Knowing When to Refer Out vs. When to Challenge Yourself as a Therapist

When to Refer Out

Referral is typically appropriate when:

1. Lack of Competence or Training

   • The client’s needs are beyond your training or experience (e.g., complex trauma work when you’re not trained in EMDR or other trauma-specific approaches).

   • The client requires specialized care you aren’t equipped to provide (e.g., eating disorders, active psychosis, or substance use requiring intensive treatment).

2. Personal Triggers or Countertransference

   • You notice your personal feelings are consistently interfering with your ability to provide objective, effective care.

   • The client’s situation triggers unresolved issues in you that impact your clinical judgment.

3. Risk or Safety Concerns

   • The client’s needs exceed your ability to provide the necessary level of care (e.g., immediate crisis stabilization, hospitalization, or intensive outpatient support).

   • You lack the resources or connections to manage ongoing high-risk situations.

4. Ethical or Boundary Concerns

   • Dual relationships or conflicts of interest arise.

   • The client requests services that would breach your ethical code.

5. Stagnation in Progress

   • Despite your best efforts, the client’s progress has plateaued, and you believe another provider may offer a better approach.

6. Incompatibility in Style or Values

   • The therapeutic alliance is strained, and attempts to repair it haven’t been effective.

When to Challenge Yourself and Continue

Pushing yourself to grow is often appropriate when:

1. Skill Expansion with Support

   • You recognize a gap in your skills, but there’s time to seek consultation, training, or supervision to build your competence.

2. Mild Discomfort or Imposter Syndrome

   • You’re feeling nervous because the case feels “hard,” but not unsafe or unethical.

   • The discomfort comes from your own growth edge rather than a true skills deficit.

3. Therapeutic Alliance is Strong

   • The client is making progress, even if the work feels challenging.

   • The relationship is solid, and you feel they trust you.

4. You Have Resources for Support

   • You can access consultation groups, supervisors, or training to expand your knowledge while maintaining care.

5. Client Preference and Buy-In

   • The client prefers to continue with you and is aware you’re expanding your knowledge to better meet their needs.

Key Questions to Ask Yourself

• Is this outside my scope of practice or just outside my comfort zone?

• Can I ethically and effectively support this client with added consultation or training?

• Would continuing to see this client be in their best interest or mine?

Both growth and referrals are essential to being an ethical, effective therapist. Balancing both takes self-awareness, humility, and a commitment to your clients’ well-being.

To discuss how mentoring could help you during this season of your life, please schedule your free 15 minute consultation.