Steven Walfish, Ph.D.

Informed consent is the bedrock of the therapeutic relationship. It is only by providing adequate informed consent that clients can know what is to take place in treatment, their financial obligations, and the particulars about how you practice (e.g., sessions are 45 minutes long, cancelation policies, emergency procedures) and what they can expect in working with you. 

Therapists have an obligation to describe their policies and procedures in a Disclosure Statement and also to let them know about your privacy practices.  This is better known as your “HIPAA form.”  

So where do clinicians obtain these forms? Many professional organizations either provide them or sell a package. Most people going into practice simply ask other clinicians, “Can I borrow your HIPAA form?” and with a simple name change use the same form. 

In doing so, the assumption is that the form you are buying or borrowing is adequate. Research by Mitchell Handelsman and his colleagues have consistently found that forms used by mental health professionals are written at a reading level of college graduate or beyond. This raises the question of whether you are getting “true informed consent” – since according to research by Doak et al, 50% of the adult population read at or below a ninth grade level. 

Bryan Ducey and I conducted a national study, sampling the reading level of Notices of Privacy Practices (e.g., HIPAA forms) of psychologists. We found that a large majority (82%) of these forms were written at 12th grade-plus, and almost the entire sample (94%) fell in the Difficult Range of reading ease. If you would like a complimentary reprint of this study write to me at

Providing adequate informed consent is an ethical mandate of all the mental health professions.  Check the reading level of your informed consent documents (Microsoft Word has an easy procedure for doing so) and try to make sure that it is indeed readable to your clients. 

With true informed consent you will improve the therapeutic alliance and reduce your liability exposure. It’s a win-win all the way around.