Neutrality, autonomy and mental health: a closer look

Clinicians have traditionally viewed neutrality as the primary means of promoting patient autonomy, and by extension mental health. But patients also require expert direction, want other values incorporated into their treatment, and benefit from collaborating with clinicians toward shared therapeutic objectives. A historical perspective on the physician-patient relationship reveals an evolving richness in the concepts of autonomy and neutrality. Formal, or authentic, autonomy is more descriptive of mental health than individual autonomy, and nurture is a more effective strategy for promoting it than neutrality, although technical neutrality remains an indispensable tactic. This model of mental health treatment is comprehensive, relational, and developmental.