Informed consent: the elements the exam expects you to list.
What must be disclosed, when, in what form, and the special cases: minors, groups, mandated clients, research.
By Dr. Andrew Wichterman · September 15, 2026 · 5 min read · Updated October 4, 2026
Informed consent is both an ethical standard and a legal one, and the exam tests it as a list of elements plus a set of special situations. The Code is explicit; here is what it requires.
The elements
- The purposes, goals, techniques, procedures and limitations of counseling.
- Potential risks and benefits.
- The counselor's qualifications, credentials, relevant experience and approach; whether the counselor is under supervision and the supervisor's role.
- Continuation of services if the counselor becomes incapacitated or dies.
- Implications of diagnosis, and the intended use of tests and reports.
- Fees and billing, including procedures for nonpayment.
- Confidentiality and its limits.
- The client's right to obtain information about records and to participate in ongoing treatment planning.
- The right to refuse any service or modality and to be advised of the consequences of refusal.
- For technology-assisted services, the additional items in Section H.
When and how
Informed consent is a process, not a form. It begins at intake, is reviewed as counseling proceeds, and is documented. It must be given in language the client understands, with culturally and developmentally appropriate adjustments and translation or interpretation where needed. It is both written and verbal.
Capacity, assent and the law
Consent requires capacity: the ability to understand the relevant information, appreciate how it applies to one's own situation, reason about the options and communicate a choice. Capacity is decision-specific and can fluctuate; a client in acute psychosis or intoxication may lack it today and have it next week, and a client with a cognitive disorder may be able to consent to counseling while unable to manage finances. When capacity is in doubt, the counselor assesses it, documents the assessment, and seeks consent from a legally authorized representative while still seeking the client's assent.
For minors, the parent or guardian holds the legal right to consent in most situations, and the minor gives assent, an agreement to participate that is ethically required even though it is not legally sufficient. States vary on when a minor may consent alone: many permit it for substance use treatment, reproductive health, and sometimes mental health care after a certain age or a limited number of sessions; emancipated minors consent for themselves; some states recognize a mature minor doctrine. The exam does not test your state's rule; it tests that you know the rule is state-specific and that the counselor must know it before the first session with a minor.
What a good disclosure statement contains
The professional disclosure statement is the written vehicle for most of the consent elements, and many boards require one by law. A complete one carries the counselor's name, credentials, license number and the board's contact information for complaints; education and training; theoretical orientation and the kinds of services offered; fees, billing, insurance and cancellation policies; the limits of confidentiality in plain language, including the duty to warn, mandated reporting and court orders; how records are kept and for how long; emergency procedures and how to reach the counselor between sessions; the supervision arrangement, if any; and what happens if the counselor becomes unavailable.
The item pattern asks what is missing from a described statement, and the missing items are usually the uncomfortable ones: how to file a complaint, the limits of confidentiality stated specifically rather than generally, and the plan for the counselor's incapacity. A statement that says "everything you tell me is confidential" is wrong on its face and is a frequent stem. The statement is reviewed verbally, signed, copied to the client, and revisited when anything in it changes, which is what "process, not form" means in practice.
Special cases
- Minors and adults unable to consent. The counselor seeks assent from the client and consent from the parent or guardian, and includes the client in decisions to the extent possible. State law defines when a minor may consent alone (often for substance use or reproductive health).
- Mandated clients. The counselor explains what will and will not be shared with the referring agency, and the consequences of refusal. Mandated clients retain the right to refuse and to know the consequences.
- Groups. Screening, group rules, and the fact that the leader cannot guarantee confidentiality among members.
- Couples and families. Who is the client, and how information from individual contacts will be handled ("no secrets" policies).
- Research. Voluntary participation, right to withdraw, procedures, risks, confidentiality, and debriefing when deception was used, which is permitted only when justified and no alternative exists.
- Supervision and training. Clients are told when sessions are observed or recorded and who will have access.
Three items, worked
A fifteen-year-old tells her counselor, in the second session, that she has been cutting; the counselor tells her parents that evening. The client feels betrayed and refuses to return. The error is not the disclosure, which may have been warranted on safety grounds, but the consent: the limits of confidentiality with a minor, and what the counselor would and would not share with parents, should have been explained to both at the first session. The keyed answer names the incomplete informed consent, not the decision to tell.
A couple begins counseling, and in an individual session the husband discloses an affair and asks the counselor not to tell his wife. The keyed answer depends on what was agreed at intake: a counselor with a stated no-secrets policy returns to that agreement; a counselor who never stated a policy has an informed consent failure to repair before anything else. A court-referred client says he does not want counseling and asks what happens if he stops coming. The keyed answer: explain exactly what will be reported to the court and the consequences of discontinuing, and respect his right to refuse with that knowledge. Mandated clients are still entitled to consent, including the consent to say no.
The item pattern
An item describes something missing from an intake and asks what should have been included, or describes a client who is surprised by a limit of confidentiality and asks where the counselor erred. The answer is nearly always that informed consent was incomplete or not revisited.
Practice this. The flashcards and practice tests on this site are sorted by content area, so you can drill this one until it holds.
Know the list, know that it is a process, and know the five special cases. That covers every informed consent item you will see.