Autonomy
- Carolyn Cummings
- May 19
- 3 min read
The first of this series on ethical principles guiding clinical decision-making is on the principle of autonomy. There are many ethical codes developed by professional associations across the United States, including the AAMFT, CAMFT, NASW, PCC, and the APA. At the end of this blog, I will list where you can find some of them! They all, however, promote a version of the principle of autonomy. According to Forester-Miller & Davis (2016), mental health professionals ought to highly regard clients' independence and self-determination. Clients are allowed the freedom of choice and action.
Autonomy in Action
Mental health therapists demonstrate autonomy when they encourage clients to make their own decisions guided by their values and beliefs.
Encouraging the autonomy of clients requires two things:
• 1. Helping clients understand how their decisions and values may be received by others around them, and how they may impinge on the rights of others, and
• 2. Evaluating their ability to make sound, rational decisions based on factors like age, mental status, or disability.
The first requirement is where many of the curative effects of therapy occur. While honoring a client’s ability to choose, mental health professionals also help them with perspective taking, predicting consequences, and determining whether their actions and values are congruent. However, therapy is ultimately driven by the client’s beliefs, attitudes, and decisions, not by their therapist's.
The second requirement is necessary because persons who cannot make competent decisions should not be allowed to act on decisions that can harm themselves or others. In many situations, a client’s choices are considered unacceptable legally due to their potential for grave harm. It is in these circumstances that a therapist’s legal duties to protect and duty to warn take precedence over client autonomy.
Special Considerations in Working with Children
In my work with children and adolescents, client autonomy naturally looks somewhat different from what it might with adults. For one thing, minors are not always legally allowed to consent to mental health treatment, although many states, including California (CA Health & Safety Code section 124260), have legal exceptions for adolescents who are capable of autonomous decision-making to seek and receive mental health treatment without parental consent. However, within these exceptions, mental health professionals are still required to determine whether an adolescent seeking treatment has the judgment and maturity to participate with benefit to themselves. Similarly, for children and adolescents whose parents have consented for them to receive mental health treatment, it is still important to gain the assent of these minors and give them as many choices in the therapy process as possible. Gaining assent means sharing with the child, in developmentally appropriate ways, what mental health treatment is for and how it works, and ensuring they understand and are willing to participate, or at least give it a try.
Restore Client Autonomy as Soon as Safely Possible
Finally, even when client autonomy must temporarily be set aside for the client's or others’ safety, mental health professionals need to consider how to return to this principle as soon as safely possible and assist clients in regaining their lives. After all, it is only by taking ownership of their own choices, responsibilities, and decisions that a person can truly mature and become, as Rogers phrased it, “inwardly free”. (Rogers, 1961, p.196).
References
CA Health & Safety Code section 124260
Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making(Rev.ed.).
Rogers, C. (1961). On Becoming a Person. Houghton Mifflin.