| Course | PSY 650 Ethics |
|---|---|
| Module | Module 5 |
| Paper type | Consent and capacity case |
| Length | About 1,083 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Psychology and Addiction Studies |
| Updated | October 2026 |
Free sample paper for PSY 650 Module 5
Whose Decision Is It? Informed Consent and Capacity for an Older Client With Memory Loss
Student Name
Psychology and Addiction Studies Program, Aspen University
PSY 650: Ethics
Instructor Name
Month Day, Year
Whose Decision Is It? Informed Consent and Capacity for an Older Client With Memory Loss
Lisa called Hannah's Montana practice to arrange counseling for her mother, Ruth, seventy-four, whose husband had died eight months earlier. Ruth had become withdrawn, and her doctor had recently noted mild memory decline. Lisa asked Hannah to see her mother and to call Lisa after each session with an update. All are invented for this course. Hannah's first ethical questions were whose decision this was and whether Ruth could make it.
Informed Consent in Psychotherapy
Beahrs and Gutheil (2001) argued that informed consent in psychotherapy serves more than legal protection. It respects clients' autonomy, invites them into an active role in their treatment and can strengthen the therapeutic alliance. They described the information that consent should cover: the nature of the proposed treatment, its likely benefits and risks, alternatives, including no treatment, and practical matters such as confidentiality and fees. They also noted difficulties particular to psychotherapy, where the course of treatment cannot be fully predicted and too much information at the outset can overwhelm. Their solution was to treat consent as a process: an initial discussion covering the essentials, revisited as treatment develops and as new decisions arise.
The APA Ethics Code requires psychologists to obtain informed consent using language reasonably understandable to the person, and, for people legally incapable of giving consent, to provide an appropriate explanation, seek their assent, consider their preferences and best interests and obtain appropriate permission from a legally authorized person (American Psychological Association [APA], 2017).
Judging Capacity
Appelbaum (2007) set out four abilities that clinicians use to judge a person's capacity to consent to treatment. In his account, a person with capacity can state a decision, grasp what they have been told, see how it bears on their own life and think through the alternatives against one another. Appelbaum emphasized that capacity is specific to a particular decision, that it can fluctuate and that the level of capacity required may rise with the risks of the decision. A diagnosis, such as dementia, does not by itself establish incapacity; many people with mild cognitive impairment retain the capacity to make many decisions.
Assessing Ruth
Hannah met Ruth alone for the first part of the initial session, after greeting Lisa in the waiting room. She explained in plain terms what counseling would involve, what it might help with, what it could not do, other options such as a grief group and the limits of confidentiality. She then asked Ruth questions to assess each ability.
| Ability | What Hannah asked | Ruth's response | Judgment |
|---|---|---|---|
| Communicate a choice | Would you like to meet with me regularly? | "Yes, I think I need to talk to someone." | Present |
| Understand | What did I just say we would be doing together? | Described weekly talks about her husband and her low mood; recalled confidentiality limits with one prompt | Present, with some prompting |
| Appreciate | Why might this help you? | Said she had stopped seeing friends and that her daughter worried | Present |
| Reason | How does this compare with the grief group at the church? | Preferred individual sessions because she "cries too easily in groups" | Present |
Conclusion on Capacity
Ruth showed all four abilities for this decision, which carries low risk and is easily reversed. Her mild memory problems meant she needed some repetition, not that she lacked capacity. The decision to begin counseling was hers to make, and she made it.
Risk and the Level of Capacity Required
Appelbaum noted that the threshold for capacity can reasonably rise with the stakes of a decision. Agreeing to talk with a counselor carries little risk and can be reversed at any time, so the level of understanding required is modest. A decision with serious, irreversible consequences, such as refusing medical treatment for a life-threatening illness, would call for a more demanding assessment. Matching the bar to the stakes protects people from harm without denying them choices they are fully able to make.
Adapting the Consent Process
Because consent is a process, Hannah adapted it to Ruth's needs rather than relying on a single conversation. She gave Ruth a one-page written summary of what they had discussed, in large print, and agreed to review it at the start of the next session. She planned to revisit consent whenever treatment changed direction and to watch for any change in Ruth's memory that might affect her decisions.
Why Capacity Is Not Assumed Either Way
Two errors are possible. A clinician might assume that an older client with memory problems cannot decide for herself and let a relative arrange everything, which would deny Ruth the respect for autonomy the code requires. Or a clinician might assume capacity without checking, which could leave a person without adequate protection if her understanding were in fact limited. Appelbaum's framework guards against both by asking specific questions and recording specific answers. In Ruth's case it confirmed her capacity; in another case it might not.
The Daughter's Role
Lisa's request for updates after each session raised the question of who the client is. Ruth, not Lisa, was the client, and her confidentiality belonged to her. Hannah asked Ruth what, if anything, she wanted Lisa to know. Ruth said she was glad for Lisa to know she was attending and generally how she was doing, but not the details of what she discussed. With Ruth's written consent, Hannah agreed to a brief monthly call with Lisa covering attendance and general progress. Hannah also told Ruth and Lisa together what would change the arrangement: a significant decline in Ruth's memory or safety would be discussed with Ruth first and, if needed, with Lisa.
If Capacity Changes
If Ruth's memory declines, her capacity for some decisions may change. Hannah noted the need to reassess, to involve Ruth in any decision as far as possible, to seek her assent even if she can no longer consent and to identify, in advance, whether Ruth has a health care power of attorney or other legally authorized person, as the code and state law require for situations where a person cannot consent.
Conclusion
Informed consent in psychotherapy is a process that respects the client's autonomy and supports the alliance, as Beahrs and Gutheil describe. Capacity is judged by specific abilities, as Appelbaum sets out, not by age or diagnosis. Ruth showed the capacity to consent to counseling, the process was adapted to her memory needs and her daughter's role was set by Ruth's own choices, with a plan if her capacity changes.
References
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Beahrs, J. O., & Gutheil, T. G. (2001). Informed consent in psychotherapy. American Journal of Psychiatry, 158(1), 4-10. https://doi.org/10.1176/appi.ajp.158.1.4
What the PSY 650 Module 5 instructions ask for
The fifth module of PSY 650 typically asks for a paper on informed consent and competence or capacity. Base your work on the Module 5 instructions in your Aspen course; the people here are invented. Explain the elements of informed consent and why consent is a process. Set out how capacity is judged, using a named framework. Apply it to a case where capacity may be in question. Adapt the consent process to the client's needs. Address the role of family members or others who seek to make decisions for the client. List your sources in APA 7, and note any state rules on substitute decision making that apply. Record the client's own words where they show understanding, since those details carry the capacity judgment.
How this PSY 650 Module 5 example is built
Ruth, seventy-four, a composite client, has mild memory decline; her daughter, Lisa, calls Hannah to book counseling and asks to receive updates. Beahrs and Gutheil's American Journal of Psychiatry article describes consent in psychotherapy as an ongoing process. Appelbaum's New England Journal of Medicine article supplies the four abilities. The APA Ethics Code requires consent in language the person can understand and, where capacity is limited, assent and appropriate permission. A four-row table rates Ruth's abilities. Hannah finds Ruth able to consent, adapts the process with written summaries and repetition and agrees with Ruth on what Lisa may be told. A section on what happens if capacity changes sets out reassessment, assent and identifying any legally authorized person.
PSY 650 Module 5 rubric: what earns full marks
Consent and capacity papers earn credit for treating consent as a process, assessing capacity with a framework rather than assumptions and respecting the client's own decisions. This example explains what consent involves in psychotherapy, using a source specific to it. The capacity table addresses each of Appelbaum's abilities with evidence from the interview. The conclusion, that Ruth can consent, rests on assessment rather than her diagnosis or age. The process is adapted rather than abandoned. The daughter's involvement is decided by Ruth, which honors her autonomy. Planning ahead for possible decline shows that respecting autonomy now includes preparing for a time when it may be limited.
PSY 650 Module 5 help: mistakes that cost marks
Consent papers often reduce consent to paperwork signed at intake. Describe it as a conversation that continues. Assess capacity rather than assuming it from age or diagnosis. Capacity belongs to a particular decision at a particular time, and it can rise and fall. Adapt the process to the person, using plain language, written summaries and repetition. Clarify who the client is when family members are involved. Check state law on guardians and surrogates. Document the assessment, including what the client said that showed understanding, because a capacity judgment without recorded evidence is hard to defend later. Meet the client alone for at least part of the first session, so that the assessment reflects their views rather than a relative's.
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This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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PSY 650 Module 5 questions, answered
What does PSY 650 Module 5 usually ask for?
Aspen's PSY 650 covers informed consent and competence in this module, so a paper on consent as a process and on assessing capacity is typical. Look at your Module 5 prompt.
How is capacity to consent judged?
Appelbaum describes four abilities: to communicate a choice, to understand relevant information, to appreciate the situation and its consequences and to reason about options.
Does a dementia diagnosis mean a person cannot consent?
No. Capacity is specific to a decision and must be assessed; many people with mild cognitive problems can consent to treatment.
Where can I find a free PSY 650 Module 5 sample paper?
This page has the full paper: informed consent as a process, a capacity table using four abilities and a consent plan for an older client.
What is informed consent in psychotherapy?
Beahrs and Gutheil describe it as an ongoing process of sharing information about treatment, its risks, benefits and alternatives, that supports the client's choices and the alliance.