Journal of Family Therapy (1990) 12 281-286

The context-setting function of the video ‘consent’ form?

Jim Birch*

When introducing the use of video recordings in a number of work settings I have often become involved in drafting video ‘consent’ forms. As part of this process I have taken a n interest in forms produced for this purpose by other agencies. Whilst each agency’s approach reflects its own particular culture, a common style can be discerned. This style defines a relationship between the agency and its clients which is both unrecognized and widespread. I have developed a caricature ofa typical consent form (Fig. 1). I do not knowingly represent a form produced by any identifiable agency, but the features chosen are found in most forms, and I have not included any which I have not actually seen.

The issue raised in this paper concerns the effect of the consent form on the emerging relationship between client and therapist. The consent form, even ifgiven out after the first session, represents one of the earliest communications received by the client, and ranks with agency telephone contacts, public literature, and reception procedures, as a significant context-setting event which has been neglected in the therapy literature. I t necessarily sets a context, which may not fit with the therapist’s notion of the way in which he or she ought to relate to the client.

Context-setting

Context-setting can be understood using Bateson’s (1951) distinction between the ‘report’ and ‘command’ functions of a communication. He argues that when two people are interacting we can both infer something about the individual’s wishes or intentions (the report function), and of how the individual construes his or her relationship with the other (the command function). This distinction is also available to the participants-within the limits of self-knowledge.

* Department of Psychological Medicine, South Shields General Hospital, Harton Lane, South Shields, Tyne and Wear NE34 OPL t This is a revised version of a paper first published in the Dulwich Centre Newsletter.

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THE ABOVE CONSENT FOR VIDEO-TAPE RECORDING AND DO SO CONSENT IiWE HEREBY CERTIFY THAT W E HAVE READ AND FULLY UNDERSTOOD

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Figure 1

Suppose, for example, in response to a child's behaviour an adult gives a shake of the head, with closed eyes and a straight face. We can first infer from this that the adult disapproves of the child's actions: the adult's signal is a report of her or his disapproval. We can further infer that the adult expects to relate to the child as a parental authority: this

The video ‘consent’form 283

expectation is the command function of the communication. If the adult were to wheedle and say, ‘Look, please don’t do that’, then the communication is different. The report function is the same (the adult disapproves of the child’s behaviour) but the command function is new: the adult here does not expect the child to defer to his or her authority.

Watzlawick et al. (1967), recognizing that the ordinary use of ‘command’ applies to an unnecessarily restricted range of relationships, refer instead to the ‘relationship level’ of a communication. For the report function they introduce the term ‘content level’. I believe it does no disservice to these authors to use the two sets of terms as if they were synonymous.

To return to the form, the report function conveys the therapist’s wish to establish clear agreement about the use of video recordings. But what is the command function of this form? That is to say, what is the implicit relationship it defines between client and therapist? At least six themes seem worth exploring.

The form

A particular relationship is already implicit in the use of a form. I t is: a ) typically an instrument of bureaucratic authorities; b) administered by a person perceived as having greater power than

the person who is responding-at least within the power structure for which the form has relevance;

c) impersonal/printed, the response personal/written-another con- text marker for a power relationship. ( I t is no accident that one speaks of ‘making a submission’ on a form.)

Translated into the therapeutic relationship, the use of a form will elevate the authority of the therapist over that of the client. This command function will not fit with the work of a therapist who wants to enhance the personal authority of the client.

Implications of consent on inititiative

The language of consent has its own contextual implications. Consent is given to a ‘do-er’ by a ‘done-to’. The command function of passivity is clear-‘consent’ is what the soon-to-be-unconscious patient gives to the surgeon. ‘Agreements’ and ‘undertakings’ allow for the possibility (not necessarily realised) of co-operation between persons perceived as taking the initiative conjointly, ‘consent’ implies an inequality. Multiple dated signatures, witnesses, authorizations, and certifications all sustain the context of the client signing over the initiative to the therapist.

284 J . Birch

Consent can thus imply a relationship where the therapist becomes identified as having the sole claim on taking the initiative in the therapy. Such a relationship would not be consistent with a therapy which sought to foster the taking of initiatives by the client.

Leadership and direction

In respect to the form, the agency leads and the client follows. An illusion of choice is often presented, especially around who will or will not be permitted to view the video tapes, but the options for the use of tapes will be chosen from that restricted set of options prescribed by the agency. The command function of an illusion of choice specifies that the client leaves the choice of choices to the therapist. In such a context the therapist may be inadvertently dictating the direction of therapy, even whilst believing that he or she should ‘follow’ the client.

Defining status

One apparent function of most video consent forms is to inform the signatories of the agency’s prestige. As a report function, documenting the skill and experience of agency staff might be seen as reassuring. As a command function, it can implicitly define the client as ignorant or inept. A client who accepts this definition is less likely to challenge unexamined aspects of the therapist’s style, to the detriment of both parties. In addition many clients come to therapy specifically troubled by their believing themselves to be insignificant, incapable, or unworthy. If invited to assume a low status within the therapy such beliefs will be harder to challenge.

Ownership

The typical form deals with the transfer of ownership of a record of the therapy to the therapist. The command function ofthis transfer identifies the therapist as a proprietor who, within defined limits, has the use ofthe record. Insofar as the tape stands for the therapy, the therapist becomes the proprietor of the therapy.*

A consent context which defines the therapist as a proprietor is not congruent with a therapy context which seeks to empower clients and to

*Ifyou find this issue obscure recall the most recent presentation oftherapy you attended. Was the therapist claiming the therapy and its outcome as his or her own? Alternatively, was the therapist referring to the therapy as ifit was a joint enterprise? Was the client or client family present? Ifnot, what might their responses have been ifthey were somehow to eavesdrop on the proceedings?

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increase their sense of agency in their own lives. This discrepancy would be heightened for a client who consented to the therapist’s ownership of the record whilst privately harbouring strong misgivings.

The issue becomes more problematic when tapes are used by the therapist for teaching, publication, or lecturing. There is the potential here for the client to understand that not only the therapy but also part of their life is available for the therapist to put to his or her own use.

Constraints on the therapist’s imagination

An emphasis on consent in the handling of video tapes also has a command function. This command function defines the ‘relationship’ of the therapist to the video recorder. The therapist is directed to regard video taping solely as the generation of a record, and the potential to use tapes creatively as part of the therapy process is not assumed. A wider use of tapes could include taping therapeutic interventions which can be replayed out of the session; drawing attention to progress by reviewing old tapes; or sharing sessions with absent family members.

Before we meet on I have something to ask you to ihink about.

make use of their time in therapy. The betier an undersianding one has of things people do which are helpful, ihe Pan of a therapisi’s iask is 10 iiy to ihink in a general way about the many ways in whrch individuals and families

progress in iherapy is to look back at video-tapes of their meetings, sometimes also 10 drscuss such recordings with betier able one is to offer a us@l variety of ideas to oiherpeople. One effective way of revrewing the way people make

other iherapisis. I would like you to consider wheiher you might be agreeable 10 having your meetings with me recorded. I am

aware of aperson‘s nghis ofprivacy and confideniiality and I would explain 10 you how I look apEr video recordings of meetings, ifyou feli comfortable aboui helping rn thrs way. Of course, even ifyou were to agree 10 recordings being made you would have an absolute right at any time to ask that all recordings be deleted, or a recordrng of a pamcula5 meeting or a segmeni of a meeting.

agree to recordings, I would far rather you decline the mvitaiion ihan accept under duress. If you have questtons aboui this please remember them and alk me. Above all, please do not feel you should

Yours sincerely,

Jim Birch

Figure 2

An example of alternative consent practice

The above letter (Fig. 2) is offered as an example of one alternative to the typical consent form. It was written to be congruent with a therapy in which both therapist and clients (or client) are expected to meet as peers, sharing responsibility for the therapy, pooling their contrasting

286 3. Birch

areas ofexpertise. A therapist whose style necessitated a power hierarchy of status and knowledge would find such a letter quite inappropriate to his or her purposes.

A consent form is a communication. I t must have a command function: i t must define the relationship between client and therapist. This paper draws attention to the possibility that a therapist can be using a consent form which establishes a context for his or her relationship with clients which is inconsistent with the relationship he or she would ideally wish to establish. The point is not that there are ‘good’ or ‘bad’ consent forms, but rather that consent practice is not necessarily congruent with therapy practice.

A postscript: child sexual abuse

The ideas put forward in this paper arose from practice which did not include any significant work in the area of child sexual abuse. Video- recordings cannot be isolated from their legal context, and issues of consent will be constrained by the prior requirements ofthe legal system. Consent forms designed for this setting must also have a command function. The consent letter (Fig. 2) is unlikely to be congruent with the demands placed on a therapist by the legal system. Workers in the field of sexual abuse might like to ask whether their current consent practice is congruent with the context in which they have to work.

Acknowlwedgement

I am indebted to John Carpenter for pointing out the implications of the legal context on consent practice in the field of CSA; also for drawing my attention to Smith’s (1988) letter regarding video-tapes being subpoenaed by the courts, regardless of the confiden- tiality offered by video consent forms.

References

BATESON, G. (1951) Information and codification. In: G. Bateson and J. Ruesch

SMITH, G. (1988) Correspondence. The Psychologist, l ( 10): 405. WATZLAWICK, P. BEAVIN, J. and JACKSON, D. (1967) The Pragmatics o f Human

Communication: The Social Matrix o f Psychiatry. New York. W. W. Norton.

Communication. New York. W. W. Norton.