MAKING EFFECTIVE REFERRALS - Christianity Today

As you enter the house after an exhausting day, your spouse greets you with news of a call: “The Browns are having trouble again, and they want you to come right over.” You wince as you remember the last time you went to help the Browns with their “domestic disturbance.” After three hours of crisis intervention, you felt you had made some headway. Now you suspect they’re going to want long-term help, but you’ve promised the board, your spouse, and yourself that you would reduce your counseling load. How can you help the Browns?

After a number of premarital sessions with a young couple in your church, you become convinced they need specialized help in setting up a workable budget. Whom can you get to help?

A 16-year-old girl has just called you, the only one she felt she could turn to. Through her tears, you learn she’s pregnant and is considering having an abortion. Her parents don’t know yet, and she wants your help. As she’s on her way over, you rack your brain to think of others who might help with her parents, with medical care, with practical and emotional support. Who?

Ministers frequently find themselves lacking either the time or the qualifications for a given situation. They need to make a referral. But most of us have never been trained in making referrals. Having served both as a pastor and as a full-time counselor, I’ve seen the matter from both sides. Here are some insights into the three questions pastors usually ask.

Should I refer?

In deciding whether to refer a person to someone else, I ask three questions:

Do I have the skills necessary to help this person? This doesn’t mean I have to have professional training in every area of need presented to me. It does mean I want to be sure I’m the right person at the time. I ask about the history of the situation, what help has already been sought, and exactly what the person wants to receive. These questions can reveal a great deal about what type of person should be providing help. When a need is clearly outside my area of expertise, referral is the obvious choice, but at other times it’s a matter of someone else’s being better equipped to help.

Can I give adequate time to this situation? A counseling case can easily take up five hours a week, even if the client and I are meeting only once a week for an hour. Thought, prayer, phone calls, background research, and consultations all take time. When you add the possibility of crisis calls, it becomes clear that most pastors can take on only a small number of these commitments. My experience and research suggest most ministers should avoid handling more than half a dozen counseling cases at a time.

Given the roles I fill, am I the right person in this situation? One pastor, in referring a case, told me, “I feel comfortable dealing with the situation itself, but I think I’m too close to the couple.” His role as a “father figure” to the couple made it difficult for him to be objective. His making a referral allowed the couple to get the help they needed while still receiving support from him as their pastor.

Counselees should also be referred if there is any sexual attraction between them and the pastor.

To whom do I refer?

I develop a list of available resources for various types of needs. Many communities make referral directories available at little or no cost, but you can also make your own. In any event, no referral should be made to someone with whom you haven’t talked personally. Screening takes time, but it pays great dividends when you’re assured of the qualifications and character of the person to whom you are referring. Making one new contact a week is usually workable.

In assessing potential resource people, you’ll want to learn the type of help they offer, their academic training and experience, and special characteristics of the service provided (including fee structure).

Where appropriate, you’ll also want to know such personal information as philosophical biases and spiritual convictions.

How do I make the referral effective?

Each situation is unique, but I try to follow a few basic steps:

1. Ascertain where the real need is. When you’re asked for help, your primary task is to decide what help is needed and who is the best person to meet the need. This will usually mean at least one meeting or extended conversation with the counselee. Ask enough questions to be sure you know what the need is.

The most common experience I’ve had concerns the difference between individual and marriage or family counseling. A man I’ll call Cliff, for example, called to ask if I would counsel his daughter Jeri, age 13. Jeri had become increasingly hostile to other family members and was spending a lot of time with “the wrong crowd.” Jeri was physically well developed for her age, and her parents were afraid she was becoming sexually active. I agreed to meet with Jeri to hear her perception of the problem, with the understanding that I would discuss with her parents how to proceed after the initial interview.

When I met with Jeri, I was candid about her parents’ concerns. She explained she had been feeling pressure to measure up to her older sister. She also said her parents didn’t really care about her. When I asked why she felt this way, she told me her father never spent time with her, though they had been close a year earlier.

When I asked Cliff about their time together, I discovered he was uncomfortable around Jeri. He confessed he used to love wrestling with her, going camping, and just sitting around talking with her. But when she began to mature physically, he felt ill at ease and began to withdraw. He said he hadn’t hugged Jeri in the past year.

On the surface, the Johnsons’ need was individual counseling with Jeri. But the real need was for family counseling to explore and heal the fears that Cliff, Jeri, and other family members had regarding Jeri’s growing up.

2. Make the referral personal. Once you know the need, you can use your list to decide whom you will refer to. (If there’s more than one person you would feel comfortable suggesting, you can give counselees the options.)

In making a referral, I’ve learned to refer to a person or persons-not to an institution. One time I referred Joan, a member of my church, to an agency in our community for specialized counseling. I knew and respected the director of this agency. After the referral was made, however, I found that Joan was being counseled by a person I didn’t know. At the end of the third session, Joan came to me and said her new counselor had spent the last two sessions telling Joan about her problems. Joan was feeling frustrated and overwhelmed, and she decided to discontinue counseling. Had I done my research on this counselor, and not just the agency, I would have learned she wasn’t qualified.

3. Make the recommendation clear. As you make your suggestions to the counselees, be ready to explain exactly why you believe it’s best to refer them to someone else. You’ll greatly increase the likelihood of a successful referral by answering all legitimate questions straightforwardly. Give them time to think about the referral if they need it. In many cases, you will want to assure them that you’ll continue to be involved, but in a different role.

4. Make the first contact, if necessary. Kate had been a widow for six months. It took all her strength to get out of bed, get the kids ready for school and the sitter, and go to work. She knew there were resources available to provide the emotional and social support she needed, but she was immobilized by grief. After waiting several weeks, I called the leader of a local support group and suggested she visit Kate. She did, and Kate began attending the support group meetings and making friends there.

It isn’t always necessary to make the initial contact with the resource person. In some situations, it might be important for the counselee to take responsibility for making the call. We need to be sensitive, however, to those situations in which it’s better that we take the initiative.

5. Insure communication with the new helper. In one community I served, an agency providing a wide variety of counseling services rarely got referrals from area ministers. The reason: when ministers tried to follow up on referrals, no one was willing to talk to them. I never refer people to anyone who is unwilling to communicate with me. This doesn’t mean I need to know all the details of what’s going on, but I have a responsibility to the people I refer; I need to be sure they are truly being helped.

A good tool to use here is the standard release-of-information form. Most ministers don’t require such a form, but virtually every community professional does. If you have the counselee sign a release when you make the referral, you give the other professionals the freedom to communicate with you.

This release is a simple statement giving the parties named the freedom to exchange specific information. It should include the counselee’s name (printed) and signature; the date of the signature; the person(s) being given the freedom to exchange information; the nature of the information to be disclosed (test results, clinical opinions, general information related to pastoral care, or any and all information); the purpose of the disclosure; and the date the release expires. If the person being referred is a minor, it should also be signed by a parent or guardian.

6. Specify to the new helper, before the referral is made, what his or her role is to be. If you want a specific type of help to be provided, this should be spelled out clearly. I’m often asked to do parent education with families who are undergoing therapy with someone else. In such cases, it’s vital that I know exactly what I am and am not supposed to be doing.

For example, the Gypsums were referred to me for parent education, specifically, discipline from a scriptural perspective. The minister made it clear that any questions about Scripture that didn’t relate directly to parental discipline should be referred to him. In such a case, it was important for the minister that I agreed to abide by the limitation on my role.

When referring people to doctors or therapists for technical counseling, such as sex therapy or treatment of depression, I request that any questions related to moral or spiritual issues (e.g., birth control or abortion) be referred back to me.

7. Follow up on the referral. John and I saw each other at a ministers’ meeting, and he asked how my work with the Jones family was going. I asked who he was talking about. He was surprised; he had referred a family to me a month earlier. They had promised to call me, and he assumed they had. They had not. In fact, they had called no one, and their situation was getting worse.

Because of this and similar experiences, I try to follow up within a week after a referral, and periodically thereafter. Has the counselee made contact? How is the work going? How can I best support the process? If I’m still working with the person, how can my work complement the efforts of the other helper?

None of us can meet all the needs of everyone who comes to us, but we can guide people to other qualified helpers. And making appropriate referrals can save us from overwork and provide the best resources available for those who need them.

-Randy Christian

Beaverton Christian Church

Beaverton, Oregon