How to Refer a Client to Another Therapist Without Hurt Feelings
Every clinician will encounter a situation where they have to refer a client to another therapist. There are many reasons to refer, with some being fiercely debated.
Unfortunately, there aren’t many resources out there for how to actually approach the client about making a referral. It’s important to do it right, since the wrong approach can be detrimental to a client’s mental health.
We spoke to BreezyNotes EHR founder Jim Jonas, LICSW, LMFT, about how he approaches referring a client to another therapist. Keep in mind, this is just his approach, and it may not work for you or your clients. But we think it is a good start.
According to Jim, the two most important things to do when you refer a client to another therapist are:
- Be inquisitive.
- Respect the client’s right to self-determination.
The most common reason Jim refers a client to another therapist is when he believes the client is in need of a more intensive intervention.
However, Jim explains, “To paraphrase a lesson in marriage and family therapy, there are three realities: your reality, your client’s reality and reality.” So before even suggesting a referral, Jim will ask how the client feels therapy is going.
How he proceeds depends on the client’s answer.
If they answer “yes,” Jim then asks the client to describe the progress they feel has been made. There are times where it has turned out that his perceptions were wrong.
“Clients are smart,” says Jim. “They know if they are making progress. That’s why it’s so important to respect that right to self-determination.”
If Jim and the client agree there’s not enough progress being made, Jim frames the referral as a mutually beneficial decision.
One example of how to do this is to say, “I think trying a therapist who will help you get to the bottom of what’s going on.” Another example would be when referring to more intensive services such as to a psychiatrist or more intensive level of care. In that case, Jim would discuss what benefits the client could expect and encourage the client to think about it.
Jim always suggests more than one person or agency, thus assuring the client is making their own choice.
If the client agrees to be referred to another therapist, it is very important to talk with the client about this because of the relationship that has been developed and the client’s previous experiences with relationships that have ended for them.
Jim uses a very powerful therapeutic intervention to frame the end of the relationship: discussing goodbyes. Many clients have negative memories of the goodbyes in their life, whether they include moving away from friends, divorcing a spouse, or losing a loved one.
To make the referral a positive experience, Jim finds it helpful to review the person’s history with good-byes, the positives and the painful. Then, he brings that back to the present. What positives will the client take away from knowing him? What would the client have wanted to be different in the relationship? Jim then gives the client feedback about what he has valued about the client as they’ve gotten to know each other.
The most important thing to remember when you refer a client is that you’re doing this for the client’s well being. To make sure you’re protecting their well being, you need to investigate their perceptions and respect their right for self-determination.
If you keep all of these ideas in mind, you should be able to minimize the pain involved in the referral process.