When to refer on, part 1

How do we 'know' when we are working within our own practice competence? And from there, how do we then decide to refer clients on?

We should consider referring on in any of the following scenarios. A client may have become 'stuck' with us and no progress is being made. Emerging client problems may appear too complex or demanding for us to make meaningful progress. We may feel we have lost our way. Our own lives may suddenly become too complicated, so we need to lighten our load: and we can be "hesitant to admit to feeling stressed because of fear of being labelled weak, unable to cope or incapable of professional practice" (Cooper, 2011, p. 137). It takes courage to refer clients on to other professionals. But doing so can make us a better practitioner.

But how do we know, in the midst of practice, that we need to refer on? We need to 'practice' reflection. So after each session, we reflect (no matter how briefly), but running through anything that was good, could be improved, or surprised us is likely to need more attention. We can deliberately consider a time when our work with a client felt 'too hard', or when client sessions were producing nothing new: then we are likely to gain some insight. The following questions may help:

• Did we feel competent to work with this client?
• Did we stop, and let them know that we felt stuck?
• Did we ask the client what they needed?
• Could we have referred them to someone else at that time?
• On reflection what would we do differently next time?

And remember that we need a safe pair of hands to share this with. As we learn or formalise our practice, and as a reflective practitioner, we learn that we too need to seek "support, advice, and consultation" (Nelson, 2014) from our colleagues - or specialists - to assist our client work; to both keep us safe, and to further develop us. In an NCDA article, Nelson provides us with a few sensible pieces of advice:

• "Know when to refer a client to a therapist; it is okay to suggest putting aside career work until personal issues are worked through"
• "Don't be afraid to refer clients to colleagues whom you think would be a better fit; colleagues will refer clients to you"
• "Consult with colleagues when it makes sense, to learn about resources or for their particular expertise. This experience will enrich your practice by learning from your peers. Don't underestimate how important fellow counselors are not only for support but for future career opportunities"
• "Always maintain the confidentiality of your clients unless they give you permission to disclose. Even if you have permission, disclose as little as possible"
• "Take care of yourself. You can't give anything if you're empty yourself. Counseling can take a lot out of a person" (Nelson, 2014).

It sounds simple, but it isn't: we need to be able to step out of our practice and observe. And like most things in our field, this too is a learned skill.

Sam

References:

Cooper, P. A. (2011). Chapter 10: The implications of workplace stress on service development. In D. B. Cooper (Ed.), Developing Services in Mental Health-Substance Use (pp. 137-146). Radcliffe Publishing Ltd.

Nelson, M. (2014). 30 Tips for New Career Counselors. National Career Development Association (NCDA). https://www.ncda.org/aws/NCDA/pt/sd/news_article/5417/_self/layout_details/fals