The Riggs Difference: Where Understanding Leads to Recovery
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Why Self-Direction and Agency in Mental Health Treatment Matters
Central to our mission at Riggs is helping people to live a more self-directed life in which they are free to pursue their own interests and goals. But what exactly is self-direction or agency? And how do we foster it through the course of treatment?
Defining Self-Direction and Agency
Self-direction is the belief that one has the ability to control one’s life (Bjornestad et al., 2017). It is similar to the idea of internal locus of control (Rotter, 1966)—the sense that one can influence life outcomes—while those with an external locus of control feel their lives are determined by fate or circumstance.
Not surprisingly, people with serious mental health challenges often struggle to feel a robust sense of agency due to a variety of reasons.
Common Barriers to Self-Direction
Several factors can interfere with an individual’s ability to feel in control of their life:
- Debilitating symptoms such as severe depression, mania, psychosis, or obsessive-compulsive disorder (OCD)
- Overwhelming emotions like panic, anxiety, shame, or anger
- Problems with identity, such as self-criticism or confusion about self
- Interpersonal difficulties or attachment insecurity
Let’s talk about each of these barriers and how they affect self-direction.
Depression and Low Agency
For example, someone who is struggling with depression often feels indecisive, low energy, and lacks the drive to engage with the world. Severe depression may cause withdrawal, leaving individuals feeling weighed down, lethargic, and unable to be assertive or self-directed.
Research suggests that a submissive, nonassertive interpersonal style can be a risk factor for chronic depression and poorer functioning (Cain et al., 2012). Therefore, not only can depression decrease a person’s sense of agency, but a lack of interpersonal agency makes someone more likely to develop recurrent depressive episodes.
Anxiety and the Fear of Decision Making
Emotions, especially anxiety, can make it challenging to move out into the world and take risks. People who struggle with chronic worries or anxiety disorders may find it difficult to assert themselves in class or ask a friend to go out and get coffee. Anxiety constricts our ability to be free and to make decisions.
The existentialist philosopher, Søren Kierkegaard (1844), once wrote that “anxiety is the dizziness of freedom.” To be free and live a self-directed life requires grappling with anxiety and learning how to tolerate and accept the inherent uncertainty and risk in the choices we make. Of course, it is tempting to not want to choose, because choosing introduces the possibility of getting it wrong or failing. This is why some people may live their life according to certain routines to eliminate the need to make decisions and think about what they want to do and how to spend their time.
Self-Esteem, Identity, and Self-Criticism
Low self-esteem, self-doubt, or severe self-criticism can prevent people from having the confidence needed to pursue and accomplish their goals while sustaining the necessary failures that everyone encounters on the road to success. Furthermore, if someone is confused about who they are, what they think, and what they value, then they may not know what to pursue or what matters to them. At Riggs, treatment helps patients better understand their thoughts, emotions, and desires, supporting the insight required to piece together a more coherent sense of self. As one has more clarity about one’s sense of self, then one is better able to decide what path to take.
Interpersonal Challenges and Attachment
Attachment insecurity, rejection sensitivity, or difficulty with expressing anger can also limit self-direction. These vulnerabilities can leave someone feeling that others are frightening, judgmental, or unavailable. Accomplishing goals requires trust, collaboration, and reliance on others. If someone feels they are a burden or that others dislike them, it can be difficult for them to do things or assert their needs in their personal or professional relationships.
Some people have significant anger about the ways they have been hurt, mistreated, or failed by friends or family. Based on their experiences, they may feel that their anger will not be taken seriously, leading them to suppress it. Alternatively, they may find themselves unable to communicate their anger effectively, potentially driving others away because it is too intense or severe. One of the greatest challenges in life is to learn how to make productive use of one’s anger, taking a stand and being measured, while not pushing others away.
Learning how to use emotions—especially anger—in constructive ways is a key part of building healthy relationships and strengthening agency.
Balancing Agency with Acceptance
While fostering agency is essential, we also recognize the importance of balance. Our culture often overemphasizes and glorifies personal achievement (Wallace, 2023). While it is important to feel that one has power and agency, there is also wisdom in recognizing the limits of one’s agency and learning how to accept and live alongside those challenges.
O’Keeffe and colleagues (2021) introduced the concept of “patiency”—the ability to endure problems and obstacles without resistance, allowing oneself to be shaped by one’s environment. In other words, as valuable as it is to feel a sense of control, acceptance of limitations within oneself and others, patience, and self-compassion are also important. Sometimes people suffer not simply because life is hard but because they cannot learn to embrace the person they are and the people around them.
How Treatment at Riggs Supports Self-Direction
At Riggs, we empower patients to take charge of their treatment and find their voice through:
- Individual psychotherapy (four times a week) tailored to personal goals and interests.
- Therapeutic community feedback from staff and peers to build self-awareness and interpersonal insight and recognize blind spots. We want to hear about how individuals experience themselves and others in groups so that we can learn about their emotions, perceptions, and assumptions about others. Staff and peers also give patients feedback that enables them to gain greater insight into how others see them, which may allow them to correct problematic interpersonal patterns.
- The opportunity for family work to help patients learn more about how they relate to their family and to work on communication challenges that may prevent them from being able to speak about experiences openly and more effectively.
To learn more about treatment at the Austen Riggs Center, or to inquire about admission, please visit our Admission page or contact a member of our admissions team.
Related Resources
General Articles and Interviews
Austen Riggs Featured on The Visionaries
August 14, 2025
In 2000, The Visionaries aired a documentary featuring the Austen Riggs Center, narrated by noted actor, producer, and director Sam Waterston.
Clinical Perspectives
Austen Riggs Center: Fostering Self-Direction through Understanding and Connection
July 17, 2025
At Austen Riggs, time, space, and support for reflection can lead you to better understand yourself and your relationships, enabling you to resolve a range of issues and build a more satisfying life
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