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Submission to authority and dependence on hierarchy come under contractual terms and conditions in public institutions. The notion of consent is inevitably ambiguous. While it has a long history in certain healthcare and mental health settings, it is rare for it to be formalized in occupational health. Based on clinical monitoring and our experience as a work and organizational psychologist and a clinical psychologist within the occupational health service in the public sector, we highlight the intricate trade-offs required to achieve acceptable consent. These compromises concern both the beneficiaries of these mechanisms and psychologists. However, for the beneficiaries, the psychologist’s professional practice methods, which provide a secure framework based on support and agreement, make it possible to mitigate these pitfalls and support free and informed consent whenever possible. As for the psychologist, they are less and less protected by the conventional rules that have been modified, and are therefore more at risk and must play their part as well as possible while protecting themselves.