chaplaincy – Real Social Skills

whirling-ghost replied to your post “About making therapy referrals”

Make sure it’s the appropriate type too. Like I got referred for group, despite the fact I was terrified of being in a room with people I didn’t know. Obviously that wasn’t going to work

realsocialskills said:

Yes, this too. Therapy isn’t just one thing. It’s a lot of different things. It also matters who is involved; therapists are not interchangeable. Even when someone unquestionably needs therapy, the wrong therapist can still make matters worse.

Generically telling someone “get therapy” is not likely to be a helpful suggestion. Everyone knows that therapy exists; everyone will have had others tell them to get therapy.

A useful referral has to be more specific and based on something. It also needs to involve respecting the person you’re working with, listening to what they think of your suggestion, and recognizing it as their decision.

Eg:

“It sounds like you’re struggling with your sexual identity. I know a therapist who has a good track record of helping men think through that. Would you like their name?”
“Some people who find that talk therapy doesn’t help them have found that CBT does, since it is concrete and based on learning skills and changing your thinking. What do you think about trying that?”
“A lot of students who have come to me with similar problems around finals have found the counseling center helpful. Is that something you feel comfortable trying?”
“It’s hard to go through that kind of loss when none of your friends can relate; I think that peer support might help you. There’s a grief support group; would you like to try that?”
“The problems you’re describing are often caused by clinical depression, which is often treatable. I think it might be a good idea to get evaluated in case that’s the problem. There is a doctor we recommend who is respectful and listens to patients. What do you think about that?”

Content note: Today’s post is primarily directed at people who make therapy referrals and recommend therapy as part of their job (social workers, doctors, ministers, rabbis, school counselors, etc). This post is specifically about something that goes wrong when people make therapy referrals for the wrong reasons. If you haven’t been in a position to recommend therapy from a place of authority over someone you have a responsibility to help, this post might not make a lot of sense.

There’s something that can go wrong in therapy referrals. This is a thing that happens:

A social worker, doctor, teacher, clergyperson, chaplain or someone in a similar role is faced with someone suffering really serious problems
They don’t know how to help with most of them
And they are afraid of the magnitude of this person’s problems, and need to set a boundary to avoid becoming responsible for managing them
And, so, they default to making a therapy referral, as a way to assert boundaries and feel that they have done all that they could
Therapy referrals are often appropriate, but sometimes people make therapy referrals even when they are not appropriate as a way of asserting a boundary

This is how therapy referrals ought to work:

You assess that a person you’re working with might benefit from therapy
You make this suggestion to them, and you say why
You suggest specific therapists you think might work well with them
And you assume that they are the ones who should be making this decision
And therapy is one decision/referral among many; it might be the solution to finding space to work on emotions and relationships, but it doesn’t replace the need to find food stamps or medical insurance or housing or proper diagnosis of a medical condition

This is how therapy referrals often do work:

You assess that someone has problems that are much, much bigger than you can handle
You want to assert a boundary so the full brunt of their struggles do not become your problem
You don’t actually want to say flat-out to a person who is suffering that you’re not going to help them
So, you tell them that they should get therapy, and make that referral as a way to gracefully assert a boundary without having to say outright that you’re not going to help them even though you know they need help
Don’t do this. It isn’t good for anyone, including people who really need therapy.
Be honest about boundaries you’re asserting, and make sure that any referrals you are making are appropriate
Therapy referrals are for the client, not for you

It’s important that, when you make therapy referrals, you’re making them to meet the needs of the person you’re working with, not your own needs

You have to have boundaries in order to do your work. That means that you will be routinely faced with suffering people who you won’t be able to help
That’s awful, but it’s something you have to face and be honest about
There will be people you can’t help with most of what they need, and people who can benefit from therapy. These are overlapping, but not identical categories.
Recommending therapy to people who can’t benefit from it can sometimes just be a dishonestly comfortable way of saying “I’m not going to help you, and I’ want you to feel good about my refusal”
Whether or not someone should get therapy is a separate issue from whether or not you can or should try to help them yourself
Some people who you can’t help should go to therapy instead (eg: someone whose primary problem is probably treatable depression or learning certain classes of things about relationship dynamics)
Some people who you can help in some ways also ought to go to therapy (eg: someone who comes to you for prayer might need prayer, Bible study *and* a therapy referral)
Some people you can’t help should not go to therapy (eg: a gay person whose primary issues have to do with their coming out process who lives somewhere where all available therapists are homophobic probably should not go to therapy; that doesn’t mean that you are going to be able to help them through that in your role as a crisis center intake social worker)
Some people who ought to get therapy also need other help, and that might be the more pressing issue. Don’t imply that therapy is the solution to a broader range of things than it actually is. (eg: therapy might help a homeless person deal with their emotional issues, but it doesn’t provide housing; don’t use your therapy referral script as a way to avoid telling them that you aren’t offering help with housing)
Therapy is an important tool, but it’s not magic. Don’t treat it as universally important, or as the solution to all problems that you don’t know how to or can’t solve.

Short version: when you’re recommending therapy to someone, make sure that it is an appropriate referral and that it’s about meeting their need for care rather than your need for boundaries. To that end, make sure that making a therapy referral isn’t the only way you can assert a boundary; develop other ways to say no respectfully.