As a social worker, we care about people.  We want them to live the best life they can.  And…at least secretly – we are sure we know what the best choices are to get what we view as the best life.

It turns out though – that even though we are assisting people in finding their way – their choices and their desired outcomes aren’t up to us.  One of the main tenets of social work is self – determination.

The National Association of Social Workers states self-determination is an ethical principle of professional practice.

 “Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.”

It is imperative that a social worker is aware of their own value system and beliefs so they aren’t subconsciously or subtly moving the client to the clinician’s goals.  You want to act for your client’s best interest but who decides what that is?

Maybe you are a social worker providing case management to an individual in the community who is struggling with medical needs.  The client is diagnosed with diabetes and has dangerously high blood sugars because he isn’t interested in following the diet.  If he continues to disregard the diet it is possible his kidneys could fail and he will have to go on dialysis or he may lose a limb.  As the social worker you may be thinking the choice to follow the diet is obvious but the client doesn’t agree.  What could you do?  You would discuss with him the consequences of not following the prescribed diet and explore the barriers and his feelings.  However, if the client still says “I get it, I am not going to follow the diet.  It is just not important to me” then that is OK.  The social worker doesn’t get to say – let’s throw out all the unhealthy food or I’m not going to help you get assistance if you don’t follow the diet.  His choice may not be the same choice you or I might make but it is still his choice.

Clients often make life choices we wouldn’t choose for ourselves.  Sometimes people prefer to be homeless rather than live in an apartment.  Sometimes people will choose to cheat on their spouse.  Sometime people will stay in a job that seems to be completely unhealthy.  Someone could choose to not take psychotropic medication and still function in the community.   A client’s religious or other cultural values might feel abhorrent to you but it is not on the social worker to change them but to meet the client where they are at and let them live their own destiny.  It can be frustrating for a social worker because you want so much for your client’s to be successful.  Each of the clients we work with know themselves better than we know them.

I had a client once who left a destructive and abusive marriage and really struggled with self-confidence.  Almost immediately after the separation the client came in and said she met someone on an internet dating site.  She went on to share all these reservations she had regarding the man.  Within 2 months she was engaged to him.    In my head – I’m thinking “this seems like a really bad idea.”  She ended up being engaged for about a year and then married this man.  Now, they have been married about 4 years and this relationship seems to be the most stable and affirming that the client has ever been in.  I definitely wanted what I believed was in best for this client but if I had pushed her to what I thought was going to be better for her – I would have been wrong.  She knew herself better than I knew her.

Of course there are times when safety and well-being take precedence over self-determination.  A social worker will use their professional judgement to make that decision.  There are obvious situations such as when a client is suicidal with a plan or planning to cause destructive harm to another where the decision to act against the client’s choice is relatively.   However, deciding to limit a person’s self-determination is often not clear cut at all.

How can you make sure you are encouraging client self-determination?

  • Start by asking the clients what they want for themselves? Ask those open-ended questions and srocks-trees-hiking-trailee where it goes.
  • Help them clarify their goals and set concrete hopes. Make sure they are the client’s goals – not what you think they should work on.
  • Be cautious of having an agenda. There might be things you want to cover in a session but the client should determine where the conversation goes.
  • Ask yourself – Is this what the client wants or is it me who thinks this is a good idea?
  • Is what the client plans to do put them or someone else at imminent risk for harm.
  • Consult with other social workers to get different perspectives.
  • Remind yourself that your client’s reactions and their situation is not about you.
  • Ask yourself – Is there a really good reason I am taking away this person’s right of choice?

 

As a social worker, self-determination is a value I have a huge affinity for. I have found there are times when I am in a room full of professionals and everyone is stating what they think will be best for the client regardless of what the client is saying they actually want.  As a social worker, I am sometimes the lone voice advocating for the individual’s choice.

Perhaps one of the reasons I became a social worker is that I want to choose my own path and I believe that each person should be able to choose theirs and this career gives me a way to fight for people.