with existence.

At night he dreams. His dreams in this primal non-time and nonplace are full of enigmatic hints and presences. Each night he goes to sleep praying that this will be the night of the great vision. It will be then and thus that he discovers his spirit guide or his guardian elder. That voice will tell him his true vocation and his real name. It may teach him a sacred chant to heal the sick or to bless the newly planted corn.

When this has happened, he will know the time has come to return to the village and take up the rights and responsibility of his new status and his new identity. Marked by his scars and empowered by his new knowledge, he will re-join the social order on a new basis. He is in a profound sense a new person.

The person he used to be is dead. It died in the ordeal and the mortuary ritual with which his rite of passage began. His parents signified his death by burning the sleeping mat he had used throughout his childhood. When he returns to the village, he will not recognize them-at least at first. For he is no longer theirs.

In the first weeks of his new life back in the village, he will not remember his old name. He is reborn, and for a time his behaviour will recall that of a very small child. He will have forgotten how to do basic things-washing and feeling himself for example. He will be unable to remember the old terms for familiar objects, although during his time with the initiation master he has acquired strange new names for many of these objects. To some degree, and on some occasions, he speaks a new language.

The youth has been renewed and enlightened by his ritual transformation. The time-out in the nonplace was his gateway to the original chaos from which the gods fashioned the world in the beginning. All new form, his people believed, must begin with chaos, and any gap in time or space may provide access to it. Such gaps occur at the end of any cycle. At the end of a year or a season, at the end of the reign of a chief, and at the end of a phase in the individual’s own life, nature or the society or the person enters the gap and dies.

After a time, each is reborn, and that is the way in which life sustains itself. It is the way of withdrawal and return. It is the way of forgetting and of rediscovery. It is the way of ending and of beginning. In following it, the person crosses over from an old way of being to a new way of being and is renewed. (pp. 101-103)

The description of a youth in the middle of a rite of passage is a metaphor. In any one culture or tribe the methods followed during initiations differ. However, regardless of obvious differences, they share the same process of development and change.

The interpretations of such rituals are provided by anthropologists. All rituals surrounding an important life event i.e. death, puberty, marriage etc share three distinct phases: separation, transition and incorporation.

During the first phase, of separation an individual was removed from anything old and familiar and put through a symbolic death. Then came the second phase of isolation or being subjected to a neutral zone. A no man’s land between the old way of being and the new. Finally, when the intended inner changes took place, the individual enters the third and final phase of incorporation. The individual is brought back and reintegrated into the social order of their group on a new basis. Using this frame of reference in understanding rituals of passage makes the natural pattern of change more visible: death, chaos, renewal. Arguably, this process applies to all aspects of life and development.

If a culture or an individual does not come to view this order of things as naturalistic, rituals will be rejected, and their benefits will not be realised. These passage rituals can be seen as examples of personal change. Beyond their superficial strangeness, they provide us with the names for the elements of our personal experiences that are typically nameless in western cultures.

The next blog spots will be exploring the three natural phases of transition in more detail. Watch this space.

From me, to you.

All the best,
Dr. M.