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80 In this chapter, we address some important limitations of our study, suggest future studies that might address those limitations, and offer other suggestions for future research. First, and perhaps most important, analysts may have different conceptions of informed consent when they answer questions such as whether they provide an informed consent to their patients. The first question of our survey asks, “Do you give an informed consent to your patients?” noting that “By ‘informed consent’ we mean a disclosure, roughly, of the nature of analysis, its risks and benefits, and alternatives.” So, although the essential elements of informed consent are given—that is, nature of the process, risks and benefits, alternatives, and risks and benefits of alternatives—analysts may include a greater or fewer number of items under each element when they answer questions such as the Rates questions (such as how often one gives an informed consent, and how often one thinks it should be given). For example, one analyst may say he doesn’t give an informed consent because he doesn’t list all possible relevant risks, and another may say he does even if he discloses only, say, the most benign items listed as risks. Also, while no mention is made about whether the informed consent should be in writing, some analysts may say they don’t give an informed consent, even if they provide a large quantity of the relevant information, because they don’t use a form. That is, they have a fantasy that “if it is not in writing, it is not informed consent.” Other analysts identify what we call the “process view” of informed consent as just the process of analysis itself, and therefore they answer “no” to the question of whether they give an informed consent, even though a particular communication could be both analysis and IC. (For instance, an analyst who explains transference at the moment it will 5. Limitations of Our Study and Directions for Future Research Limitations and Directions for Future Research 81 be most effective may think he is doing analysis, not informed consent, while really he is doing both.) That is, analysts may think that only what happens at the front end is informed consent, and that revealing relevant things over the course of the analysis is just the process of analysis, when it is actually both. A number of features of the survey, however, temper this potential problem. The survey asks specific questions about particular items under the different elements of informed consent—for example, about a whole host of different risks. So we have a much more detailed and precise picture of what analysts actually do, even if they have different ideas of what IC means. In addition, the options are limited in terms of what IC can refer togiven that the first question, on rates of giving informed consent, lists the relevant elements. Also, the “process view” specifies how “doing process informed consent” may also be part of “doing psychoanalysis .” Still, some responders may have made certain assumptions that we hadn’t intended—for example, that informed consent needs to be in writing. Future studies should clarify this. The bottom line is this misinterpretation does not affect the Rates issues in any important way. We have indeed collected the data on what analysts do, in regards, say, to disclosing the risk of regression, even if the question regarding the general rate of disclosure may be complicated by the fact that analysts interpret this differently. This problem, however, affects not just the general Rates questions but some others as well. For example, an analyst may think of IC as providing a minimal amount of information, and therefore may not be worried about the possible countertherapeutic effects of IC. We think that the detailed Rates questions will cue most analysts to the fact that we are thinking of a robust informed consent, but we can’t be sure of this. One final note: This type of problem affects much research. As an example , a study of what therapists think about requirements of reporting child abuse may be affected by different assumptions they have about when a report is required. Or a study of how mock jurors respond to different evidence in deciding whether a defendant is guilty “beyond a reasonable doubt” may be complicated by the jurors’ different understandings of what “beyond a reasonable doubt” means. Consider a study that asks doctors whether they adequately wash their hands before touching a patient and whether this...

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