Referring On.

As we counsellors are aware, some clients can be relatively easy to work with and others less so. For example, I see a man, who has Psychology for Dummies tattooed up his arm, and I can read him like a book. By contrast, I meet with a young erotic dancer who works for a nightclub; she performed for two men, Apollo and Zeus, fell in love with both of them and cannot choose which to elope with - how we will work through this dilemma really is in the lap of the gods. Equally demanding, in a different way, is the compulsive gambler who is obsessed with Roulette; last week, he went to the casino and put all his money, down to the last penny, on number 13; the wheel was spun, the ball landed on 16 and he lost the lot – no wonder, he is all at odds with himself. And there are times, no doubt for all of us, that we are kept awake at night thinking about our one client or another: for me most recently, it was a depressed 50 year with chronic insomnia, and before that a gorgeous kleptomaniac who stole my heart.

I could go on (and believe me I do), but my reason for writing this is to invite us, to step into new areas of discourse and to consider not the clients we continue seeing in our consulting rooms, but those we need to refer on. Perhaps we have no availability and cannot see them (this happened to me only two weeks ago when a glazer rang asking if I had a free window), or, perhaps, we have already been seeing them, reached a limit and think they would benefit from specialist help. To kick off this discussion, I shall share with you some of my experiences of referring on and some thoughts about this very important topic.

If you are worried by people with strong spiritual beliefs, consider this. I received an enquiry from a religious man, a shepherd by calling, and unhesitatingly, recommended him for pastoral counselling. However, this is not a rule of thumb; another religious person, an orthodox Jewish man, called me up in a panic as his wife was insisting he stopped wearing his skull cap and he refused to comply: in this instance I referred them to couple therapy.*

Openness to all modalities is key. In the case of a pot-holer and caver, I was certain that depth psychology would suit him best; by contrast a mountaineers needs a Maslowian to focus on his peak experiences. While for a glue-sniffer, I suggested attachment-based therapy; a procrastinator with severe constipation was directly to a Gestalt therapist to work on his unfinished business; for a charming elderly man (with a minor drinking problem and a touch of exhibitionism) called Noah, I encouraged he see a Jungian therapist to work on his archetypes.

Like many existential therapists, I am sceptical about psychiatry, but one has to be judicious. One time, a morbidly obese lady came for an initial meeting and our conclusion was that her best next step was to go to a shrink. A psychiatric referral was necessary too for a workaholic tree feller whom, you might say, barking mad. And, while I was willing to meet with a man with a diagnosis of oppositional defiant disorder who sought me out, paradoxically, it was he who refused to take up my offer of therapy.

There are occasions too, when we meet our limits quite unexpectedly. Recently, very unfortunately, a regular client came for her meeting, on entering my consulting room tripped on the rug, landed on her head and was out cold; I immediately contacted a local Freudian analyst whom I know to be expert in working with the unconscious.

And let us remember that there are some for whom therapy may never work and we should think twice about referring on. For example, I needed to say no very firmly to seeing an avid fox hunting fanatic who didn’t stop hounding me. And, on another occasion, a man who was working in an abattoir and wanting help with his sadism, bestiality and necrophilia, needed to be told that therapy for him would be like flogging a dead horse. Disappointingly also I needed to advise a pleasant young woman who was born by Caesarian section, that she was not cut out for therapy.

I hope these disclosures have opened the debate slightly and look forward to your responses. Next time, I shall be looking at Loss and Endings; another central theme of our work.

*a cupple is a Yiddish word for a skullcap