A pervasive model of the psychotherapeutic relationship has assumed that patient welfare is best served by the therapist's exercise of control over, and responsibility for, methods, goals, and decisions in treatment. However, increased sensitivity to ethical dilemmas in the routine conduct of therapy and more vocal demands by the users of mental health services are likely to lead to a restructuring of the psychotherapeutic relationship. This article argues for a mutual participatory model of therapy that would give a central place to active, skeptical efforts by the patient to be informed and to share responsibility for therapeutic decisions.Recent efforts to define rights and responsibilities in the psychotherapeutic relationship have focused almost exclusively on involuntarily committed or at least hospitalized patients. These discussions have tended to ignore the problems of voluntary outpatients, because violations of their rights are not as blatant. However, in the long run, cases in which outpatients consent to treatment or even request it pose complex ethical questions for psychotherapists and society as a whole (Halleck, 1974). The present paper considers how aspects of traditional practice that have been previously considered noncontroversial enter into these questions and how they are in need of change. Much of traditional thinking has been based on an inappropriate analogy to medical treatment by physicians. The results have been a consistent and pervasive model in which it is assumed that patient welfare is best served by the psychotherapist's exercise of predominant control over and responsibility for methods, goals, and decisions of treatment. This paper suggests the need for an alternative model in which it is assumed that patient welfare is best served when the patient participates actively in decisions as to whether to or how to treat his problems and that this participation is facilitated by the therapist's sharing of information.Increasingly, patients are defining themselves as consumers of mental health services with legitimate demands for full participation in treatment decisions (Adams & Orgel, 1975). Recent discussions of the treatment of a highly religious person (Cohen &
