What It Looks Like When It's Done Right

I want to tell you about two very different medical experiences.  Not because I enjoy being vulnerable about this, but because I think what they illustrate is too important to keep in code.

The first kind: a doctor who laughed when I winced during a pelvic exam. Another who told me to relax and be still when I asked if the pain was normal. No explanation of what was happening. No checking in. No acknowledgment that my body was mine and my discomfort was real information worth attending to.

I accepted that as just what you put up with. For years.

The second kind—recently, a different doctor—changed everything.

Before she touched anything, while I was still dressed, she explained every step she would take. She told me she would use the smallest speculum available for adults. She told me what to expect and when. And then she said something that stopped me completely:

You can stop this exam at any time. For any reason. No explanation required.

I didn't know that was an option. I had never been told that was an option.

I sat with that for a long time afterward.

What consent actually looks like.

We talk about informed consent in our training. We get it. We do it. We have clients sign the paperwork.

But what that doctor did was something different from paperwork. It was enthusiastic, continuous, embodied consent.  The kind that isn't a formality at the beginning of a relationship but a living practice throughout it. The kind that returns the power to the person who is most vulnerable in the room. The kind that says, clearly and without ambiguity: you are in charge of what happens to your own body and your own process. I work for you. Not the other way around.

That is not a remarkable exception. That should be the standard.

And I don't think it always is... in medicine or in therapy.

What our clients have told us.

Clients have described both experiences to me for years.

The therapist who pushed when they said they weren't ready. The one who interpreted resistance as something to work through rather than information to honor. The one who decided, with good intentions, with genuine care, that they knew better than the client what the client needed to look at and when.

And the other kind. The therapist who said: we don't have to go there today. You get to decide what this looks like. We can slow down. We can stop. You are not required to explain yourself to me.

The difference between those two experiences is not technique. It is a fundamental orientation toward who holds the power in the room...and whether we are actively, continuously returning it to the person it belongs to.

The part that stopped me.

You can stop this at any time. For any reason. No explanation required.

I keep coming back to that last part. No explanation required.

Because so much of what we ask of clients—implicitly, without meaning to—is explanation. Justification. A good enough reason for the boundary they're setting or the pace they're choosing or the thing they're not ready to say yet.

What if we didn't require that? What if the client's no...or their not yet...or their I need to slow down...was enough, full stop, without us needing to understand it first?

That is consent as a practice rather than a form. That is what it looks like to actually hold the power differential with integrity.

What this looks like in my office.

I check in constantly. Maybe more than clients expect at first.

Is it okay if we keep going?
Are you comfortable telling me more?
Do you want to set another appointment?   Even that, especially early on, because the answer should never be assumed.

I've had clients look at me a little sideways when I ask. Like they're not sure what to do with being asked. Like nobody thought to check before.

That confusion is information too. It tells me something about what they're used to. And it tells me we have some work to do—not just on whatever brought them in, but on what it feels like to be in charge of their own process.

That's where the real work starts.

The standard we should be holding.

I want to celebrate my new doctor. Genuinely. What she did was not complicated.  Itt was clear, calm, and took maybe two extra minutes.  And it changed my entire experience of an exam I had dreaded for years.

I also want to name it as the standard. Not the exception. Not the gold star for going above and beyond.

The baseline.

Our clients come to us having had all kinds of experiences with helpers—medical, therapeutic, pastoral, educational—who did not return the power to them. Who moved at their own pace. Who decided what was appropriate without asking. Who meant well and still caused harm.

We have the opportunity to be the different experience. The one that stops them. The one they think about later. The one that shows them what it actually feels like to be in charge of their own process.

That opportunity is not optional. It is the work.

Dr. Jamie English is a licensed clinical social worker, supervisor, and educator. The DJ English blog explores the inner life of the clinician — the parts of this work we don't always talk about out loud.