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Self-determination is an ethical principle that recognizes the right and need of clients to be free to make their own choices and decisions. As a mental health professional, your ethical responsibilities with regard to client self-determination include the following:
• You respect and promote the right of your clients to self-determination whenever it is socially responsible to do so.
• You help your clients determine and clarify their goals and work to improve your clients’ capacity and opportunity to change and meet their own needs.
• You may limit a client’s right to self-determination when, based on your professional judgment, you conclude that the client’s actions or potential actions pose a “serious, foreseeable, and imminent” risk to self or others.
Help Clients Clarify Their Goals, Change, and Meet Their Own Needs:Â
As noted above, you should help your clients to determine and clarify their goals and to improve their capacity and opportunity to change and meet their own needs. Effective ways of fulfilling this responsibility are described below.
a. Establish Mutuality at the Start of the Relationship: “Mutuality” refers to mutual efforts by you and client to work on the problem. Establishing mutuality with a client involves adopting a posture of professional competence, while at the same time, communicating that you and the client are equal partners in the helping relationship who are both responsible for what happens in the helping process.
b. Allow the Client to Choose the Focus of Treatment: The principle of self-determination dictates that a client has the right to choose which problems will be addressed by the intervention. You may make recommendations, when appropriate, but should allow the client to make the final decision unless a problem is mandated. Even an involuntary client who has been mandated to see you should be given as much choice as possible. You or your agency might mandate one problem (i.e., the problem mandated by the court or other legitimate authority) but allow the client to choose the second or third.
Sometimes, you and the client will disagree about the treatment goals or objectives or some other aspect of treatment planning. With regard to this issue, Persons, Davidson, and Tompkins (2001) suggest the following as a useful principle for determining whether or not a disagreement is manageable: “If the disagreement is not likely in [your] judgment or as determined empirically to prevent the patient from reaching his or her goals or to lead to a catastrophe (e.g., financial insolvency), then disagreement is acceptable” (p. 44). When this is not the case, consultation or referral is often the best course of action.
c. Facilitate Decision Making and Problem Solving by the Client: As a mental health professional, your primary role in the helping process is to facilitate decision making and problem solving by the client, and to do this appropriately, you must respect the client’s right to and need for self-determination.Â
The following guidelines can help you to do this effectively:
• When helping clients explore alternatives and make decisions, be sure to respect their values and belief systems and avoid imposing your own. You don’t have the right or responsibility to make decisions for your clients. A client might make a decision that you disagree with, but because the client is the one who must live with the decision, he/she has the right and responsibility to make it.
• You may help clients understand how the values they hold influence their goals and decisions, but you should never tell clients how to proceed based on your values.
• You should expect clients to work toward the intervention goals and convey this expectation to them. Be willing to challenge or confront clients when they are not making reasonable progress.
• To avoid creating dependence, use interventions that allow clients to learn problem-solving skills and that prepare and empower them to ultimately function and cope without your assistance.
• Allow clients to participate as much as possible in decisions that affect their lives and keep them informed of what you’re doing on their behalf.