The Use of Referrals in the Counseling Process

Signing a Release of Information Form

Confidentiality must be broken if your client is in imminent danger or a court order mandates a release of information. Outside of these rare circumstances, any type of communication or information cannot be shared without a signed release of information:

The HIPAA Privacy Rule, from HHS.gov US Department of Health & Human Services (2022): 

…establishes national standards to protect individuals’ medical records and other individually identifiable health information (collectively defined as “protected health information”) and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of protected health information and sets limits and conditions on the uses and disclosures that may be made of such information without an individual’s authorization. 

The Rule also gives individuals rights over their protected health information, including rights to examine and obtain a copy of their health records, to direct a covered entity to transmit to a third party an electronic copy of their protected health information in an electronic health record, and to request corrections.

A signed release form can vary from counseling practice to practice, although in general, it shows the counselor’s name, address, and phone number and the referral source’s name, address, and phone number. There is an expiration date that can be set by the client and counselor. The client can also rescind the release of information at any time.  

Lastly, the release can specifically state the exact information to be shared. For some clients, it may be a diagnosis, for others, it could be symptoms. This depends on the circumstances of the referral and the client’s case.

The signed release also facilitates communication between the two sources. This ensures both parties are working in collaboration rather than opposing goals, which could impede treatment.

Types of Referral Sources

The list of referrals goes well beyond what is listed below. Through this listing, you can get an idea of some of the many sources of support:

• Couples Therapy – If your client’s issues involve an interpersonal or romantic relationship, couples counseling may be more appropriate than individual services.
• Crisis Referrals – When a client is in danger of harming oneself or others, a crisis referral is warranted. Examples of crisis referrals include the ER, police, shelters, the Department of Social Services, and Elder Services.
• Family Therapy – If your client’s issues involve family dynamics, a family therapist may benefit him or her.
• Group Therapy – These are therapeutic groups run by counseling professionals to address various client needs. A counselor can work with multiple individuals at once, utilizing group dynamics. Some examples of group therapy are coping skills, expressive arts, and cognitive-behavioral. 
• Medication Management – A psychiatrist or nurse practitioner can be referred to assess the client’s mental health symptoms and determine if medication could be helpful. Both of these providers can prescribe and monitor medication management.
• Self-Help Groups – These groups bring together people who share similar challenges to help support one another. These are not led by a licensed professional but by peers, who have lived experience. Examples include 12-step groups, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Adult Children of Alcoholics (ACOA), Al-anon, Alateen, etc.
• Specialists – Specialists are professionals with a specific skill set. Some examples are those that hold certifications or licensure in art therapy, vocational counseling, or financial counseling.
• Support Groups – These groups are often run by counseling professionals who bring people together with similar experiences. Support groups can be found in counseling agencies, hospitals, or clinics. Some examples are sexual abuse survivors, bereavement, parenting classes or groups, and caregiver groups.
• Psychological Testing & Assessment – A referral to a psychologist can help with diagnosis through the use of tests and other assessment tools. 

In the example of psychological testing, information about the client is needed for the referral source to understand which instruments would most benefit the client. 

The American Counseling Association Code of Ethics ACA E.6.b. Referral Information states:

If a client is referred to a third party for assessment, the counselor provides specific referral questions and sufficient objective data about the client to ensure that appropriate assessment instruments are utilized.

Referrals Before the Termination of Services

A referral is done before ending counseling to ensure those clients who wish to continue services with a different provider can do so, uninterrupted. The client may request a referral if they do not feel the therapeutic relationship is a good fit. Counselors may initiate a referral when they do not have the skill set to work with a particular client issue, feel unsafe with the client, or have a conflict of interest. Keep in mind, a referral should be the last resort.

If a counselor does not have the skill set to work with a client, first seek to increase your knowledge through education, consult with colleagues, and seek supervision. Even if the client has seen the counselor for a short amount of time, a therapeutic relationship has been established. Any type of referral disrupts this connection and could cause harm to the client.

When a counselor feels unsafe with a client, seek supervision for guidance. If it is necessary to meet with the client, have at least one other counselor who is aware of this issue, near the vicinity of your office, when treatment takes place. You can also sit close to the door and leave it open slightly during your session.

The counselor may also recommend referrals when leaving a place of employment. In all of the above scenarios, the counselor must not abandon the client and may need to continue to provide services until the referral has been completed.