In counseling practice, it is our responsibility to provide appropriate referrals when necessary. These may include referring clients to other service providers when transitioning out of a counseling relationship or recommending supplemental services that could benefit their overall well-being. Additionally, referrals to psychiatrists may be necessary for a secondary evaluation of a condition when a physiological cause is suspected or if medication could support the client’s treatment progress.
Referrals to psychiatrists are often met with resistance. Clients may fear stigma, be opposed to medication, or perceive the referral as an indication of a more serious condition they wish to avoid. The strength of the therapeutic alliance plays a crucial role in how clients respond. When the relationship is strong, clients are more likely to consider the referral, even if they have initial reservations. Conversely, if the alliance is not as strong at the time or the client is ambivalent about the counseling process, the referral can sometimes be used as a reason to disengage or prematurely terminate therapy.
In my experience, using metaphors has been highly effective in engaging clients during the referral process. One of the most common metaphors, often taught in school, is comparing medication to "crutches"—a temporary support that helps clients regain stability, which resonates with many. However, as with all aspects of counseling, there is no one-size-fits-all approach. I've experimented with other metaphors, some of which have been successful, while others fell flat.
I’m curious—if you were the one being referred, what would make that initial visit feel more approachable? Or, if you're the one making the referral, what metaphors have you found effective in helping clients feel more open and engaged in the process?
Handan is a Data Analyst and Research Coordinator for our lab. She is also a mental health counselor.
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