April / May / June • Issue 2 • 2019
Debora A. Davidson, PhD, OTR/L
Spotlight
Did you know that the cluster of attitudes
and skills that fall under the umbrella of “self-
determination” have been shown to be one of the
strongest predictors of success for people with
disabilities’ attainment of their transition goals? It’s
as necessary to quality of life and independence as
the other basic ADLs we traditionally focus on and,
like grooming and hygiene, it’s a teachable skill set.
From what I have seen and read, most
occupational therapists do not explicitly and
systematically pursue self-determination as part of
everyday clinical practice. Like a lot of the more
psychosocial goals, I think we often expect clients
to just pick it up by osmosis because we offer
opportunities to choose whether to work on putting
on socks or learning to button first. While this is
essential to building self-determination, it’s hardly
sufficient.
We may expect other team members, like social
workers, counselors, or teachers to do the job. I have
honestly never seen this happen, but even if another
professional was working on it, self-determination
must be practiced across all settings if it is to develop.
If we aren’t actively helping in the effort, our clients
are deprived of prime opportunities to acquire this
essential array of attitudes and skills.
What is sufficient intervention for building self-
determination? At the Person level, it consists of
presenting and supporting the integration of specific
knowledge, attitudes and abilities.
Knowledge:
• That there are choices to be made
• What the array of possible choices is
• Ways to determine which options to choose
(i.e. reflecting on one’s feelings and preferences,
thinking through the “pros and cons” of
various options)
Attitudes:
• Considering oneself worthy and capable of
making choices and decisions
• Owning one’s personal strengths and
limitations in general
• Being aware and considerate of others’
perspectives and needs
Promoting Clients’ Self-Determination
• Assuming
responsibility for
making personal
choices and decisions
• Assuming
responsibility for
identifying and
resolving one’s errors
• Being comfortable
with asking for help
• Owning one’s right to
set limits and refuse
requests
Abilities:
• Making well-considered choices and decisions
in a timely manner
• Making one’s wishes known clearly and politely
• Asking for assistance clearly and politely
• Self-management skills for coping with
emotions
• Effective and polite refusal/limit-setting
Environmental Intervention
People with disabilities are rewarded for
compliance. As people who rely on others for
everyday assistance, they often learn to just agree with
whatever others suggest. The result can be learned
passivity and acceptance of chronic frustration.
These patterns may make life easier for others, but
ultimately leave the client vulnerable, unable to
direct their own lives, and unfulfilled.
If we want self-determination to generalize
beyond the bubble of our therapy sessions, we
can help people in clients’ everyday environments
to value a more assertive and self-determined
student, son, daughter, friend, spouse or worker.
We must make sure that our clients are supported
(and not punished) for their efforts toward self-
determination.
Family members, teachers, caregivers and health
professionals can be educated and persuaded to
help support each client’s fledgling and ongoing
actions toward self-determination. We can start
by pointing out that the attitudes and actions of
self-determination help people to move through
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