Date of Award


Degree Name

Doctor of Philosophy


Counselor Education and Counseling Psychology

First Advisor

Dr. Patrick H. Munley

Second Advisor

Dr. Alan Hovestadt

Third Advisor

Dr. C. Dennis Simpson


Client informed consent is an important component and ethical dimension of counseling and psychotherapy required by each of the mental health professions. The purpose of this study was to examine the extent to which informed consent in counseling/psychotherapy may relate to client perceptions of the working alliance, measured by the Working Alliance Inventory - Short Version (WAI-S) (Tracey and Kokotovic, 1989), and clients' general opinion of the counselor/psychotherapist, measured by the short form of Counselor Rating Form (CRF-S) (Corrigan and Schmidt, 1983). In particular, the study investigated: (1) how discussion and understanding of informed consent related to client perceptions of the working alliance and (2) how discussion and understanding of informed consent related to client general opinion of the counselor/psychotherapist.

One-hundred sixty clients receiving counseling/psychotherapy at a Community Mental Health Authority (CMHA) in a rural Midwest county who had completed a minimum of 3 counseling/psychotherapy sessions served as participants. Participants completed a demographic form, an Informed Consent Survey (ICI); the Behavioral and Symptom Identification Scale (Eisen, Dill & Grob, 1994); the WAI-S; and the CRF-S. On the ICI, clients rated the amount of discussion they had with their counselor/psychotherapist and how well they understood items pertaining to six areas of informed consent. ICI surveys were scored for amount of discussion and understanding across six informed consent areas.

Hierarchical multiple regression analyses were performed to investigate the relationships between ICI Discussion and ICI Understanding and working alliance measured by the WAI-S and client general opinion of the counselor/psychotherapist measured by the CRF-S. In the regression analyses age, gender, number of counseling/psychotherapy sessions, social class, and functionality and severity of psychopathology were entered first in the model, followed alternatively by ICI discussion, ICI understanding and then ICI Discussion and ICI Understanding together. When entered individually in the regression model ICI Discussion and ICI Understanding each made a unique significant contribution to predicting WAI-S and CRF-S. When entered together ICI Understanding emerged as the significant unique predictor.

Results highlight the possible relationship of informed consent to client perception of the counselor/psychotherapist and the working alliance. Findings are discussed and suggestions made for future research.

Access Setting

Dissertation-Open Access