Clients to Therapists

If you are very uncomfortable with a match that is provided, one strategy is to develop a backup plan to offer the client in the event that the match he or she desires does not work out. Here is an example. Suppose you as a therapist have worked with a client who is not getting better with your help. You believe strongly that the client needs to be matched with a therapist who will demand abstinence in the client as a precondition for therapy. The client insists that he or she wants a therapist who will not demand abstinence immediately upon entry into the program. What do you do  

Making a proper referral is an art form, one part of which — the when and why to make a referral — was discussed in the previous chapter. Another part of that artistry involves making the referral in an appropriate way. For the sake of simplicity, there are certain dos and don ts related to making an appropriate referral. For example, do make referrals in a timely fashion. Our clients often need help quickly when a referral is necessary. Delay can harm progress. Related to this, do make sure that you have your client sign a release so that you can talk with another professional about the client, and do make sure there is little to no lapse in treatment services between referral to appointment. 

Do thank another professional who has accepted your referral, because showing your appreciation will help develop your professional network. And do follow up to make sure that the referral led to contact. We have an ethical responsibility to determine whether the client made it to his or her appointment. Many times this may require the treatment professional to whom the referral was made to sign a release in order to talk with you. 

Do make sure that the client is safe before referring him or her to another professional. A client should be stable before such a referral if possible, unless the goal of the referral is for more intensive care to stabilize the client. Care should be taken to make sure that the client is not at high risk to harm him- or herself, or someone else for that matter, between referral and appointment. If the person is at risk, then the referral should be postponed until that risk has diminished (again, unless the goal is for stabilization). 

Don t violate confidentiality during a referral. Be careful not to allow information about your client to be accessible to people who have no business with that information. One way to inadvertently violate confidentiality is to leave a phone message that may be picked up by a secretary rather than by the professional for which it was intended. Another way is to informally contact an insurance provider to check on benefits. Yet another way is to discuss the case in public places. Consider whether the information being shared has the capacity to find its way to unintended hands, eyes, or ears. If so, then modify the way you are sharing the information. 

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Finally, if you have worked with a client for a significant amount of time (which may be defined in different ways, depending upon your model) and she or he is not getting better with your help, then it may be time to consider a referral. This may be the hardest referral of all, for both therapists and clients. We therapists would like to believe we can help most people, but certainly we cannot help everyone. Sometimes it is hard not to be upset when you cannot help a... 

If you are a person with a drug problem, referrals can be very helpful for you because they allow you to receive appropriate services that fit your needs. There is no need to take offense at a referral sometimes therapeutic matches are not ideal, and in other instances new issues arise during therapy that were not considered at the start. Sometimes a referral represents a necessary midcourse correction in treatment. If your therapist is recommending a referral, then it is likely being done to help you help yourself. Good referrals usually make winners of both clients and therapists. 

In addition, the therapist should ask the client whether she or he has access to the instrument of harm (e.g., a gun or razor blade). If the instrument is at home, the therapist should ask the client to call a friend or relative and ask that person to remove that instrument from the client s access. If the client is unwilling to do so, then legal steps may have to be taken to protect him or her (discussed shortly). The therapist also should ask whether the client has the instrument on him or her right now (e.g., in a backpack or purse, in the car out in the parking lot, in a pocket or jacket, etc.). If so, you need to ask the client to give the instrument to you. The exception to this request might be if the instrument is a loaded firearm,... 

The therapist assures the client that the items will be held in trust (rather than kept permanendy by the therapist or counselor), and that these items will be turned over to a family member or friend if the client requests it. If the means involve pills, then the pills should be asked for and kept safe by the therapist for the client. If the pills are not needed by the client (e.g., an unnecessary medicine such as Tylenol), or are a necessary medicine (e.g., a prescribed antidepressant), then the therapist may ask the client to therapeutically dispose of them at a later time in therapy. If the instrument is a car (intended to be driven into a tree, off a bridge, etc.), the therapist must intervene and not allow the client to drive home, and instead have the client call for a ride. When a plan is in place and the means are available, professionals need to throw up as many roadblocks as possible to prevent the client from accessing the planned means of harm. 

On the other hand, identifying problem areas allows for interventions to be devised to reduce or remove roadblocks to recovery. In a well-designed treatment plan, a problem area and its specific links with the drug use are identified and described. After the descriptive portion of the problem area, the treatment plan prescribes specific courses of action on the part of the client, with therapist or counselor support, to change the problem behavior. Problems areas may be biological, environmental, behavioral, cognitive, or emotional domains, or in some cases may represent complex combinations in more than one of these areas. 

Diagnostic assessment represents a very powerful tool since these interviews may pin a label on a client. How therapists use this label can have some potentially important consequences for treatment and, in some cases, for what happens after treatment. Researchers have found that diagnostic labels can be helpful if they provide clients with useful information on how to successfully treat their... 

Drug problems take a great toll on the human body, so therapists and counselors need to be aware of how the physical effects of drug use can be treated. As recommended in Chapter 4, clients with drug problems should receive physical examinations by a physician as part of the routine care of treatment, if possible. Since drug use can adversely affect a client s diet, it also may be important to refer the client to a nutritionist who can determine whether there are any dietary deficits and perhaps develop meal plans to aid the client in restoring her or his health. 

Sometimes therapists practice meditation themselves and can instruct clients on the basics. However, it may be more desirable that the client find a teacher in a nontherapeutic setting so that the meditation training can continue uninterrupted after therapy has ended. In some cases a recommendation to attend an intensive meditation retreat may be a good way to help the client to start learning these skills. 

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