Assignment 6 report on referrals By Sonia Mahmood 2. 1 Identify and answer common client questions about referral, referral processes and referral agencies. Once a decision has been made to refer a client to another agency reasons for the referral should be discussed in detail with the client. Often clients will have mixed feelings with regard to their referral, some may welcome their referral whilst others may feel a sense of rejection and heightened anxiety feeling that they may be an unsuitable client for your agency.
Some will have specific and common questions as to the reasons for the referral etc. A clear explanation should be offered at all times and the reason for the referral should correlate with what the chosen agency has to offer. The client should be given a reasonable timeframe and as much information to come to an informed decision. Details about the referral process, the agencies fee structure, if there is waiting list and geographical location should also be provided, as the provider must be accessible to the client.
Specific needs of the client i. e. disabled access should also be taken into consideration if applicable. The counsellor will need to explain to the client the process of referral specific to that agency for referring on for example whether this is done through a phone call or correspondence. Once the client is willing to be referred the counsellor will need to discuss and agree what information will be passed onto the agency. The client’s permission will be required of any notes made of the assessment are to be passed on to the referral agency.
In the case of receiving correspondence from the client’s GP you will need the client’s agreement for this to be included in the notes and you may also need to obtain permission from the sender of the letter for it to be passed on. There is a tendency for agencies to do their own assessment of the client’s needs even if they have been assessed by the referring agency. The client needs to be informed about this so that they are in preparation of a second assessment together with any expenses involved. If the client has agreed for any notes to be sent on, these should arrive prior to the client’s initial appointment.
The client should be made aware of the timeframe for receiving an appointment. They should also be informed as to whether they have to call for an appointment or if an appointment will be sent to them. Once the particulars of the referral have been discussed with the client and providing they have reached a decision the details of the procedure will have to be put in writing so that the client can refer to them before moving forward. Clarity with regard to confidentiality when planning a referral is important. Most clients agree to basic information about their problems and their personal details being passed onto the new agency.
The limits of confidentiality should be disclosed to the client i. e. clinical or administrative staff. It is advisable to obtain a policy on confidentiality from the agency you are referring the client to and hand it to the client along with the agency’s agreement policy and any other relevant information. Clients often disclose sensitive material during an assessment session as result of establishing a therapeutic relationship with the counsellor. Clients may object to certain disclosure of information and it is important to establish this before referring them.
Clients may ask to see a copy of any correspondence that are in the process of being sent and a copy of the letter etc should be given to the client and the agency should be informed of this. Should a referral not work out as planned the counsellor must be clear about the procedure to follow in the event of this happening. You need to inform the client if they should contact your agency again or seek assistance through their GP. Agencies vary in their policy with regard to this and the counsellor should be well versed with the procedure specific to their agency.
Some agencies offer group or individual counselling. Sometimes an individual who has received one to one counselling may be ready to move into a group. This would be an internal referral and it would be advisable for the client to end the individual counselling before moving to a group. Evaluation of the referral can be useful tool for the counsellor. By keeping a register of the referrals made from their agency, dates and reasons for a referral, agency to which client is referred, outcome of the referral. This will enable the counsellor to evaluate the effectiveness of the referrals that are made. . 3 Evaluate ways to manage resistance Clients may decide not to be referred when they are offered the option to do so if they are deemed not suitable for your agency. This can cause a huge dilemma. It may be possible to refer the client back to the GP or another health professional if applicable. Support should be offered to the client but they have full autonomy in their decision-making. Sometimes the counsellor may not want to refer the client as they may feel a sense of not being able to release the client until completion.
In other cases the counsellor may not admit to their limitations, not being able to separate themselves from the client and lack of creating awareness in the clients mind from the initial onset regarding the possibility of a referral to another agency. Clients who have been pushed from “pillar to post” will find the possibility of a referral difficult to deal with as they already feel that they are beyond help. Evidently the longer the therapeutic relationship exists the harder the acceptance of the referral becomes.
Counsellors should do all in their remit to make the transition smooth perhaps through allowing the client to make contact with the agency, arranging a visit, working with the client preparing a summary of targets met so far. Clients who are involved in the referral process are more likely to benefit from the input of the new relationship. 2. 4 Summarise the process of endings The ending should be built into the initial contract and kept in view throughout the counselling relationship. Endings can be difficult for both the client and counsellor. The initial hurdle being the decision when to end.
Ideally this is determined mutually between the client and counsellor but at times this proves to be an unrealistic expectation. External influences may have a bearing on the ending such as if either moves away or becomes ill. When a decision has been reached for the therapeutic ending a date and session number should be set. The sessions leading up to the end are a good time to undertake a review of the client’s journey through therapy through the use of questions. Some counsellors ask the client if they would like to mark the ending in some way. 2. 5 Review ways to utilise supervision/support in relation to referral. A good supervisory relationship is the best way we know to ensure that we stay open to ourselves and our clients” (HAWKINS & SHOHET 1989,p157) BACP maintains in its Code of Ethics and Practice for Counsellors that ongoing supervision is a professional requirement for members who are practising and trainees be supervised for their client work. Meaning they should use the services of another more experienced counsellor to discuss their work with their clients, their professional development and sometimes their personal development. This is a formal arrangement designed to maintain adequate standards of counselling.
Supervision is important as it facilitates and enhances the counsellor’s theoretical knowledge, skills and personal development as a practitioner. Supervision is not aimed at providing personal therapy to the counsellor and the relationship is better described as that of the expert and apprentice. Supervision can be a valuable tool in scenario of a counsellor being faced with resistance from a client say for example if they do not want to b e referred, if the relationship has turned sour, if the client is actively being resistant, hostile or difficult.
This is the first port of call if the counsellor is concerned about any of the issues mentioned. Often the counsellor is stuck and unable to see the best way forward. Supervision prevents the counselling relationship from degenerating on the part of the counsellor and client. It helps the counsellor to clarify and modify any negative emotions they may experience in relation to certain clients. There is an ethical responsibility to use supervision to support professional and self-development. Supervisors provide guidance and a one-step removed perception on difficulties that may arise in the therapeutic relationship.
Objective rather than subjective views are obtained. As the supervisor is a spectator/observer they are able to use what is happening within the supervisory relationship to point out what may be happening between the counsellor and the client. This enables the counsellor to grow and develop in their awareness thus enhancing their counselling skills further more as through their work the counsellor will encounter experiences that will awaken them to create a resistance to conflict. 2. 6 Explain the reasons why you would refer a client
In cases where the counsellor is not able to meet the needs of the client they would need to be refer to client on possibly for one or a combination of reasons as listed; medical, social, pastoral, psychiatric, emotional, spiritual and legal reasons, re-locating, the client requesting a referral, the boundaries of the agency you work with, time limits, policies, the counsellor and client may share a relationship with a third party and there are issues surrounding confidentiality and loyalty, the client may develop etter in group counselling rather than one-to-one, the client may have issues regarding their sexuality and may request a counsellor of the same sex, they may have certain religious beliefs and may request to see a counsellor from the same faith, for reasons to do with the language barrier as English may not be their mother tongue. The counsellor should be aware of the resources available in the geographic location of the client. 2. 7 Explain how to refer ethically In order to refer a client ethically you would need to consider if you are acting in accordance with the ethical principles.
The basic ethical principles identified in counselling are: Fidelity: honouring the trust placed in the counsellor Autonomy: respect for the client’s right to be self-governing Beneficence: a commitment to promoting the clients wellbeing Non-maleficence: a commitment to avoiding harm to the client Justice: the fair and impartial treatment of all clients and the provision of adequate services Self respect: fostering the counsellor’s self knowledge and care for self There are many opportunities for clients to exercise their personal choice when choosing a therapist.
Their choice will often depend upon gender, cultural or ethnic background. When a counsellor refers they need to maintain that the ethical principles are at the forefront of their mind when making a decision to refer. They should respect the client’s autonomy to be self-governing and respect the client’s values and beliefs, which may be different from one’s own. Diversity of beliefs should be taken into consideration when referring the client. Counsellors and clients work together satisfactorily when their personal values are compatible rather than identical.
The onus is on the counsellor to provide the client with sufficient space to work within his or her own value system. Fidelity – Being trustworthy is regarded as fundamental to understanding and resolving ethical issues. Practitioners who adopt this principle act in accordance with the trust that is placed in them; regard confidentiality as an obligation arising from the client’s trust; restrict any disclosure of confidential information about clients to furthering the purpose for which it was originally disclosed.
Autonomy – This principle emphasises the importance of the client’s commitment to participating in counselling or psychotherapy, usually on a voluntary basis so a counsellor could not refer a client if they refused to be referred as they have a choice. The principle of autonomy strictly prohibits the manipulation of clients even for beneficial social ends. Beneficence – This means acting in the best interest of the client based on professional assessment. It directs attention to working strictly within one’s limit of competence providing services on the basis of adequate training or experience.
There is an obligation to use regular and on-going supervision to enhance the quality of services provided and to commit to updating practice by continuing professional development. Non-maleficence – A commitment to avoiding harm to the client. This involves avoiding sexual, financial, and emotional or any other form of client exploitation, avoiding incompetence or malpractice, not providing a service when unfit to do so due to illness, personal circumstances or intoxication.
The practitioner has an ethical responsibility to strive to mitigate any harm caused to a client even when the harm in unavoidable or unattended. Justice – The fair and impartial treatment of all clients and the provision of services. The principle requires that the counsellor is just and fair to all clients and respect the rights and dignity. This requires the ability to appreciate the difference between people and to be committed to equality of opportunity and avoiding discrimination against people or groups contrary to their legitimate personal or social characteristics.
Practitioners have a duty to strive to ensure a fair provision of counselling and psychotherapy services, accessible and appropriate to the needs of potential clients. Self-respect – Fostering the practitioners self-knowledge and care for self. The principle of self-respect means that the practitioner appropriately applies all the above principles as entitlement for self. There is an ethical responsibility to use supervision for appropriate personal and professional support and development.
