Disabled
client agency.
Disabled clients are routinely spoken about, decided for, and managed by professionals. Agency in the therapy room means actively working against that pattern, not just declining to add to it.
What this is: the specific, active work of protecting a disabled client’s say over their own therapy and life, against a professional pattern that routinely decides things on their behalf.
Why it matters: a therapist who simply avoids being overtly controlling isn’t automatically supporting agency. Being spoken about, managed, and decided for by professionals is often so routine for disabled clients that a merely neutral therapist can still be experienced as one more voice deciding things for them.
The sharpest reframe: agency is not the same as independence. A client who needs significant physical or communication support still has full agency over what that support is for and how it’s given.
One thing to take away: conflating agency with self-sufficiency is one of the more common ways disabled clients end up with less say over their own care, not more.
You might
recognise this.
Where agency
quietly erodes.
- A therapist setting the goals of therapy without asking what the client actually wants from it
- Treatment decisions explained to a carer or family member instead of the client
- A client’s own account of their experience overridden by a clinical interpretation
- “Compliance” framed as the marker of a good client
What agency
looks like in practice.
- Being asked what you want from therapy, not just what’s “wrong”
- Having your own account of your experience taken as the starting point
- Being offered choices about pace, format, and method, genuinely open to your answer
- Being able to say no to an intervention without it being read as resistance
- Having disagreements with the therapist treated as data, not defiance
- Feedback about the therapy itself being genuinely welcomed, not just tolerated
Where these ideas
come from.
James Charlton’s Nothing About Us Without Us: Disability Oppression and Empowerment (1998) documented the disability rights movement’s central demand: that disabled people be the authors of decisions about their own lives, not the subjects of decisions made elsewhere on their behalf.
Edward Deci and Richard Ryan’s self-determination theory identifies autonomy as one of three basic psychological needs, alongside competence and relatedness, whose frustration is linked to poorer psychological wellbeing, providing a clinical-psychology grounding for why agency matters therapeutically, not only politically.
Carl Rogers’ person-centred tradition already places the client’s own frame of reference at the centre of therapeutic work, a resource already present within psychotherapy that disability-informed practice can draw on directly, rather than needing to import entirely from outside it.
Self-determination theory is a general psychological framework, not developed specifically for disability; its application here is a reasonable extension rather than a disability-specific finding.
Agency isn’t
the same as independence.
A client who needs significant physical or communication support still has full agency over what that support is for and how it’s given. Conflating agency with self-sufficiency is one of the more common ways disabled clients end up with less say over their own care, not more.
A fictional
teaching example.
A client who uses AAC (augmentative and alternative communication) attends sessions with a support worker who has, over time, started answering the therapist’s questions on the client’s behalf, often accurately, but without checking first. The therapist has come to unconsciously direct questions to the support worker rather than the client.
Noticing this requires actively redirecting, consistently, back to the client, even when the support worker’s answer would likely be faster and just as accurate. The point isn’t efficiency. It’s that the client, not the person assisting their communication, is the actual author of what gets said about their own therapy.
In the
therapy room.
I don’t think that interpretation is right. It’s not what I meant.
Thank you for correcting me. I’d rather get it wrong and be told, than have you sit with an interpretation that doesn’t actually fit. What did you mean?
The therapist doesn’t defend the original interpretation or soften the correction into something smaller than it was. Treating the disagreement as useful information, rather than something to be managed or talked back down, is itself the practice of agency in real time.
The ordinary
specifics.
Where should
therapy work?
Processing the accumulated experience of being spoken about rather than to. Rebuilding trust in one’s own account after years of it being overridden. Practising disagreement in a relationship secure enough to hold it.
Another place where goals are set on the client’s behalf. Another professional relationship where disagreement gets read as a symptom. A space where communication support quietly becomes communication substitution.
A process
to try.
- Check who set the goalDid the client actually choose this aim, or did I set it based on my own read of what’s “wrong”?
- Notice who’s being addressedAm I directing questions to the client, or to whoever is easiest to communicate with in the room?
- Treat no as an answerWhen a client declines something, am I accepting that, or quietly revisiting it later?
- Welcome the correctionWhen a client disagrees with my formulation, do I treat that as useful information or as something to manage?
- Separate support from substitutionIs assistance helping this client communicate their own view, or quietly replacing it with someone else’s?
Words
you can use.
Questions worth carrying,
as a therapist.
- Have I actually asked this client what they want from therapy, or assumed it from their referral or presentation?
- Do I address this client directly, even when a carer or support worker is present and easier to talk to?
- When this client has disagreed with me, what did I do with that disagreement?
- Am I treating a communication or physical support need as evidence of reduced capacity to decide?
A few things
not to do.
Mine. Yours.
Ours. System.
A genuine ambivalence about a goal or intervention, worth exploring on its own terms.
A therapist’s own discomfort with disagreement, misread as the client’s resistance.
An ordinary negotiation over pace and method that any two people would need to work out together.
A lifetime of professionals deciding things on this client’s behalf, now shaping how safe it feels to disagree here.
Evidence
& sources.
James Charlton’s Nothing About Us Without Us (1998) documents the international disability rights movement’s core demand for self-determination in decisions affecting disabled people’s lives.
Deci & Ryan’s self-determination theory (developed from the 1980s onward) is one of the most empirically supported frameworks in motivational psychology regarding autonomy as a basic psychological need.
This page treats disability rights’ political demand for self-determination and psychology’s self-determination theory as mutually reinforcing, rather than proposing a new synthesis between them.
Through a humanistic lens
- Locus of Evaluation – who gets to decide whether your experience is legitimate.
- Safety → Agency → Choice – the conditions that make authentic choice possible.
- Non-Directivity – an active therapist who leaves authorship with the client.
Part of the Humanistic Psychotherapy hub.