When to Refer Clients for Mental Health Services
by Karen Romine
Originally Published in Coaching for Transformation
Working with people to facilitate personal growth and achieve goals can sometimes trigger emotional or pathological issues that require professional intervention. Your services are valuable, and to ensure your continuing success, it’s important to protect yourself against accusations of practicing therapy without a license. Here is a handy reference of symptoms and signs that psychotherapy or other mental health treatment is needed.
- Depressive symptoms, including sadness, hopelessness, lethargy, lack of pleasure, weight loss or appetite change, irritability, insomnia or sleeping too much, feelings of guilt, and/ or poor concentration, particularly when symptoms endure for more than two weeks, when symptoms are accompanied by suicidal ideation, and/or when there is a history of suicide or suicide attempts in client’s family
- Periods of euphoria (“natural high”) accompanied by decreased need for sleep; poor judgment; impulsivity, such as excessive financial spending or promiscuity; distractibility; racing thoughts; and/or agitation and enthusiasm for goals
- Self-harming behavior, including cutting, pulling hair, excessive piercing or tattooing, picking at nails or skin to bleeding or other self-injurious actions
- Taking psychotropic medications without attending therapy
- Panic or anxiety attacks which occur suddenly and include physiological symptoms such as rapid heart rate, sweating, diffi culty breathing and a feeling of impending doom
- Behavior dangerous to self or others, including quasi-accidental incidents
- Primary relationship that causes client excessive fear; keeps client isolated from friends, family or you as a helping professional; or involves signs of abuse
- Despite the fact that spiritual breakthroughs can be positive, hallucinations should always be referred for assessment
- Issues born of trauma and anxiety, including fears, aversions, phobias and agoraphobia (fear of leaving home)
- Paranoia, misreading the motives of others, and persistent, irrational fear
- Addictive behavior, including drugs, alcohol, sex (including internet pornography), emotional eating, shopping and gambling, even if it seems minor or infrequent
- Frequent sleepwalking can be a symptom of epilepsy or a seizure disorder; client should be referred to an MD for evaluation
OTHER ISSUES THAT MAY BENEFIT FROM PSYCHOTHERAPY
- Client’s goals run counter to family-of-origin or culture-of-origin values and norms
- Client does not comply with recommended medical treatment
- Relationship issues, including those triggered by divorce, childbirth or infi delity
- A pattern of self-sabotaging behavior that does not respond to coaching interventions
- Periods of missing memory or dissociation (numbness, feeling/acting spacey, “going elsewhere” in consciousness)
- Unresolved grief
- Identity confusion, including issues around race gender and sexual orientation
- Anger management and impulse control issues
- Patterns of rebellion or authority issues
- Parenting and family relational issues
- Challenging relationship dynamics between trigger “upper limits” issues, taking client into a client and trainer/coach, including dependency behavior, seductiveness, manipulation, needing excessive attention, alternating between idealization and devaluation, inappropriate anger, at times very suggestible, paranoia, entitlement and/or rapidly shifting emotions
- Adjustment periods after major life changes, including a death in the family, divorce, job change or moving
- Many clients can benefit from therapy when successful training and coaching services trigger “upper limits” issues, taking client into a life better than their previous comfort zone!
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