Saturday 5th March, 2022
Negotiating consent and dissent:
Resistance and respect for autonomy in the clinical process.
Adrian Sutton, Director Squiggle Foundation
An opportunity to explore the nature of informed consent and dissent in psychodynamic practice.‘Informed Consent’ is a core ethical and legal principle for clinical practice. This no less important in psychoanalytic treatment than in other areas of health and illness care. In recognising Resistance as a part of the therapeutic process, Freud understood that patients could simultaneously bring themselves to treatment whilst something else in them appeared to be in opposition to the process: this means we have to go beyond asking “Who is consenting to treatment?” and reflect on “What is consenting and what is dissenting in treatment?” Winnicott took this further in making us look at the fact that what, on the surface, may appear to be resistance, may be an indication to practitioners that they need to change their thinking and action.
Although usually thought of as a transaction in which the patient/client gives consent to a clinician, it is also important to appreciate that, for treatment to proceed, a good-enough clinician has also to be well-informed and consenting. This process is embedded in a statutory framework and often alongside other practitioners, and within organisations, all of whom, individually and collectively, are part of a framework in which consent should be negotiated, implicitly or explicitly.
The workshop is an opportunity to explore these issues as practitioners and as patients. It is about the questions we might want to ask to ensure good practice and to better formulate the psychodynamic issues we feel can promote well-informed consent.
The morning will start with Adrian’s presentation, and this will be followed by small group discussions leading to a plenary session to share experience and formulate the clinical, legal and ethical questions which emerge.
Adrian Sutton writes “I have had a longstanding view that concepts from medical ethics are can be invaluable tools to aid practitioners in the immediacy of complex clinical encounters and processes. I also think this position is embedded in much of Winnicott’s writings. My presentation will use clinical examples to show how the combination of principles derived from psychoanalysis and medical ethics help me in my practice.”
Adrian is a Child Psychiatrist, Psychodynamic Organisational Therapist and Medical Educationalist. He was previously Academic Lead for Law & Ethics at Manchester Medical School and a member of Manchester Research Ethics Committee.