After a long pause, the client looked at her therapist and finally said “I don’t know what to do. If I pick option A I am doing what I believe God wants me to do--that’s incredibly important to me. If I pick option B, I get to be someone that I’ve always wanted to be--that’s really important to me, too. What should I do?”

Autonomy explains why we are responsible for our actions. Our autonomy does not make us immune from the influence or actions of others, but it does put us in charge of our lives: how we think, manage our emotions, and behave.

Autonomy in Psychotherapy

According to the ethical code that guides my profession, it is my job as a therapist to “...respect the rights of clients to make decisions and to help them understand the consequences of these decisions…”. Therapists help clients make informed decisions, they don’t tell clients what to do.

If I were the therapist in the vignette, it would be my job to help the client draft a list of pros and cons for options A and B based on the client’s values, goals, preferences, and the latest scientific research. In this case, the client must decide what is most important: honoring her faith or honoring her strong desire. No matter what she decides, she will be true to herself. She gets to decide which part of the self she wants to be true to.

Limitations

Our autonomy is not absolute. Illness, injury, and our environment can put limits on what we are able to think, feel, and do. The influence of other factors can make us experience things like trauma that we would not choose for ourselves. Even so, our autonomy is rarely taken away from us entirely.

Embrace Autonomy

I’ve seen many people convince themselves that they are not responsible for the decisions they make when logic and reason would prove otherwise. It is not a sign of health when people blame others for their own behavior. Yes, our environment does help shape who we are and what we understand our options to be. Only in extreme circumstances (e.g., dementia) can it control us. Yet, there are many who convince themselves that they are helpless. Believing you are helpless makes you helpless.

Embracing autonomy creates hope and helps us show resilience against life’s trials and stressors. History is full of examples of people who embraced their autonomy in spite of unimaginable hardship and injustice (Frederick Douglass is one of my favorite examples of this). Some of the last words psychologist and holocaust survivor, Dr. Edith Eger, heard her mother say before she was killed by the Nazis were, “We don’t know where we’re going, we don’t know what’s going to happen, but no one can take away from you what you put in your own mind.” When we embrace our autonomy we are given a pathway to peace of mind even in the hardest times.

Responsible To, Not Responsible For

According to attachment theory research, healthy adult relationships require people to be mutually accessible and responsive emotionally. When people decide to be responsive and accessible, the relationship environment they create helps them regulate emotions, process information, solve problems, resolve differences, and communicate clearly.

It takes two people behaving well for a relationship to be satisfying. This means that people seeking healthy relationships must use their autonomy to think, manage emotions, and behave in ways that are loving, considerate, caring, kind, and self-controlled. If only one half of the relationship does this (or they don’t agree on what is loving, caring, kind…), the relationship will be dissatisfying. The person who behaved well is not responsible for the actions of the person who did not.

Three C’s

Al-Anon, a 12-step program for family and friends of those who struggle with addiction, reinforces the idea of autonomy with a concept called the “Three C’s.” Those in relationship with people struggling with addiction are encouraged to say the following:

I didn’t cause the addiction
I can’t control the addiction
I can’t cure the addiction

The Three C’s do not only apply when people refuse to accept responsibility for another’s addiction: replace the word “addiction” with “behavior” and it remains true. Certainly, people can behave in ways that make it more or less likely for someone else to make a particular decision (i.e., people in loving, caring environments tend to make healthier decisions than those in abusive, neglectful ones). However, being able to influence others is different than being responsible for others. Whether you’ve made a mistake or someone else’s mistake hurt you, recognizing that individuals have autonomy is essential to the recovery process.

Child Dependence on Parents

Adults are not responsible for the actions of other adults, but they may be responsible for the actions of children. Kids are not capable of the same levels of autonomy as adults. Developmentally, children depend on caregivers to provide for them and help them make decisions. This dependence is most powerful in the early years of life, with kids gradually moving towards a more autonomous state as they grow older and mature. For example, parents likely bear more responsibility when their two-year-old cuts herself with a knife while playing in the kitchen than when their 16-year-old cuts herself while making some food. The former incident may be the result of parents storing knives in an unsafe place and the latter is a common accidental injury.

Although parents can’t control their children, they do have some degree of control over their kids’ access to resources and information. Parents are responsible for creating a loving, supportive, reasonably safe environment for their children to live in. They are accountable for what they teach their children about life and the world. When things go well, child dependence on their parents is gradually replaced by autonomy, maturity, and independence as they grow into adults.

The Choice is Yours

Autonomy is a gift. We are free to choose how we respond in any given situation. When we take control of what we can, we learn to redirect intrusive thoughts, manage emotional triggers, and replace problematic behaviors with adaptive ones. Autonomy gives us the weight of responsibility and it also gives us a way to make our life the best it can be.