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When we think about consent, most of us picture the beginning of therapy.
Forms are signed. Confidentiality is explained. Parents nod. A file note is made.
And then we move on.
Assent is real — not symbolic.
Even when a parent or guardian provides legal consent, the young person’s assent matters. Not as a courtesy. Not as a tick box. As an ethical position.
Meaningful assent means explaining therapy in language the young person can understand. It means checking whether they actually want to participate. It means noticing when their willingness shifts.
Sometimes children participate because a parent has told them to. Sometimes adolescents comply but disengage quietly. Sometimes they change their mind halfway through therapy.
The ethical question isn’t simply, “Do we have legal consent?”
It’s, “Does this young person understand what’s happening, and are they meaningfully participating?”
That’s a different lens
Capacity changes — often faster than we realise
The parental tension never fully disappears
Working with children often means holding three perspectives at once:
- The parent’s rights and concerns
- The young person’s privacy and autonomy
- The child’s best interests
These don’t always align neatly.
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The 2025 guidance doesn’t offer formulas. It reinforces process. When you’re making a difficult call — about disclosure, about risk, about parental involvement — what matters is that you can explain your reasoning.
Documentation becomes less about defensiveness and more about clarity.
- How did you assess capacity?
- What were the competing interests?
- What conversations did you have?
- Why did you decide what you decided?
Documentation becomes less about defensiveness and more about clarity.
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Why this feels more relevant now
Young people today are often highly informed. They are exposed to conversations about mental health, rights, identity, and autonomy earlier than previous generations.
They may ask directly:
- “Will you tell my mum?”
- “Do I have to come?”
- “What happens if I don’t want to talk about that?”
If consent is treated as static, those questions feel disruptive.
If consent is treated as evolving, those questions become part of the work.
The quiet shift
The real shift in the 2025 guidance isn’t new rules. It’s a reframing.
Consent with children and young people is not a legal shield at intake.
It is an ongoing ethical relationship.
When we revisit consent over time, we don’t weaken parental authority.
We strengthen trust.
And when tensions arise — as they inevitably do — we are standing on a clear, thoughtful process rather than a form signed months ago.