How Much Autonomy Do Therapy Clients Deserve? Balancing client autonomy with therapist skill

Curt and Katie chat about client autonomy. We look at what patient autonomy is and what therapists need to understand about this very complex topic. We explore how therapists can overstep or abdicate their role in supporting their clients in making decisions. We also look at what true informed consent is and the dimensions of client autonomy. This is an ethics continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about client autonomy

Therapists are faced with balancing their professional knowledge with the needs and desires of clients. At the core of this issue is the principle ethic of client autonomy. How much autonomy do therapists need to give clients? What do therapists do when clients don’t have the capacity for autonomy in the first place? This workshop explores the considerations that therapists must face when balancing the needs of clients with professional mental health services.hen

What is patient or client autonomy in mental health?

·      Clients making decisions about their treatment based on solid information and an understanding of that information

·      There is a debate related to whether we defer to clients’ decisions no matter what versus standing in the role of professional therapist

What do therapists need to understand about client autonomy?

·      There is a lot of complexity and nuance related to therapist responsibility as professionals versus when therapists can become too paternalistic

·      There is a not a lot of discussion within the ethics codes related to client autonomy, they are usually in the preamble, so it is more important while also be less discussed

·      Freedom (or liberty) to make choices versus agency (or capacity) to understand the choices

·      Therapists need to clarify for clients the options and make sure they can make informed decisions

How is informed consent related to client autonomy?

·      If clients don’t know what their therapists are doing, do they have client autonomy?

·      Evaluation of whether someone has the capacity to make treatment decisions can be impacted by bias, but is the role of the therapist within the mental health treatment

·      We don’t want to equate autonomy with autonomous decision-making

Dimensions of client autonomy and the therapist’s responsibility

·      Decisional dimension – being able to plan and make decisions about their mental health treatment

·      Executive dimension - being able to follow through on the plans made

·      Therapists need to be able to step forward and provide additional support to clients to bring them back to autonomy or hold a line in treatment that will and will not be offered

·      Informed dimension - understanding the difference between informed consent and informed assent and being able to give instructions ahead of time if have a mental health crises

·      Looking at a “Mental Health Advanced Directive” – one example is the Wellness Recovery Action Plan (see the resources section in the show notes).

Paternalism and client autonomy

·      Not all “paternalism” is wrong – when clients are unable to care for self, they may need some paternalism to be able to be safe or get the treatment that they need

·      Asymmetrical versus libertarian paternalism is discussed

·      The importance of understanding your own bias and how the way you frame options can be manipulative

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