I believe it can be very empowering for clients to make decisions based on a menu of options. Having choices supports the client’s autonomy and helps to increase self-efficacy. The client’s feeling of self-efficacy through his or her having an active role in the decision-making process ultimately has a very positive effect on the outcome of therapy.
Self-determination theory is a theory in social psychology that describes behavior change and personality development that is self-motivated. It initially developed out of field investigations as well as experiments on intrinsic motivation and the role of the environment. The theory assumes that all individuals have within them the tendency to move towards growth and autonomy, and the ability to resolve any inconsistencies that are psychological.
Autonomy is a very important concept in self-determination theory. Behavior which is autonomous influences a person’s overall well-being in a positive way. According to SDT, there is a continuum of autonomy. The continuum ranges from controlled behavior which is motivated by external factors such as rewards or punishments which other people may have control over, to true autonomy which is regulated by the self. If they are not motivated intrinsically, or from within, they may not be invested in the behavior
Evidence supports the significant role that a client’s autonomy plays in achieving and maintaining therapeutic change. Supporting a client’s autonomy involves helping the client to realize that they have choices and can make decisions based on those choices. Additionally, an environment that supports autonomy does not include any kind of manipulation or pressure to change in a particular direction. Motivation to change must come from within the client. Deci & Ryan (2008) specify five main components of autonomy support that can be utilized in the therapy setting: (a.) understanding and validation of a client’s frame of reference; (b.) unconditional regard; (c.) recognizing that there are choices and supporting a client’ process of decision-making; (d.) avoiding the exertion of control or pressure; and (e.) giving thorough rationale for any suggestions made.
The more autonomous the treatment goals, the better equipped a client may be to overcome any obstacles along the way. In the medical setting, research by Williams, Rodin, Ryan, Grollnick and Deci (1998) showed that patients who exhibited autonomy in following their regimen of taking prescribed medication, were more likely to take their meds regularly and consistently over time. The patients who experienced the physician as supportive of autonomy rather than one who was controlling, allowed the patients to exert their autonomy and to have internalized reasons for taking the medications. There have been numerous studies on the application of the principle of autonomy in the psychotherapy setting, and its role in the therapy’s outcome. In 1995, Ryan, Plant and O’Malley’s study on alcohol dependent clients indicated that autonomous motivations for treatment resulted in greater participation in the treatment process, and higher consistent attendance.
Research conducted by Zeldman, Ryan and Fiscelle (2004), examined the role of autonomy support and internal motivation in methadone maintenance treatment. Their study showed that those patients who reported feeling supported in their autonomy and were driven intrinsically followed the treatment program better and had a more positive treatment outcome. Michalak, Klappheck, and Kosfelder (2004) examined treatment goals in outpatient clients in psychiatric treatment. Consistent with past studies, the clients with the best outcomes exhibited the most autonomy. Those clients with autonomous treatment goals exhibit more effort in therapy and make the most progress
It can be empowering to have an active role in the therapy process! I believe in a collaborative partnership with my clients where I provide guidance and the tools to make lasting changes.
Deci, E.L., & Ryan, R.M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum
Michalak, J., Klappheck, M. A., & Kosfelder, J. (2004). Personal goals of psychotherapy patients: The intensity and the “why” of goal-motivated behavior and their implications for the therapeutic process. Psychotherapy Research, 14, 193–209.
Ryan, R.M., Plant, R.W., & O’Malley, S. (1995). Initial motivations for alcohol treatment: Relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviors, 20, 279-297.
Williams, G.C., Deci, E.L., & Ryan, R.M. (1998). Building health-care partnerships by supporting autonomy: Promoting maintained behavior change and positive health outcomes In P. Hinton-Walker, A.L. Suchman, & R. Botelho (Eds.), Partnerships, power and process: Transforming health-care delivery (pp. 67-88). Rochester, NY: University of Rochester Press.
Zeldman, A., Ryan, R. M., & Fiscella, K. (2004). Client motivation, autonomy support and entity beliefs: Their role in methadone maintenance treatment. Journal of Social and Clinical Psychology, 23, 675-696.
Author: Dr. Masha Godkin,Psy.D, MFT is a professor of counseling psychology, a licensed Marriage and Family Therapist in the state of Ca. with an Online Therapy Practice, as well as a former child actor. One of her specialties is in addictive behavior and counseling those in the performing art professions. Visit http://www.onlinetherapywith-dr-masha.com to learn about the Online Therapy service options that are available.