Referrals in Counselling
Definition
Feltham and Dryden (1993: 157) define ‘referral’ as ‘directing someone to a counsellor or alternative source of treatment’.
Clients may be referred inwards to a counsellor (by, for example, a GP or another counsellor) or be referred onwards by a counsellor (to another professional helper better suited to helping the client). This article is about onward referrals.
Some services may accept only self-referrals (that is, the client must refer themselves – though may often have been ‘signposted’ (i.e. given information on the service) by a third party.
Making appropriate referrals is part of professional conduct for counsellors in practice. A referral procedure should provide a seamless journey from one professional helper to another.
Reasons for Onward Referrals
The Ethical Framework for the Counselling Professions, published by the British Association for Counselling and Psychotherapy (2018: 6), includes in its commitment to clients that counsellors will ‘work to professional standards by … working within our competence’.
Working within your own competence is key, and thus there will be times when making a referral is the ethical decision.
For example, this situation could occur if:
- the client needs help with other issues (such as housing problems, financial difficulties, law-related matters or medical issues) instead of – or before being ready to engage in – counselling
- the client has a mental-health issue that prevents the establishment of psychological contact (e.g. they are delusional or are hearing voices)
- the counselling issue that the client is bringing is not within your area of competence (e.g. if they need specialist counselling for substance misuse or addiction)
- your agency offers a limited number of sessions, and you know this amount will be insufficient to work safely with the client
- your modality is not a good match for the client’s issue (e.g. the client needs help to overcome a fear of flying before an imminent holiday abroad, and you are a person-centred counsellor rather than a cognitive behavioural therapist)
- the client is experiencing difficulties that mirror your own – i.e. there is parallel process (e.g. if a client wishes to work on feelings related to their divorce, and you are currently struggling with this in your own life)
- you feel unsafe with the client (e.g. if lone working in private practice).
It is important that clients are not taken by surprise by your suggestion that referral maybe be needed; this could feel like a rejection, and lead them to believe their problems are particularly complex and therefore difficult to solve.
Preparation for referral should ideally begin during contracting, with the counsellor introducing the idea that this is a process that sometimes happens, simply because different professionals are trained and have strengths in different types of helping and different client issues.
In this way, the client is aware from the very start that referral is not threatening but is instead intended as a genuinely helpful action to support them in getting the right help at the right time.
Deciding Whether to Refer
If you are considering referring a client, it is always important to explore the possibility of referral with your supervisor, who can help you decide whether this is the right course of action.
For example, might you be thinking of referring because you are lacking confidence in your ability to help a certain client? Discussion in supervision may reveal that you are in fact competent to work with the client.
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Referrals in Counselling
Steps in Making a Referral
If you do decide with your supervisor that referral is the right course of action, it is important to plan ahead for this. You will already have explained to the client during contracting how referral in general is managed.
Before telling the client about your specific plan to refer them, make sure:
- you know where you will refer to
- you are familiar with the referral pathways and processes (including any documentation needed
- you have ascertained current waiting times for the new provider
If you need to transfer any personal information about the client, ensure that you do this in a way that fits with the Caldicott principles.
For example, unless the situation justifies the breaking of client confidentiality (e.g. if the client is at imminent risk of causing serious harm to themselves or others, or has knowledge of a serious crime), then do ensure that you get the client’s written consent for the information you will transfer before doing so.
Even though you are not able to help [the client] fully with their issue (hence the need to refer), your ability and willingness to accompany them as they wait, offering them the core conditions to support them during this time, could be invaluable to them.
Impact of Referral on Client and Counsellor
Bear in mind that being referred may lead to the client experiencing difficult emotions: be ready to explain your decision and reasons clearly and calmly, pointing out what you feel the client will gain from the referral. You can also help the client work through their reaction.
Before raising the topic with the client, consider whether this may key into any other issues they have – for example, attachment difficulties, or struggles with loss or rejection – and be ready to link these themes to how they experience being referred.
If there is a waiting list for the service to which you are referring the client, you may wish to offer the client some ‘holding sessions’ during this time, so that they are not left unsupported during this gap.
Even though you are not able to help them fully with their issue (hence the need to refer), your ability and willingness to accompany them as they wait, offering them the core conditions to support them during this time, could be invaluable to them.
It is also important to allow yourself time to reflect on and process your experience of referring the client, ensuring that your professional decision to do so does not lead to feelings of incompetence (sometimes known as ‘imposter syndrome’).
You may also feel emotions in yourself relating to loss, or to how the client reacted when you raised the topic of referral. This is a good opportunity for reflection and personal development, so enhancing your own self-awareness and growth.
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Referrals in Counselling
References
BACP (2018) Ethical Framework for the Counselling Professions, BACP: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/
Feltham C & Dryden W (1993) Dictionary of Counselling, Whurr Publishers