Autonomy In Therapy

“Well, only you are the expert on you. What do you think? How do you feel? What are your goals?” I probably say these things daily in my job as a therapist in hopes of promoting autonomy, empowerment, and self-directedness.

Autonomy is very important in my work as a counselor and guides me in my practice daily. It is one of the six values on which the American Counseling Association code of ethics is based and it means “fostering the right to control direction in one’s life.”

Sounds pretty simple, but many counselors lose sight of the autonomy of our clients. Other times, clients may not want autonomy. After all, the therapist is the expert, right? Shouldn’t they tell their clients what to do? Well, not always.

Here’s how and why I work to foster autonomy in my work:

  1. Informed consent: I make sure my clients know what they are getting into when they start therapy. It is their choice to make to start working with me. It is also their choice to stop working with me. This is a bit trickier with children, since parents ultimately provide consent for them, but I still share as much information as I can upfront with kids.
  2. I prompt clients to define their own goals. If that’s difficult, I may develop some ideas for goals and share them with a preface of “it’s OK to tell me if I’m wrong.” Which leads to me to #3.
  3. Providing frequent opportunities to be told I’m wrong. I often ask my clients for feedback on how we are doing. I say things like, “tell me if I’ve got it right,” “are we working on what you need to work on?,” and “am I missing anything?”. I try to create a safe environment where clients can correct me and be open and honest.
  4. I let my clients schedule their own appointments. Sometimes I may provide boundaries of how long is too long between appointments or how often is too often, but for the most part clients are allowed to come back whenever they’d like by scheduling their own appointments online. If I don’t see someone in a while, I may email to check on their wellbeing, but I will never try to coerce them into returning to therapy.
  5. I give my clients the right to make their own mistakes. Not dangerous mistakes, but uncomfortable mistakes. Promoting autonomy also means promoting choice in a space where it’s ok fail because there is a therapeutic safety net in place.
  6. I encourage my clients to find themselves and go for it! This allows them to embrace their own direction, even when others around them may not be so supportive. I do this by affirming the genuine self of my clients. This is especially powerful for gay or transgender clients.

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