Consent, choice and
the right to stop.
Being able to stop is the only reason I could start.
Consent as a continuing process, how to make “no” easy for people who use communication aids, and a no-touch route through the work.
What this is: a practical guide to consent throughout therapy.
Why it matters: agreement isn’t the same as consent, especially when saying no takes time.
The sharpest reframe: silence, stillness and politeness don’t show comfort.
One thing to take away: agree quick signals for stop, not now and not sure.
The short version
Agreeing to therapy isn’t agreeing to every exercise, and agreeing last week doesn’t settle this week. Consent in trauma-informed work is a continuing process: explaining the purpose, describing what participation involves, offering alternatives, checking understanding in an accessible way, agreeing how to pause or stop, and reviewing afterwards. For people who use communication aids, signing, gestures or supported communication, it means agreeing in advance how “no”, “not now” and “I’m not sure” will be expressed. Silence, politeness, stillness or compliance can’t reliably show comfort. And there should always be a route through the psychotherapeutic work that doesn’t involve touch.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Consent as a process
Our framework1. Explain the purpose
Why this exercise or question, and what it is meant to help with.
2. Describe what it involves
What the person would do, for how long, and what they might feel.
3. Offer alternatives
Including doing nothing, or doing something different.
4. Check understanding accessibly
In the person’s communication method, not only “does that make sense?”
5. Agree a pause or stop signal
One the person can use quickly, even when distressed.
6. Review afterwards
What it was like, and whether to do it again.
This is this site’s practice framework, drawing on SAMHSA’s principles of transparency, collaboration, and empowerment, voice and choice.
Cáit is 25. After a brain injury, she communicates using an eye-gaze device; composing a sentence takes time. Her previous therapist would ask “Is that okay?” and wait a few seconds. Cáit usually blinked yes, because forming “no, I’d rather not” took too long and felt rude. She left that therapy feeling as though things had been done to her, though she had agreed to everything.
Cáit is a fictional teaching example, not a real person.
Consent when communication takes time
Our framework- Agree signals in advance: separate, quick ways to say “stop”, “not now”, “I’m not sure” and “yes”. Pre-stored phrases on a device, a card, a gesture.
- Wait. Build in real time for the answer. A quick yes is not more valid than a slow no.
- Ask open questions as well as yes/no, so the person can say what they actually want.
- Don’t read stillness, silence or politeness as comfort. Check directly, in the person’s way.
- Make declining easy. The therapist avoids pressure, shows no disappointment, doesn’t withdraw warmth, and doesn’t treat a “no” as a problem to be worked on.
Touch, supporters and interpreters
Our framework- A no-touch route. Every psychotherapeutic exercise should be possible without touch. (Help with positioning, transfers or personal care is different, and needs its own arrangements, agreed separately.) Any touch is offered, explained and agreed each time, never assumed. See Touch & Consent.
- Supporters and interpreters need clear roles agreed with the person, including that the person’s own “no” overrides anyone else’s “yes”. See Triangles, Supporters and Speaking Through Someone Else.
- Withdrawing consent is always possible: someone can stop at any point and decline future work. What has already happened can’t be undone, but it can be talked about, and it shapes what is offered next. See Withdrawing Consent.
What it might sound like
Before we start, could you tell me how you usually say no, or not now? What already works for you, on your device or otherwise?
(after a while) Look away means stop. I have ‘not now’ stored already. Long sentences tire my eyes.
Then we’ll use those, and I’ll ask mostly short questions when you’re tired. Would a stored ‘not sure’ help too? I’ll wait for an answer every time, however long it takes. There’s an exercise I’d like to describe: it involves remembering a calm place. You can say not now, or ask for something else.
(selects) Not sure.
Thank you. What would help you decide?
(after a while) Tell me how long. And can I stop halfway.
What changes: Cáit tries the exercise for two minutes, stops it once, and decides she likes it. She uses “not now” three times in the next month, each time without any fuss from the therapist. She says it is the first therapy where “yes” has meant yes.
What needs attention here?
The person always agrees
Possible focus: whether declining is genuinely easy
Watch for: taking agreement at face value
Communication takes time
Possible focus: agreed signals and real waiting
Watch for: short pauses and yes/no questions only
An exercise involves touch
Possible focus: a no-touch route, and fresh consent each time
Watch for: assuming previous agreement
A supporter answers for the person
Possible focus: the person’s own answer, which overrides
Watch for: treating the supporter’s yes as consent
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- The person uses “no” or “not now” and nothing bad happens.
- Consent is asked for each exercise, in their way.
- They say their “yes” means yes.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- How would this person say no to me, quickly?
- Do I wait long enough for an answer?
- Is there a no-touch route through everything I offer?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Trustworthiness and transparency; collaboration and mutuality; empowerment, voice and choice: SAMHSA (2014), SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.
The six-step consent process and the guidance on communication aids, touch and supporters are this site’s synthesis.
Cáit and the dialogue are constructed for learning. She is not a real person.
We have not located research on consent processes in psychological therapy for people who use augmentative and alternative communication.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Consent, Choice and the Right to Stop. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/trauma-informed-approaches/consent-choice-and-the-right-to-stop/ (Accessed: [date]).