With so many Americans living without adequate access to mental health services, more would-be psychotherapy patients are seeking alternative options such as coaching sessions, massage, reiki and even tarot reading.
Competence can mean a lot of different things for non-psychotherapists practicing alternative therapies—from possessing basic “people” skills to being trauma-informed. But being competent also means knowing your limits. Regardless of the ethics of your particular field, as a practitioner in human services, you are morally obliged to “refer out” those patients whose needs you’re not adequately trained to meet.
You do not need to know the DSM-5 by heart—or even own a copy—in order to know when a patient’s needs go beyond the scope of your abilities. But it’s a good idea to achieve basic familiarity with common diagnoses and presenting symptoms so that you can both identify when an individual’s needs are “out of your league,” and refer out properly.
The following steps to making a referral have been adapted from “Maximize Your Coaching Effectiveness with Acceptance and Commitment Therapy” by Richard Blonna.
1.Know the signs that a client needs to be referred out.
As a rule of thumb, if a client’s needs, challenges or goals are beyond what you know how to help, you should plan to refer out.
If you are not a psychotherapist and a client struggles with hopelessness, expresses having suicidal thoughts or ideations or asks for information that is clearly outside of your wheelhouse, you should plan to make a referral. If the client becomes triggered, experiences flashbacks, is overwhelmed by emotions or completely shut down during a session, it’s likely they’d benefit from work with a trained trauma therapist.
Sometimes you won’t realize that a client needs services beyond the scope of what you’re able to offer until after one or two sessions. You may have concrete evidence or an intuitive sense that his or her needs go beyond what you are qualified to handle. Either way, no matter how much you may enjoy working with the person, it is never too late to refer out.
2. Be clear with the patient about what’s happening.
Explaining to the patient why you’re referring him to another professional is an important step if you want to ensure that he will take your advice and seek the services he needs. It can be a delicate process of ensuring that you do not stimulate feelings of rejection, shame or overwhelming negative self-concepts, but with the right approach, a smooth transition is possible.
In his book, Blonna suggests explaining to the person that you’re concerned, which may include specific examples of why you’re concerned, as well as why you’re unable to help. It may also help to “normalize” the referral process, letting patients know that it happens frequently within the field and is not an indication that they are “a lost cause,” “broken” or “too messed up” to help.
3. Follow up.
Once you’ve made the referral, it may be useful to reiterate why reaching out to a qualified professional is important for the client. It’s okay to ask the client to keep in touch with you about whether or not she made an appointment with the referred practitioner, Blonna says, and if you don’t hear back, you can also follow up with her yourself.
Remember that knowing your limits is a core competency for all human services practitioners. Particularly in the field of mental health care and counseling, we risk doing more damage to clients when we get in over our heads with symptoms that we aren’t trained in managing.
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