How to Refer Clients Out Ethically in Private Practice
By Shannon Heers
As a mental health therapist in private practice, one of the most challenging yet essential tasks you’ll face is deciding when and how to refer a client out to another provider. It can feel difficult to admit that you might not be the best fit for a client’s needs. However, understanding how to refer clients ethically can not only enhance their therapeutic journey but also reflect your professionalism and dedication to their well-being.
Let’s break down what ethical referrals look like, why they’re so important, and how you can navigate this process in your private practice.
Why Is It Important to Refer Clients Out?
You’ve likely encountered situations where a client’s needs exceed your scope of practice or expertise. This isn’t a reflection of failure but rather a recognition of the diverse and complex needs individuals have. By referring clients out, you’re prioritizing their care and acting in their best interest, which is the foundation of ethical practice.
Common reasons to refer a client out include:
- Specialization: You may not have expertise in a specific issue, such as eating disorders, severe trauma, or substance abuse.
- Conflict of Interest: Perhaps the client’s situation involves a conflict that may cloud your judgment or prevent you from offering the best care.
- Lack of Progress: Despite your best efforts, the client may not be progressing as expected, and a different therapeutic approach might be needed.
Burnout or Overload: Recognizing when your own capacity is limited, either due to a full caseload or personal factors, is important. You want to ensure every client receives your full attention and energy.
Knowing When It’s Time to Refer
One of the first questions you may ask yourself is, How do I know it’s time to refer this client? Trusting your clinical instincts, being self-aware, and regularly reviewing your client’s progress can help guide you.
For example:
- Client is stuck in therapy: If a client has plateaued and you’ve tried different techniques without much success, it could be time to consider whether a fresh perspective from another provider would benefit them.
- Specialized treatment needed: Imagine a client discloses they are struggling with something you’re not trained to handle, such as self-harm or substance abuse. In this case, it’s vital to connect them with someone who has that specific training.
- Therapist’s well-being: If you’re facing burnout or stress, it may impact your ability to provide effective care. Ethical practice involves recognizing your limits and making the tough call when you’re not able to give your best to the client.
This all boils down to one thing: What is in the best interest of the client?
The Ethical Guidelines for Referring Clients
Referring clients out isn’t just a decision made lightly—it’s guided by ethical standards. The American Counseling Association (ACA) Code of Ethics provides a framework for making referrals, highlighting the importance of ensuring clients receive competent care.
Here are some of the ethical guidelines to keep in mind when referring clients out:
- Client Autonomy: Your client has the right to make informed decisions about their care. Any referral must be discussed with them in detail, explaining why you believe it’s necessary and providing options.
- Informed Consent: Always obtain consent before making a referral. Your client should understand why you’re referring them, what their options are, and have the right to refuse if they don’t feel comfortable.
- Non-discrimination: Referrals should never be made based on discriminatory factors, such as race, gender, or sexual orientation. If you’re not the best fit due to personal values or biases, it’s important to address this openly and ensure the client is referred to someone who can provide competent and non-judgmental care.
Competence and Continuity of Care: Referrals should only be made to another provider who is competent to handle the client’s needs. It’s also important to facilitate a smooth transition to ensure continuity of care, so the client doesn’t experience a gap in services.
How to Communicate a Referral to Clients
Now that you’ve decided a referral is necessary, how do you tell the client? This is often the trickiest part, as you want to handle the situation with care and avoid making the client feel abandoned or rejected.
Here’s a step-by-step approach:
- Frame the Conversation Positively: Approach the conversation by focusing on what’s best for the client. Instead of saying, “I can’t help you,” you might say, “I believe working with someone who specializes in this area could really benefit your progress.”
- Be Transparent: Clearly explain why you believe a referral is in the client’s best interest. For example, “You’ve mentioned that managing your anxiety around food is becoming more difficult, and I think it would be helpful for you to work with a specialist in eating disorders who can provide targeted strategies.”
- Provide Options: Offer multiple referral options so the client can choose the provider they feel most comfortable with. This empowers the client and ensures they don’t feel forced into one option.
Assure Continued Support: Let the client know that you’ll continue to support them through the transition. You could say, “I’ll remain available to collaborate with your new therapist or help you in any way I can during this process.”
Common Challenges When Referring Clients
Referring clients can come with a host of challenges, especially in private practice where you may feel more personal responsibility for each individual. Some common concerns therapists face include:
- Client resistance: Some clients may feel abandoned or question whether they did something wrong. It’s important to reassure them that this referral is about meeting their needs in the best way possible.
- Finding the right referral: Depending on your location or the client’s specific needs, finding a competent therapist who is accepting new clients may be difficult. Building a strong professional network can help ease this process.
Personal discomfort: Referring a client may stir up feelings of inadequacy or guilt. It’s important to recognize that referrals are not failures but rather a sign of ethical and responsible care.
The Benefits of Ethical Referrals
Referring clients ethically not only benefits them, but also you and your practice in the long run. Clients are more likely to trust you when they see that you’re genuinely invested in their well-being, even if that means directing them to another professional. This can build long-term credibility, strengthen your relationships within the mental health community, and reduce the stress of trying to meet needs outside your expertise.
How we can help
Navigating the process of client referrals can be complex, but you don’t have to do it alone. Whether you’re struggling with burnout, are unsure how to handle a particular client, or simply want to grow your practice ethically, engaging in clinical consultation with an experienced clinical supervisor can help. Firelight Supervision specializes in providing ethical clinical consultation to private practice therapists, regardless of your location.
Let’s talk about your needs and how we can work together to provide the best care for your clients.
Click here to schedule a Free 20-minute Phone Consultation today!
Author Bio
Shannon Heers is a psychotherapist, approved clinical supervisor, guest blogger, and the owner of a group psychotherapy practice in the Denver area. Shannon helps adults in professional careers manage anxiety, depression, work-life balance, and grief and loss. Follow Firelight Supervision on Instagram and Facebook.
