Make an Ethical Referral

UNIT 2 (COVER SHEET 3) MAKING AN ETHICAL REFERRAL 2. 1 Quite often, a counsellor’s role is to assess and refer clients on to more appropriate help. Sometimes a client needs specialist counselling or a different approach and it is up to the counsellor to make this transition as smooth as possible for the client and to manage the process as sensitively as possible. The counsellor needs to take responsibility for making all arrangements but the client should also be empowered. SOURCES FOR REFERRAL

Its good practice for a counsellor to keep an up to date file of local and national agencies. A network of personal links is also important as it can help to instil a more human/caring element within a potentially anxiety provoking situation. PROCEDURE: The procedure for referrals differs from agency to agency but possible ways of managing this are: * Contact the agency concerned and find out about referral and appointment procedures. Be clear in your own mind, possibly after conferring with the help-seeker, what information you will pass to the agency in any discussion that arises during a telephone call. Contact the agency by telephone whilst the help-seeker is with you so that you can hand over to him to make the appointment after you have made the initial enquiry. * Write a referral letter to the agency. You could send a copy to the client so that he knows the letter has been sent to the agency. You might consider drafting the referral letter with the client so that he/she agrees the content Whatever the process of referral it is a time of contemplation and reflection for all involved.

Confidentiality, boundary issues, supervision and adherence to laws/codes of practice need to be taken into account. 2. 3 When you suggest referral the help-seeker needs to understand that this is not a rejection. Many help-seekers have been passed from pillar to post and despair of genuine help being available, so they may feel cynical and/or rejected. It’s also possible that, having shown considerable courage to get this far, they feel daunted by approaching someone else and starting all over again.

It is important to explain the reason why the referral is necessary and assure the client that their personal information will be help in confidence. The client also needs to be assured that the referral agency are the best placed to further their progress and ultimately that the referral is valid and necessary. 2. 4 When you engage with a client for a number of sessions you have a choice between an immediate (date/time defined) ending and a phased ending. A phased ending can take different forms: * A planned ‘weaning off’ (longer intervals between sessions) * An open door policy Endings with a follow up some weeks/months later Difficulties that clients may have with endings are: * Client is emotionally upset * Client is reluctant to end the sessions * If the ending is abrupt or unexpected * Client breaks the contract and sessions are ended Within the endings process you need to draw upon what you know about his/her attitude and experience of endings. For many people it’s a relatively small issue – if they are fairly self-supporting and motivated they probably move on with little regret.

For others it’s a much bigger event. A Counsellor needs to ensure to flag that the end is drawing close and to give an opportunity for the client to comment on how he feels about the end. The longer the contact you’ve had, the more time you want to allow for this discussion and the earlier it needs to happen. Although you need to make the time limit clear in the initial contract, both counsellor and client are sure to have feelings about the ending of even short-term work.

The extent of feelings probably relate to the intensity of the work and the investment in it by each party. Preparation for the ending should include: * Recognition of where the client is now (positive and negative) * A decision about the reason for the ending (planned or immediate) * Goodbyes 2. 5 Supervision is an important part of the referral process and should be used to facilitate and explore how the process should be managed, how the client will react and how the counsellor will feel about the ending.

I think as a counsellor you should have a prior understanding of how you feel the client will/is reacting to the ending of the helping relationship and the supervisor can draw upon his/her experience as to how the process should be best managed. I think as a counsellor, particularly when the ending has been abrupt or ‘premature’ may experience feelings of inadequacy or failure for not helping the client to overcome their presenting issues. I think a supervisor will be able to empathise and advise on the situation and how to frame it within your mind.

The supervisor will advise how to end the relationship in a systematic way as positive as possible. 2. 6 Reasons for referral may be: Because the counsellor: * Has a personality clash with the client * Is out of their depth in terms of professional limits * Lacks experience to help the client further * There are boundary issues with knowing the client/friends of client on a personal basis * The clients issue is triggering issues within the counsellor * There is a clash of beliefs/values/culture that cannot be overlooked in terms of empathy Because the agency: Has time limits/limited sessions * Has a policy complication relating to clients issues * Does not deal with certain areas of counselling Because the client: * Needs/wants a different type of counsellor or other type of care * Has issues around availability/accessibility * Needs/wants a different package of care 2. 7 The BACP guidance relating to ethical referrals are that: * All referrals should be discussed with the client in advance and the client’s consent obtained both to making the referral and also to disclosing information to accompany the referral.

The referral should benefit the client, all confidential information should be protected during referral and the service/counsellor must be capable. * Prior to accepting a referral a practitioner should ensure that the referral is appropriate, will benefit the client and that the client is consenting. If the referrer is ultimately responsible for the client then they can receive update reports providing the client is consenting