What determines whether people believe they are architects of their own lives, or merely passengers along for the ride? This question lies at the heart of the concept in psychology known as the ‘locus of control’. This ‘locus’ or ‘place’ of control can be internal or external, and it influences not only how people respond to challenges, but also how they manage their health, interact with society and interpret their role in the world.

The locus of control refers to an individual’s perception of where control over their life resides. Those with an internal locus of control believe that outcomes are mostly a consequence of their own actions, decisions and efforts. By contrast, people with an external locus of control attribute outcomes to luck, fate or other forces way beyond their control.

Though these are often treated as a simple dichotomy, the locus of control has far-reaching implications. It underpins motivational psychology, it helps explain health-related behaviours and it offers a lens through which we can understand cultural and social attitudes towards individual responsibility and external fate. In healthcare, it plays a critical role in patient empowerment, the movement to help individuals take ownership of their health decisions and treatment outcomes. But to appreciate the value of an internal locus, what it means and where it comes from first need to be understood.

Defining Self-Agency

An internal locus of control is the belief that an individual is in charge of what happens to them. It is the mindset that success and failure are largely self-determined. They are shaped by effort, skill and choices rather than random chance or the will of other people.

People with a strong internal locus see themselves as active participants in life. They don’t wait for circumstances to change; they act to change them. If they face setbacks, they evaluate what they can do differently. If they succeed, they credit their preparation and hard work. This doesn’t mean they ignore external realities, but rather, they prioritise what they can control.

This sense of agency doesn’t just emerge in adulthood. It begins forming in childhood through interactions with caregivers, schools and social institutions. Environments that promote autonomy, reward effort and encourage problem-solving tend to bring about internal control beliefs. On the other hand, highly restrictive or inconsistent environments can lead to locating the locus of control externally.

Environments that promote autonomy, reward effort and encourage problem-solving tend to encourage internal control beliefs. Meanwhile, highly restrictive or inconsistent environments can lead to externalised thinking.

The Psychology Behind the Concept

The internal focus of control emerged from Julian Rotter’s social learning theory, which sought to understand how people learn from their environment and apply expectations to future situations. Rotter argued that behaviour is shaped by two key variables:

·       Expectancy: the belief that behaviour will lead to a desired outcome, and

·       Reinforcement value: how much that outcome is valued.

Central to this theory was the idea that people develop beliefs over time about whether their actions influence outcomes.

This laid the foundation for decades of research into motivation, personality and resilience. This sheds light on understanding why two people might respond to the same event, such as a diagnosis, a job rejection or a failed driving test, in radically different ways. One person might see it as a cue to work harder or adjust their approach; the other as confirmation that success is out of reach.

Internally Oriented Individuals

People with well-developed internal locus tend to share several traits:

·       Responsibility-Taking: They own both their mistakes and their achievements, often seeking feedback and ways to improve rather than blaming others.

·       Resilience: When challenges arise, they are more likely to adapt and try again. Failures are seen as learning opportunities rather than dead ends.

·       Goal Orientation: With a strong belief in the power of effort, often setting clear goals and pursue them systematically, staying focused even when progress is slow.

These traits contribute to a proactive, constructive mindset that is especially valuable in domains requiring persistence and self-regulation, such as education, career development and, of course, health.

The Tangible Benefits of an Internal Locus

Research consistently links an internal locus of control with a range of positive outcomes. In education settings, students who believe they control their academic success are more likely to study regularly, seek help when needed, and perform better overall. In the workplace, people with an internal locus show greater initiative, better problem-solving skills and higher job satisfaction.

Perhaps the most compelling evidence of the power of the internal locus lies in the area of health. People with an internal health locus of control are more likely to follow treatment plans, engage in preventive behaviours and actively manage chronic conditions. They tend to ask questions, proactively seek information and make lifestyle changes because they believe those actions matter.

This has direct implications for patient empowerment. This is a concept that emphasises the role of individuals in shaping their own health journey, Empowered patients are informed, engaged and actively participate, at least according to the stereotype. According to the model of patient empowerment, they don’t just comply with instructions; they collaborate, question and participate. In many ways, developing an internal locus of control is at the heart of building this kind of autonomy and engagement.

A Foundation for the Journey Ahead

Understanding the internal locus of control is a gateway to understanding human motivation and behaviour across contexts. It reveals how beliefs about health shape resilience, initiative and the ability to cope under pressure.

This set of articles explores how the internal locus of control functions as a cornerstone of patient empowerment, how it contrasts with external control orientations and why this balance varies significantly across cultures. We will also revisit the role of liminality – the concept of being in a state of transition – and how control beliefs shift and evolve during times of uncertainty.

By understanding how different people and cultures interpret control, we gain the insight to support health, healing and human potential in more nuanced and effective ways.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, May 2025