Counselling Dilemma: Client Referral
In this scenario, the counsellor has been experiencing deteriorating health problems and is required to go into hospital in 2 weeks time for major surgery. It is likely that the counsellor will be spending a few weeks in hospital and some further months at home recovering from surgery.
The counsellor runs an independent practice and has notified clients of his absence. He has been concerned about leaving his clients, although most of them seem content to either wait or take a referral to another counsellor. There is however one client whom he is most concerned with at present and is reluctant to break this news to.
The client is a recently reformed drug addict whom the counsellor has been volunteering his services to. She is quite young (17) and has spent the last few years of her life on the street. The counsellor has been seeing her for about a month (in her own environment) and a relationship of trust and respect has developed between them. The client is naturally distrustful of most people, which is a survival mechanism she developed to survive the poverty and abuse associated with her environment. The counsellor is very sensitive to the significance of the trust the client has developed with him.
The counsellor is concerned that she will not accept the fact that he will be absent for several months and fears she will treat it as “being deserted once again”. He is concerned that she may slip back into her drug habits and sink further back into the street life again. He is afraid that if her progress doesn’t continue, she may find it harder to leave her surroundings next time, due to failure the first time around.
The counsellor doesn’t know of anyone personally whom he might refer her to and who would continue to work with her in a voluntary capacity. How might you handle this scenario if you were the counsellor?
When presented with this dilemma, I found I was looking at issues that were very close to home. The counselling profession is an emotionally draining one and to be physically ill can compound issues. We often place unrealistic expectations on ourselves and when we can?t live up to these, we feel we have failed.
As counsellors we often get caught up in the health and well being of others often to our detriment. Health problems are often unforeseeable hurdles that we must all deal with. It is important to remember that if we, the counsellor, are not well then we are not giving our full attention to our clients. There is a point when we need to step back and reflect on our practice. We need to take stock of our motives and actions.
From the on-set my aim would be to link this young lady into services appropriate for her. She has indeed taken a big step and I feel she needs acknowledgment of this not only from me but from people of her own age. A trusting relationship is very important however we must know where to draw the line and not become over-involved with the client. The likelihood of this client slipping back into old patterns is a very real one however this would be her choice and not the counsellor?s. I would link her into the services I thought most appropriate ? the next step in her recovery is hers.
Counselling is about empowering our clients to make their own choices and decisions in life. If my ill health is a catalyst to push her back into her old life then it is possible that she may have reverted anyway. It is not unusual for recently reformed drug addicts to relapse several times before making the decision to change. Having said this she is also very young and she has a better chance of permanent change now than she would if she continued down the old path. I can help this young lady to a point and assure her that there are others who will also help however she has also got to want to help herself.
As a trained counsellor, I have a duty to my clients. Working voluntarily with this client does not alter this. I anticipate that the client would not take my news well however, I would offer her the right to referral. Together we could source other avenues. In this way I am empowering the client to take charge of her recovery. If she chooses not to take up the referral option than I must accept that this is her choice. Some clients we can help and others we can?t ? this is a fact of counselling. I did not choose to become ill and if the circumstances where different I would continue to be this girl?s counsellor.
If you have followed correct procedure and the client leaves ? accept this, learn from the experience and move on.
Some of the issues that I would be looking at in this situation are:
– The initial contact with the counsellor/client.
– How did it come about?
– Who introduced them?
– What was the original arrangement?
– i.e. was there a time frame for how long they would meet?
– A plan of how they would work (it?s useful to have a plan/goals).
It would appear that it has taken time for trust to develop. In the present situation I believe it is best for the counsellor to discuss with the client the impending surgery (in brief) and planned recovery period. Also the counsellor would need to discuss with the client their concerns i.e. her fear that client will think that she is deserting her. Discuss this issue in detail. Until this is addressed we do not know if the ?being deserted? issue is primarily the counsellors or the clients.
Continue to engage in honest discussion with the client and ask the client what she thinks would work best for her (get the client involved ? value her input and opinions). At this stage the counsellor may need to pose options if the client is not able to come up with any. Most importantly the client needs to feel heard and valued in this process. An option to explore could be the initial introduction to the client. Who made it? It may have been someone that the client trusted/liked. It could be useful to talk with the client about this. The counsellor may need permission to go back to that person, alternatively, to do so with the client there as well, to collaborate and work out what would work best for the client in the interim period.
If the client is not willing to explore the first option, the counsellor may need to offer other options i.e. refer her on. The counsellor could explore avenues i.e. youth services who work with clients with drug issues such as Teen Challenge/Drug Arm. The counsellor could advise the client of their concern regarding ?slipping back into the street life again? and once again organise to meet with organisations, with or without the client, give the client the option to set up links and support for themselves. The client may not be willing to work with this. The counsellor may then choose to talk with the stated organisation to explore other option of support for the client.
Another option could be for the counsellor to engage in discussions with a mentor/supervisor. Further to draw on professional counsellors within their own profession i.e. Australian Counselling Association for supports and referrals. I believe one of the most important aspects is that there is trust between the counsellor and the client. Be open with the client when telling them your situation, your feelings. Keep them involved and informed ? a collaborative process.
Whilst considering this dilemma, I need to remember that the counsellor has no choice in relation to the surgery matter, and that the client has learned to survive the lows in her life. What?s more, she has learned to trust his sincerity and knows that he has been ?fair dinkum? with her.
He needs to continue this approach with her and tell her exactly as it is. Drug addicts value straightshooters and people they perceive to be genuine. They have no time nor respect for self-serving do-gooders who are regarded by them as false and targets to be exploited.
Given that he has been straight with her and is sick, I cannot see how she could possibly regard herself as being dumped or abandoned and thus return to the streets. He could suggest temporary referral to a drug rehab centre or a temporary break in his work with her. After all, he?s already made good progress with her.
To find out whether she?s genuine, he could possibly suggest that she visit him in hospital to cheer him up. This would show her that he cares about her well-being and show him that she values him too. He could also suggest that she come and see him at his place for a brief visit soon after he gets home. After all, hasn?t he been seeing her in her environment? The case history doesn?t indicate what the environment is but since she?s been making good progress, I assume it?s not the streets. Wherever she?s living, someone may be able to give her a lift to his place. That would further test her sincerity and willingness to get better.
If she rejects all suggestions and hits the streets then this is her choice. Sometimes drug addicts look for excuses to hit the streets again because that?s the world they know and feel comfortable in.
Finally, another matter that we need to consider is that if he?s so worried about a possible relapse, then he may not have made the progress he alleges he has. In that sense, he has a duty of care to urge her to attend a drug rehab centre whilst he?s indisposed.
It looks like an issue of co-dependency. If the counsellor had referred this client with substance misuse challenges, other areas could have been accessed and there may have been less problems.
Suggestions at an earlier stage could have been a Rehabilitation Centre where the client would have been able to work through the steps to a safer “clearner” life. Then, upon release, accessing this counsellor for support after the client had established sobriety.
In the interim, locating a support group for this person would be the best option. Often these venues provide a ‘safe buddy’ or sponsor to contact when the “going gets tough”.
While I am not a counsellor, I have worked as Teachers’ Assistant and Student Mentor in recent years and would like to offer my thoughts.
My immediate reaction was to refer. However, given the trust issue (which I beleive is a common human trait not necessarily exclusive to this particular client) I feel the trust would need to be “demonstrated” not merely stated or assured. In this instance, I would feel a need to personally introduce the client to a previously discussed referred counsellor, over maybe one or two meetings. In this way, I have no doubt that the client would be able to sense the degree of trust to be had by way of observing the connection between their current mentor and the introduced counsellor.
The door should then be left open for the client to make contact or not. That achieves two things. Firstly, providing the required support backup, and secondly, it encourages the client to take some initiative in making the first move if they would indeed like someone to talk to.
Further, I agree with Eugene Ross, in suggeting that the client visit their counsellor in hospital. This surely provides yet another step up the ladder of self-worth. As for the various support groups, this client possibly enjoys support and trust in small measures added one spoonful at a time. Maybe this is why it’s working out so far for them?
What client issues require referral? And what are the protocol’s you must follow?