Although self-determination is a key issue in empowerment, the perspective of patients on their experience of empowerment has been poorly investigated. The authors have attempted to understand better what the process of empowerment means to patients by investigating the situations and feelings of powerlessness from which a process of empowerment might evolve. They conducted 40 interviews of patients with various chronic conditions and looked for the commonalities in their experiences of powerlessness. Their findings show that powerlessness extends well beyond strictly medical and treatment-related issues, as the study participants all expressed or demonstrated to have at some point or another experienced a distressing feeling of insecurity and a threat to their social and personal identities. The authors therefore suggest that an empowering provider-patient interaction should address these issues by providing for reassurance and opportunities for self-exploration as a prerequisite to participation and self-determination in treatment-related decisions.