Before you begin… getting consent right

Why does consent matter?

Consent protects both you and your client.

By explaining what you’re doing and why, the risks, benefits and alternatives - and checking they are happy to proceed - you:

• respect your client’s right to choose what happens to their body or the subjects discussed
• reduce the risk of misunderstandings, complaints or claims
• strengthen the relationship between you and your client.

You know your treatment and why you use certain techniques - your client often does not. Clear consent keeps them informed and safe and helps safeguard your practice.

So, having a clear consent process means your client understands:

• what you plan to do
• why you're doing it
• the benefits of working in this way
• what other options they have if they feel unsure or uncomfortable.

Handled well, consent is not a one off event but an ongoing conversation. Clear, ongoing consent builds trust, supports best practice, respects your client’s boundaries and helps protect your own professional reputation.

 

What should you consider?

Coming for a treatment does not automatically mean a client has agreed to everything you plan to do. Consent can be:

Explicit – Clearly given, in written or verbally

Implied – indicated by a client’s actions (for example, lying down on the massage couch after you have explained the treatment).

When obtaining consent, consider:

• Capacity and vulnerabilities

Ask yourself, does the client have the capacity to make an informed decision? Are there any issues affecting their ability to understand or to retain information? Do they have any vulnerabilities that could impair their ability to make a decision?

If you are unsure, take extra care. Slow down, explain simply, check understanding.

 

• When do you need informed consent? 

Where the treatment involves touch, removal of clothing or more invasive techniques, it is in your best interests to obtain informed consent. This includes providing clear information on:

 - The nature of the treatment

 -  What the client can expect in terms of the level of areas of touch

 -  Any reasonable alternatives and the impact of choosing these.

 

• Give clients time to consider

Clients should have enough time to think, ask questions and decide whether this is the best way forward for them. They should not feel rushed or pressured.

Consent should continue throughout the treatment. If anything changes, techniques, treatment plan, or the client's situation - pause and check consent again.

 

Recording consent

When consent is obtained, you should keep clear, dated, documented evidence in your treatment records. These records are your first line of defence in the event of a complaint or claim, so good documentation is essential.

For more detail on this, please see our article on record keeping.

When deciding what level of consent is needed for the activity or treatment you provide, you should also refer to your training provider and/or professional association for best practice guidelines.

Spotlight on working with children and young people

Treating children and young people can be complex. As a health and wellbeing professional, it is important to understand what your insurance policy requires. 

Under the Balens policy you are required to obtain written consent from a parent or guardian before starting treatment. You must keep evidence of this within your treatment records.

The policy references Gillick competency. This applies in certain professions (some examples being counselling, psychotherapy, certain healthcare procedures). It means that in certain situations a minor may be able to consent to treatment themselves if they can:

• understand what is being proposed
• weigh up the pros and cons
• make a reasoned decision

This is a legal concept in the UK. If you are unsure whether it applies to your work:

• check your professional association's guidance
• follow best practice from your training provider

When in doubt, err on the side of caution and seek guidance.

Material risks

When you get a client’s consent for treatment, you must clearly explain any important risks. An important (material) risk is anything that a reasonable person in the client’s position would want to know before deciding. This includes common side effects, even if they are mild, and clear guidance on what the client should do if they notice them.

Consent in practice - Claims case study

A client attended a Massage treatment with their therapist. The treatment was explained briefly, and the client was asked to remove his clothing and position himself under the towels. During the session, he claimed that he felt his buttocks were inappropriately exposed and that the towels did not adequately protect his dignity. He later raised a formal complaint against the therapist.

What was the consent issue?

• The client did not feel fully informed about how much clothing he needed to remove
• He did not feel in control over the placement of the towel or what areas were exposed

How could obtaining consent have helped this scenario?

A conversation around consent could have:

• Clearly explained the areas that would be treated and what level of undress was needed
• Described how the towels could maintain modesty and if they required any extra cover
• Invited the client to say if they felt exposed at any point and reassure them they could ask to readjust or stop the session at any point
• Offered options, talked through simple modifications (working through clothes, avoiding certain areas) if they did not feel comfortable.

Putting clear, ongoing consent at the heart of your practice keeps clients informed and safe - and is one of the simplest, most powerful ways to protect yourself and your professional reputation.

Disclaimer: The information in this article is provided as general guidance only and does not constitute legal, regulatory, clinical or professional advice. It may not address all of the requirements or circumstances that apply to your particular situation. If you need specific advice relating to your own circumstances, please contact us in the first instance. 
All case studies are illustrative only and do not describe real clients or situations.