When Referring On Is Good Care
Listening to the quiet signs that a client may need a different kind of support
By Dr Nicholas Harris | Clinical Psychologist and Board-Approved Supervisor
That feeling that something needs a closer look
Most psychologists know the feeling. A referral arrives, or a course of therapy is underway, and something gives us pause. Perhaps the person needs support sooner than our diary allows. Perhaps their goals call for a particular area of expertise. Perhaps we notice that the work is not moving in the direction either of us hoped.
Sometimes we call that feeling “gut instinct”. I think it can be useful, provided we treat it as a signal to get curious rather than a conclusion about the client. What, specifically, am I noticing? Is there a question about fit, capacity, competence, timing or safety? Could my own anxiety, assumptions or reactions be influencing how I see this situation?
A pause like this can lead to more information, a conversation with the client, consultation in supervision, a change in approach, or a referral. The important part is giving the question proper attention.
What might prompt a referral?
No single checklist can decide whether a therapeutic relationship should continue. These are examples of questions that deserve reflection:
Timing and availability
Can I offer support at the frequency and within the timeframe this person needs?
Skills and setting
Would another clinician, team or service be better equipped for these goals or support needs?
The therapeutic process
Have we discussed what is and is not helping? Is there a way to adjust our work, or would a fresh approach be useful?
Sometimes the answer is to continue with consultation or a revised plan. Sometimes it is to help the person connect with someone else. Neither choice should be automatic.
The client deserves more than “we are not the right fit”
Being referred on can feel disappointing or unsettling, particularly if someone has already shared difficult parts of their story. A client might reasonably wonder, “Have I done something wrong?” or “Am I too much?”
A sensitive conversation makes it clear that a referral is a decision about the support available and what may best meet the person’s needs. It is not a judgement about their worth, character or prospects for change. Where possible, the psychologist can explain the reason in plain language, listen to the client’s response, discuss options, and—with consent—share relevant information to reduce the need to start from scratch.
The timing and transition matter too. If needs are urgent, a long wait for a preferred clinician may not be the kindest plan. A referral should consider what support is available in the meantime and what steps are appropriate for that person’s circumstances.
For psychologists: use the feeling, then examine it
It can be tempting to push through unease because we do not want to disappoint someone. It can also be tempting to refer quickly when a client evokes uncertainty, strong emotions or a sense of being out of our depth. Both reactions are worth bringing into supervision.
Questions to explore in supervision
- What am I observing, and what am I assuming?
- What does this client need, and what can I realistically offer?
- Would consultation, further training, a different approach or a different service help?
- Am I responding to a genuine question of fit, or to discomfort I need to understand?
- How can I speak with the client and protect continuity of care?
This is part of reflective practice: noticing our response, testing it against the available information, and making a considered decision. The aim is neither to hold on to every client nor to refer whenever the work feels difficult. It is to remain honest, thoughtful and centred on the person seeking help.
A good handover is part of the care
When a referral is the right step, it helps to be specific about what comes next. Depending on the situation and the client’s preferences, that might mean discussing suitable services, checking availability, agreeing on the information to pass on, or planning how current support will conclude or transition.
For clients, this means you can ask questions. You can ask why a referral is suggested, what alternatives exist, and what information would be shared. Your experience of the transition matters.
For psychologists, it is a reminder that how we refer can be as important to the person as the referral itself.