It can be difficult to decide to refer a client to another therapist rather than treating them yourself. But there are all kinds of reasons you may feel a different therapist would be a better match for your client.
Perhaps the client needs specialized treatment you can’t provide, or the therapeutic relationship isn’t a good fit. Maybe you just don’t have the capacity to take them on or offer the session frequency they need.
In all cases, therapists need to learn how to manage referrals in a sensitive, caring way that sets the client up for success with their new mental health professional. This article shows you how.
Nuna is a practice management software for therapists that also matches you with clients who are a perfect fit. Try it, it’s free!
Why are referrals so difficult?
Therapists frequently struggle with referrals. Mental health providers tend to be deeply invested in their clients, and they may feel they “should” be able to treat every patient or find it difficult to recognize their limitations.
Therapists often worry that ending a therapeutic relationship with a client to refer them elsewhere will hurt their feelings or make them feel abandoned. If they have developed a long-standing, trusting counseling relationship, clinicians may also have concerns around affecting the progress that’s been made.
There may also be more practical concerns at play. Therapists new to private practice could have reservations because they don’t want to lose a client or transfer business to their competitors. If that’s you, our guide on how to start an online therapy practice could help.
Often, therapists just aren’t sure who to refer the client to or how to manage the process.
Why it’s important to make appropriate referrals
Understanding when and how to refer clients to another therapist produces the best outcome for clients and therapists alike.
Therapists who provide skillful referrals prioritize their clients’ well-being and find them the effective, specialized care they need. The APA code of ethics clearly states that therapists shouldn’t treat conditions they don’t have expertise with, so it’s a matter of doing the right thing professionally.
Referring clients in the right way also helps therapists to show that they are trustworthy professionals, concerned with clients’ needs above all else, which builds their reputation.
Engaging in client referrals is also a key way to strengthen your clinical network and build connections with other therapists. There’s room for everybody, and by seeing other mental health professionals as allies, rather than competitors, they will be more likely to refer patients your way.
That’s right, you can actually end up with more clients by mastering the art of referrals. For more tips on how to get more therapy clients, take a look at our blog post.
When should you refer clients to another professional?
Now that it’s clear how important referrals are, let’s look at when you should refer clients.
Timing is key. If you haven’t started working with a client yet, ensure diagnostic interviews are part of your clinical process, so you can refer them to someone more suitable before you’ve begun treatment if it doesn’t seem like a good fit. You may know when a client first contacts you, even before speaking with them, that your counseling services won’t meet their therapeutic needs.
But many therapists also find themselves referring clients when treatment is already underway, due to either a change of circumstances or discovering new information. Therapists should regularly evaluate the effectiveness of treatment and the therapeutic relationship to ensure it’s still a good match.
Therapists should be ready to refer clients in cases when:
They need specialized help outside of your areas of competency
It’s impossible to have the expertise required to treat every psychological condition.
Therapists may find themselves with clients who need help with issues they’re not trained in. Certain conditions are more likely to require specialized help, like personality disorders, psychosis, or eating disorders.
It’s also important to consider whether your therapeutic approach is a good fit for your client’s condition.
For example, a therapist who provides Cognitive Behavioral Therapy may successfully treat clients with depression and anxiety but may need to refer a client with Obsessive Compulsive Disorder to a specialist in a different kind of therapy, like Exposure and Response Prevention, the gold standard in OCD treatment. Similarly, a psychoanalyst might want to refer a patient with Borderline Personality Disorder to a Dialectic Behavioral Therapy expert.
The therapeutic relationship is unhealthy or unsafe
Most therapists will end up dealing with inappropriate client behavior during therapy sessions at one stage or another.
This doesn’t necessarily mean you need to stop working with the client. According to certain schools of psychological thought, “transference”, where patients “transfer” strong feelings onto the therapist, can be a valuable part of the therapeutic process.
However, if this dynamic affects your ability to provide therapy, you may need to cease treatment and refer the patient to another therapist if it’s appropriate to do so.
For example, clients may behave romantically or flirt with the therapist. Depending on the degree to which this happens, this could be an opportunity to deal with issues of transference or it could become overly inappropriate or persistent, in which case you should refer the patient to someone else.
Another common example is violent or aggressive behavior from a client. Whether the client behaves in a physically or verbally threatening manner, this is unacceptable within a therapeutic relationship, and you may consider referring the client to a mental health professional experienced with challenging behavioral tendencies.
Treating the client affects your own mental health
In their work with clients, most therapists are occasionally exposed to issues and experiences that may provoke discomfort or trigger personal memories.
As a mental health professional, you likely already have strategies in place for dealing with these scenarios and remaining centered, objective and professional in the therapy space.
But sometimes a client has issues that are just too close to home – for instance, if you’re currently experiencing a challenging situation that mirrors your client’s, it may be difficult to detach.
If you feel really off-balance and you’re unable to achieve professional distance when working with your client, it’s possibly time to refer. Stepping away from emotionally triggering situations – and therapeutic relationships – can be an important form of self-care.
You aren’t available to offer the sessions needed
Sometimes, deciding to refer a client is a purely practical option. You may not have the availability to provide the number of sessions they need. You may relocate, retire, or become temporarily unavailable due to illness or maternity or paternity leave. All therapists need to have a plan in place for referring clients so that they can terminate therapeutic relationships without neglecting their duty of care.
How do you refer a client to another professional?
Now that you know which red flags should lead you to refer a client, let’s think about how you should go about transferring a client from your care to that of another therapist.
Your clients’ needs should always be front and center in the referral process, and that means ensuring you refer them to a professional you trust and think will fit their needs. This may be someone you’ve worked with previously or heard good things about. Remember to double-check that they have the relevant expertise for your client.
Manage the referral process sensitively
It’s essential that you take a sensitive approach with your client. If you’ve had a lengthy therapeutic relationship, they may feel abandoned if you try to end the relationship too brusquely or hand them over to someone else without letting them know what to expect. That’s why it’s so important that you feel confident the mental health professional you’re referring them to is skilled and reliable.
The first step is to have an honest, respectful conversation with your client, in which you let them know kindly, but firmly, that you can’t continue working with them, and explain your reasons why. You should give your client time to process the idea of working with someone else, and ensure they have the time and space to respond to you and feel heard.
You can then talk your client through the practicalities of the transition to a new therapist, and reassure them that you’ll help them through the process.
Involve the client in choosing a new clinician
You shouldn’t present just one referral option to a client – it leaves them feeling like they don’t have much choice in the matter, and if the practitioner isn’t available, they’ll feel like any subsequent recommendations are a second choice.
Give them at least three referrals, take the time to explain a little bit about why you think each psychotherapist would be a good fit, and let the client choose.
You can also involve the client by discussing your assessment of the situation with them, and listening to their input on what they feel they need from a therapist. Then, you can discuss the best referral options together and make a patient-centered plan.
Use a therapist platform to find great referral options
If you don’t have a referral option in mind, using an online therapist directory can be a fantastic way to match your client with a professional suited to their needs. You could even look through a therapist directory with your client, pointing out the kinds of therapists you think would suit them best, so that even if they don’t end up going with your referral options, they know what to look for in the future.
Nuna is a therapist platform with a full directory of therapist profiles that give details on the therapist’s background and experience, as well as the type of therapy they provide and the kind of conditions and problems they typically treat.
Nuna’s “matching” feature can help you to find trusted professionals for every client’s need.
Using an online platform like Nuna for referrals is also a great way to strengthen your network, letting other therapists on the platform know about you and your specialties.
Nuna also has full practice-management and appointment-scheduling software, as well as a teletherapy tool. Take a look at our previous article on the best teletherapy platforms out there.
Set up the new therapeutic relationship for success
Aim to make the handover as painless as possible for the client and for the new mental health professional. You can ask for the client’s permission to share their information with their new therapist so the therapist can get prepared and hit the ground running, rather than starting from scratch. Again, with your client’s informed consent, you can make yourself available to the new practitioner to answer any questions in the first few weeks or months of therapy.
You may want to have a final session with your client to ease the transition and provide closure through a formal goodbye. If it’s a very difficult transition, and your client requests it, you could even consider participating in the first session with the new therapist as backup support.
Knowing when to refer helps your clients and your therapy practice
Knowing when and how to refer clients to another professional is a key part of therapy. But it can be tricky: therapists often worry about the emotional fallout with their client or feel concerned around practical matters like knowing who to refer them to.
Referral can be the best thing for you and your client if:
- they need specialized treatment.
- the therapeutic relationship has become inappropriate.
- treating the patient is overly emotionally triggering for you.
- you’ll be absent or unavailable for sessions.
In these cases, therapists should ensure they refer clients to a trusted professional who’s a good fit or use a therapy platform like Nuna to find one. It’s also crucial to handle the process sensitively, involve the client in the transition, and offer support to the new therapist.
Referring clients in a respectful, effective way can require some extra thought and effort, but it’s worth it to prioritize your clients’ needs, ensure you comply with professional ethics, and manage your own self-care. Furthermore, referring clients strengthens your connections with a network of other therapists – and helps you to see them as allies, rather than competition.
Nuna is a practice management software for therapists that also helps match mental health professionals with clients who are a perfect fit. Try it, it’s free!