Referral can happen for many reasons, but all of them reflect a decision to help ensure a client can access the type or level of support they need.
You have logistical or scheduling issues
Logistics can be one of the most common reasons for referrals. Maybe you don’t take a client’s insurance anymore, and they don’t want to pay cash for therapy. Or perhaps the client gets a new day job, and you don’t have any evening slots available. In these cases, it’s your job to recommend other options to your client so they can continue accessing therapy.
You can’t meet the client’s needs
Ethically, you’re required to practice within your competency. If a new or existing client presents with a symptom or condition you’re not equipped to treat, then it’s always best to provide a referral. For example, if you aren’t trained in treating eating disorders and a client discloses they’ve been experiencing anorexia symptoms, you should refer them to a provider who has experience in this area.
Similarly, you may need to refer a client to a higher level of care, such as an intensive outpatient program or partial hospitalization, if you can’t meet their needs in once-weekly or biweekly sessions. If there is a suicide risk or other emergent risk, provide an immediate referral to 911, crisis center, or ER.
You’re not a good fit
Even if you’re able to treat a client, your therapeutic alliance may not be strong enough to ensure the clients’ needs are met. You may decide to address potential issues first, such as considering and applying client feedback about interventions you use. But if time passes and nothing changes, it may be time for a referral.
You or your clients’ goals change
Beyond scheduling and ethical reasons, you may determine your clients’ needs no longer fall within the practice scope you want to focus on. For example, if you’re an adolescent therapist and you want to focus on your specialty, it’s OK to refer an older client to someone else.
Similarly, even if you’re competent to treat someone, you may realize a modality like EMDR feels more appropriate to address your client’s presenting concerns, level of functioning, symptoms, and treatment goals. In that case, you may want to recommend they see a therapist who practices something you don’t offer, such as EMDR or neurofeedback.