Open therapy and its enemies

Consider a scenario where, at the start of an appointment with a therapist, she explains to you that ‘the success of the therapy will depend on your own positive expectations, the respect and esteem that you have for me as a qualified health professional, the warm tone and empathic approach that I adopt towards you, and the trust that you place in me, during the course of treatment’. You might find this transparency about the therapeutic process to be refreshingly honest. You might, however, be surprised if this openness turned out to be an ethical obligation that she owed you. Yet, for some commentators, this ‘open’ approach to psychotherapy – where there is openness about the common factors that can explain the efficacy of the therapy –is required by ethical standards of informed consent and respect for patient autonomy. In this edition of the Journal of Medical Ethics, Garson Leder formulates two responses to this type of ‘open therapy claim’: that ‘….informed consent does not require the practitioners ‘go open’ about the therapeutic common factors in psychotherapy, and clarity about the mechanism of change shows us …