Informed Consent and Shared Decision-Making
Informed consent is a person's voluntary agreement to an intervention after a meaningful discussion of its purpose, relevant benefits and harms, alternatives and uncertainties. Shared decision-making is the collaborative process through which professional knowledge and the person's priorities inform a choice. They overlap, but a signed form, a treatment preference and a clinically justified recommendation are different things. This article concerns adult therapeutic practice, with particular attention to eye movement approaches.
The professional and legal references below have defined jurisdictions and audiences. GMC guidance governs the professionals it regulates; the Mental Capacity Act discussion concerns England and Wales. These sources provide useful distinctions for a wider readership, but do not make every IEMT practitioner a regulated healthcare professional or give them authority to make medical decisions.
Consent is a continuing conversation
The General Medical Council states:
Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
This is Principle 2 of its consent guidance. Other principles emphasise what matters to the individual, reasonable alternatives and the presumption that adults have capacity. Agreement should therefore be revisited when the proposed intervention, relevant information or person's wishes change. A decision made at an initial consultation is not permission for any subsequent procedure. 1)
In psychotherapy, an exact account of every experience that might occur is impossible. Beahrs and Gutheil's conceptual review describes the tension between meaningful disclosure and an excessively legalistic approach that can undermine the therapeutic encounter. The implication is not to minimise disclosure, but to make it intelligible and relevant. Their article is an ethical analysis, not evidence that a particular consent script improves clinical outcomes. 2)
For example, agreeing to discuss a distressing memory does not settle whether someone wants to undertake an eye movement exercise, be touched, have a session recorded or have information shared with another professional. Treating these as separate decisions makes the actual scope of agreement visible. An opportunity to decline is especially important when a person feels that disappointing the practitioner might jeopardise access to help.
What needs to be discussed
NICE recommends discussing the aims, benefits, risks and consequences of options, including no treatment or no change. Information should address the person's expectations and allow time for questions. Its recommendations also support breaking explanations into manageable parts and checking understanding, rather than treating information delivery as proof of comprehension. 3)
The following is an editorial framework for organising such a conversation; it is not a validated consent instrument.
| Area | Information to make explicit | A useful check |
|---|---|---|
| Purpose | The difficulty being addressed and the proposed outcome. | Do practitioner and client mean the same thing by improvement? |
| Procedure | What participation involves, likely duration and how to pause. | Can the person describe what they are agreeing to? |
| Evidence | What research concerns this intervention, population and outcome. | Have findings from a different therapy been presented as if they apply directly? |
| Alternatives | Other appropriate services or approaches, waiting or declining. | Is there a real choice rather than a sales presentation? |
| Practical terms | Fees, cancellations, communication and review arrangements. | Are obligations clear before payment or commitment? |
| Review | How benefit, difficulty and changing preferences will be discussed. | What would lead to a change of plan? |
A useful explanation connects the intervention to the person's own aims. Someone seeking relief from recurring images may value sleeping well and returning to work more than a lower rating during a session. Those priorities should influence what counts as a worthwhile result. This is an application of shared decision-making, not a claim that choosing a personally meaningful goal proves the treatment effective.
Communicating evidence without exaggeration
A consent discussion should distinguish three statements: an approach has a plausible theory; it has produced encouraging observations; it has demonstrated benefit in appropriately designed research. Those are not interchangeable levels of evidence. A recommendation for EMDR in a defined clinical context does not, by itself, validate IEMT, EMI or every procedure involving eye movements. The actual intervention, training, population and outcomes must match the claim.
Uncertainty should be specific. A practitioner might explain that there are limited comparative data for the proposed use, that the frequency of unwanted effects is not well established, or that the evidence does not identify who is most likely to benefit. These statements are more informative than a general claim that everybody responds differently. They also avoid implying that an absence of published harm reports establishes safety.
The review by van Schie and van Veen illustrates this problem even within EMDR research: only nine of 51 examined randomised trials mentioned adverse effects, and only one used systematic assessment. These are reporting counts, not estimates of an individual patient's likelihood of harm. They support acknowledging incomplete safety information, not claiming that EMDR is generally unsafe or assigning its risks to IEMT. 4)
NICE recommends absolute rather than relative risk, with consistent denominators and time periods. 5) As a fictional numerical example, a reduction from 10 people in 100 to five in 100 over six months is both a five percentage-point absolute reduction and a 50% relative reduction. Reporting only the latter can obscure the size of the difference. These numbers describe no eye movement therapy; they demonstrate how the same hypothetical result can sound different. Where credible frequencies are unavailable, invented numerical precision should be avoided.
Decision aids and understanding
Stacey and colleagues' 2024 Cochrane review included 209 trials involving 107,698 adults across many treatment and screening decisions. Decision aids improved knowledge, understanding of probabilities and participation; evidence also supported better agreement between informed values and choices. The review concerns decision aids across healthcare, not validation of an IEMT leaflet. It does not establish that more paperwork, or a particular proprietary form, improves therapy outcomes. 6)
For this wiki, a useful practical application is a short comparison sheet that names the decision, the realistic options and the uncertainties. Its purpose is to support discussion. It should not award one option a reassuring colour or label unless that classification has an explicit evidential basis. A leaflet produced by the treatment provider should make its authorship apparent and distinguish factual statements from the provider's judgement.
Checking understanding can be framed respectfully: ask what the person understands the proposed work to involve and which parts remain unclear. An incorrect explanation indicates that communication needs further work; it is not a test the client has failed. Consider language, hearing, reading and communication requirements when choosing how to explain the proposal. A person who needs information in another format should not automatically be treated as lacking capacity.
Capacity, voluntariness and disagreement
Government guidance on the Mental Capacity Act explains that capacity relates to a particular decision at a particular time. A person must be supported to decide where possible. An unusual or apparently unwise choice does not establish incapacity; someone unable to decide now may be able to decide later or about a different matter. The relevant abilities concern understanding, retaining, using or weighing information and communicating a decision. This legal framework applies in England and Wales; other jurisdictions have their own rules. 7)
A practitioner who lacks competence to assess a complex capacity concern should seek appropriate professional input rather than converting a questionnaire score or disagreement into a declaration of incapacity. Distress does not itself show that a choice is invalid. Conversely, fluent speech and a signature do not resolve concerns about coercion or inability to understand the particular decision.
In ordinary voluntary therapy, a request to pause or withdraw should prompt an immediate review of what the person wants. Any exceptional compulsory-care context requires its own lawful authority and professional safeguards; a private consent form cannot create that authority. HCPC standards require valid consent before care, treatment or other services, and frame that requirement in terms of information, voluntariness and appropriate decision-making authority. 8)
Recording decisions and revisiting them
A useful record explains the decision rather than merely stating that consent was obtained. An editorial recording template would include the aim, options discussed, significant uncertainties, questions raised, the person's preferences, the agreed plan and the circumstances for review. Record a refusal accurately without interpreting it as resistance or lack of motivation. If the proposal changes, document the new discussion.
Consider a fictional client, Sam, who asks for IEMT after reading that eye movements treat trauma. The practitioner explains their qualifications and the distinction between IEMT and the EMDR research Sam has encountered. Sam wants relief from distress but is uncertain about recalling events in detail. A useful consultation clarifies what is actually proposed, discusses appropriate alternatives and allows Sam to defer the decision. Consent is not achieved by persuading Sam to accept the practitioner's preferred explanation.
At a later review, Sam reports that work attendance has deteriorated despite feeling calmer during sessions. That new information changes the benefit–harm discussion. The original form remains part of the record, but cannot substitute for reconsidering the current plan. Informed consent has practical value precisely because it remains responsive to the person's experience.
Evidence and editorial scope
This is a selective educational review of professional guidance and research, checked on 8 October 2026. The examples and organising framework are original illustrations, not validated clinical tools. The article is not a clinical practice guideline and has not undergone independent clinical peer review. Its application requires the reader's applicable law, professional obligations and competence.
See also
Brief quoted extracts remain attributable to their original authors and rights holders.