In coaching we like to say “When in doubt, refer it out,” but how?
A trainee of Relationship Coaching Institute with a client exhibiting symptoms of severe postpartum depression asked “How do you handle referrals when your client lives in another state and you don’t have any connections in their area?” and stimulated the following response addressing the nuances of making referrals for therapy as a coach.
Most coaches work with clients from all over the world and making referrals from a distance can be a challenge. This client is a good example of not being ready for coaching and needing a higher level of intervention. It’s probably postpartum depression but realize that you don’t know that, aren’t qualified to diagnose it, and it’s best to focus on the symptoms that need attention and be careful to avoid using a diagnostic label, especially with a client.
There are many ways to facilitate referrals from a distance and I have an easy one that all coaches can use in all situations if they wish.
–> Simply get an agreement that they will discuss their symptoms with their doctor. <–
In the case of postpartum depression symptoms your client most likely has a connection with her OB/GYN who monitored her pregnancy and perhaps even delivered the baby.
Here’s some tips for coaches who need to make a specialized referral:
- Leverage existing supports. In all cases a functional client should be plugged into the medical system in their area, either private pay or insurance, either PPO, HMO, government sponsored, etc.
- Anticipate client shock and resistance. In many, if not most cases, the client is not aware they need a higher level of intervention and what that intervention might be. They probably never thought they would ever need “therapy” for anything, know very little about whatever that is, and most likely have a strong, initial resistance to doing so. They might not even know why therapy is needed and why they’re not ready or a fit for coaching.
- Don’t make assumptions or diagnose. You might assume they need “therapy” but that is an assumption drawn from an unqualified diagnosis and the possibility of “postpartum depression” is a good example as a client who was fine before a life changing event like pregnancy needs to connect with their physician before seeking a specific intervention. Just as the coach is not qualified to make a diagnosis; self diagnosis, self referral and self treatment is not a good idea for the client either.
- Therapy referrals are rarely a good match. Referring to their doctor is a safer, more responsible place to start than a specialized service that requires a diagnosis. What are the chances that whatever “therapy” you refer to or the client self-refers will be a good match for what they need? Sadly, pretty low odds in most cases as the reality is, just as it can be hard to find a good fit of coach/client, it is hard to find a good fit of therapist/client, especially when a highly specialized service is needed.
- Refer to the referrer. In all cases a functional client should consult their doctor if they have a mental/emotional/behavioral problem they need help with that has physical symptoms and possible physical causes (most emotional/mental/behavioral disorders do), and in many, if not most cases, their Primary Care Physician (PCP) is the gatekeeper to accessing specialized care in the system that the client is a member.
- Put it in writing. Here’s a tip to cover your ethical bases and support your client to follow up- put your observations, concerns and recommendations in writing (email is fine) in a form/format that they can show their doctor. It is common for clients exhibiting mental/emotional/behavioral symptoms to not be fully aware of those symptoms and not have the language to be able to describe their symptoms to someone, including a doctor. This needs to happen when making a referral anyway (with a Release of Information, of course) and having this in writing helps the client take their situation more seriously and increases likelihood of follow up action than just talking about it.
- Handling resistance/refusal. A client who resists or refuses to get the help they need is not a functional client and sadly not a candidate for coaching. You should craft a contract/plan with them and work with them for a month or so to support them to get help, and if that doesn’t work, let them go and it would be the ethical, responsible thing to do to follow up by telephone and email regularly to find out if they followed through and if they didn’t, to remind them how important it is that they do so.
Two considerations for deciding whether to continue working with a client who needs therapy and resists:
- 1. Is coaching working? Are they really benefiting from your services? If not, you need to refer them on and let them go (terminate your services).
- 2. Is their functioning impaired in an important area of their life? If you coach them in dating and they can’t keep a job because of addiction or other reason, continuing to coach them with your head in the sand ignoring a huge problem they have in their life that does/will impact the goal you’re helping them with is unethical and not in service of the client.
While we ethically need to make a referral when needed, especially when terminating our services for a client who is not ready for coaching, when your client is not local you would need to do some research and reach out to local providers to do so, which is doable, but the reality is that a functional client should have the ability to do their own research and find local care options for anything.
However, a referral is usually needed for a higher level of intervention that might be interfering with their functionality and ability to do so, in which case the easiest, most commonly available and accessible option is the one they are already familiar with, their doctor or PCP. If they don’t have a PCP, the nearest Urgent Care clinic would be their first stop for anything that is not an emergency and is a fine place to start. In the U.S., Urgent Care clinics are increasingly located in larger drug stores such as Walgreens and CVS and are popping up in superstores like Walmart.