Relational Autonomy as the Key to Effective Behavioral Change

The common health problems that plague Americans today are often the result of people’s choices and behaviors. Two theories to effectuate change are self-determination theory (SDT) and motivational interviewing (MI). Patient autonomy is central to both of these theories, but neither fully develops the concept. We describe a theory of autonomy called relational autonomy that provides a robust foundation to help these techniques succeed not only in effecting behavioral changes, but also in supporting capacities for autonomy. Our theory of relational autonomy incorporates three components: self-determination, self-cohesion, and self-respect. We delineate how these capacities are vulnerable in the healthcare setting and demonstrate how SDT and MI, bolstered by a theory of relational autonomy, can promote and sustain these capacities and behavioral changes in patients. Additionally, SDT and MI provide practical guidelines to healthcare providers about how to support the autonomy of vulnerable patients.