Relational Autonomy and Service Choices in Social Worker–Client Conversations in an Outpatient Clinic for People Using Drugs

Abstract This article focuses on how clients’ self-determination is accomplished in social worker–client conversations when discussing choices of clients’ future services in a low-threshold outpatient clinic in Finland targeted at people who use drugs. Self-determination is approached from the point of view of relational autonomy, meaning that choices are never made completely independently but within certain societal and interactional contexts. The article applies interactional analysis to data from ten social worker–client conversations, which include forty-eight instances of ‘choice talk’. The results demonstrate how social workers work hard to promote clients’ self-determination, and how this is carried out with different emphases within the frame of relational autonomy. Social workers do not perform ethically questionable manipulation practices. Quite the reverse, their contributions in the conversations can be interpreted as endeavours to increase clients’ self-confidence and autonomy competencies. However, a concern from an ethical point of view is that real service options are rather scarce for the clinic’s clients. This considerably reduces the clients’ capacity for self-determination. Furthermore, it also reduces the autonomy of social workers, who have limited opportunities to organise the services their clients desire and that the social workers themselves consider are the best options.