To What Extent Is It Appropriate To Promote Autonomy Within Clients Across Cultures?

In this discourse, I shall be evaluating the second ethical principle put forward by the British Association for Counselling & Psychotherapy (BACP) in their Ethical Framework (2013). In their guideline for counsellors, the principle of autonomy refers to the responsibility of the counsellor to foster within clients the "right of self-governance" and the ability'"...to be self-directing within therapy and all aspects of life" (BACP, 2013, p.2).This specific account of autonomy which is characterised by self-governance seems to hold special status within therapy; not only must practitioners accommodate and encourage this 'right' of the client, additionally mainstream counselling and psychology theories assert its practice as necessary for healthy relationships, (Bowen, 1978) healthy functioning (Deci & Ryan, 2000) and self-actualisation (Rogers, 1989). Despite widespread acceptance and practice of the theories, especially in humanistic psychology, the cross-cultural application of autonomy is contested, leading me to investigate empirical and theoretical support for the opposing views. I first came across opposition to the universal relevance and therapeutic application of autonomy whilst studying a chapter written by Christopher & Smith (2006) in which they presented issues regarding cultural diversity relevant to psychotherapy. In the chapter, Christopher & Smith (2006) warned that promotion of self-governing autonomy may be detrimental, let alone beneficial for clients from collectivist ethnic minorities and made worse when practitioners fail to accommodate cultural differences that challenges theory. The chapter addressed a more general grievance oft recounted in psychology literature and verbalised by Dowd & McCleery (2007) that "The great error in the creation of all systems of therapy has been to postulate universals where there are really cultural specifics." Christopher & Smith (2006) contested the universal beneficience of self-directed autonomy by reflecting on the reactions of Japanese students to Bowen's theory of differentiation, which endorses goals analogous to self-governing autonomy as congruent with optimal functioning. Similar to the preference for internal rather than external locus of evaluation as put forward by Carl Rogers in his theory of self-actualisation, (1989) Bowen (1978) attributes the ability to emotionally detach from significant familial others to wellbeing, as compared to an individual who is emotionally attached in family relationships. Bowen explains that wellbeing is undermined in the attached or 'fused' rather than 'differentiated' individual, because attachment is defined by emotional bondage, which in itself negatively associates with both the neutralisation of emotion and separation from significant others. Bowen believed both neutralisation and separation were practised in optimal relationships as they enabled effective control of stress. In fused relationships however, as a result of the limitations of both abilities, Bowen states that undesirable interdependency is exhibited; in which actions or feelings of each member invariably illicits reactions in the other(s) and vice versa in such rapid succession that members may perceive to be unavoidably responsible for and vulnerable to each other's feelings. This seemingly stressful way of relating to others, as described in further detail later in the discourse, informed Bowen's view that fused versus differentiated concepts of self were the orientations most polarised in a scale of maladaptive to most conducive to optimal functioning in relationships respectively. However Bowen's view demonstrated the way in which Christopher & Smith (2006) anticipated Western therapists failing to honour cultural difference of clients, by confusing culturally appropriate behaviour with psychopathological behaviour. They deemed this error to be particularly likely for therapists working with collectivist clients whose values seemed most likely to conflict with therapeutic ideals created in the individualistic West. Posited by Christopher & Smith (2006) to be representative of the collective viewpoint in general, they shared extracts of interviews in which Japanese students expressed inner conflict between autonomy and relatedness that the proposition of Bowen's theory of differentiation (1978) elicited; questioning: "How can I assert who I am without offending anybody?", "I want to stay in the U.S. and pursue counselling but what about my parents?", "It feels not right for me to say 'this is my life'', (Christopher & Smith, 2006, p. 272) and "If I did not feel [sin-bad-feeling] for leaving my family to live my own life, it would mean almost as if I did not care about my family..." (p. 274). The extracts sought to exemplify the likely standpoint of collectivists; that the likelihood of practicing self-governing autonomy is inhibited by the students' subordination to external pressures associated with relatedness. Christopher & Smith (2006) concluded that pursuing the therapeutic goal of autonomy may actually associate with a negative effect on wellbeing in collectivists who were assumed to prioritise relatedness needs over autonomy needs. Instead, Christopher & Smith, (2006) argued that the perception of psychological independence of self from others, which facilitates autonomy, is synonymous with individualistic ideology which construes and celebrates the self as volitionally separate from others. They believe that theories like Roger's, which derive from individualistic culture, cannot be generalised beyond the West, as the interdependent self concept propagated in collectivist cultures does not facilitate the psychological conceptualisation of an independently volitional self. However, their so-called collectivist students did conceptualise independent volition. One Japanese student expressed their desire to stay in America to study counselling despite this goal being contrary to their parents' wishes; demonstrating an awareness of and motivation towards independent, self-directed volition. Contrastingly, none of the students expressed desirable emotions regarding relatedness or duties to significant others in the extracts. Also, according to Rogers' theory, (1989) the Japanese students would be expected to experience a state of incongruence whilst they allowed volitions of their true self to be squandered by external pressure of fear of disapproval; this incongruence was exemplified by the student who was torn between asserting herself and offending others. Bowen's theory of differentiation also seemed relevant in all cases presented by the Japanese students. If adaption to stress is least possible within interdependent, attached relationships that exasperate stress, it would run true that, as Bowen states, the experience of stress as a result of disapproval from significant others would be more intense with slower recovery than if differentiated. He goes on to suggest that if wellbeing is threatened by the stress of disapproval from significant others, individuals are likely to conform in order to avoid disapproval and stress. Again, this theory seemed congruent with the Japanese students who only seemed to engage with relatedness in order to avoid negative reactions. Similarly, supporters of self-determination theory, (SDT) believe that environments provided by family, culture, nation and politics can either hinder or support one's practice of autonomy and when environmental factors are controlling, this undermines autonomy and in turn, wellbeing, even if one is brought up in that environment (Chirkov, Ryan & Sheldon 2011) .