<\/h4>\n\n\n\n
Recognising that someone might benefit from counselling is not always as easy as it is with, say, the client who starts crying when they\u2019re on the table. Some of the subtler telltale signs I\u2019ve encountered include:
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![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/01\/stacked-1183047_1920-300x219.jpg?resize=195%2C142\")
<\/figure><\/div>\n\n\n\n- Strong startle responses to firm pressure<\/strong> \u2013 This can suggest that a client is stuck in sympathetic \u2018fight-or-flight\u2019 mode or hypervigilance, unconsciously defending against an unseen threat, perhaps a remnant of unresolved trauma. <\/li>
- Clients who constantly apologise, and seem desperate to be the \u2018perfect client\u2019 or always put the therapist\u2019s needs before their own <\/strong>\u2013 This can be a sign of excessively high standards which often go hand-in-hand with stress and anxiety. That most destructive and hard-to-shake of feelings \u2013 shame \u2013 might also be involved.<\/li>
- Clients who request \u2018punishment\u2019 (i.e. extremely firm pressure) by the massage therapist<\/strong> \u2013 This might suggest a belief that they deserve to be punished. Again, shame might be involved. <\/li>
- Clients who cannot tolerate even mild pressure, who may believe that any degree of discomfort is too overwhelming to bear<\/strong> \u2013 This client may hold beliefs about their own inadequacy, weakness or defectiveness. <\/li><\/ul>\n\n\n\n
These signs alone are not reason enough to suggest to a client that they seek counselling, but they might be a starting point for a discussion about the client\u2019s experience.
<\/p>\n\n\n\nCheck your observations with the client<\/strong>
<\/h4>\n\n\n\nWe might see generalised muscle tension and assume the client is an anxious person but we may simply be seeing them on a particularly stressful day or after a tough gym session. They might be tearful and we assume they are depressed but maybe their dog recently died.<\/p>\n\n\n\n
Start by reflecting back your observation, checking its accuracy and eliciting some ideas about the client\u2019s experience. For example: \u201cI notice it seems important to you to make sure I\u2019m<\/em> taken care of. Does that ring true for you? Is that something you often do with people? Do you have an idea of what that might be about?\u201d
<\/p>\n\n\n\n![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/01\/dog-2606759_1920-300x213.jpg?resize=334%2C237\")
<\/figure><\/div>\n\n\n\nIt may not be necessary to go any further, but you\u2019re at least letting the client know that it is safe to talk about their mental health.
<\/p>\n\n\n\nNotice that these questions are closed \u2018yes or no\u2019 questions? We\u2019re not looking to explore or resolve the client\u2019s distress but to get an indication of their willingness to talk about things, to build trust and to ensure that our understanding of their experience is accurate.
<\/p>\n\n\n\nWarm up to the idea of getting help<\/strong>
<\/h4>\n\n\n\nHow direct you are with a client about the need to see a counsellor will depend largely on what your relationship is like and how much information they have volunteered. They might be very comfortable telling you they\u2019ve been depressed or anxious and may already be seeing a counsellor.
If it seems like counselling is a new or unwelcome concept for the client, broaching the topic can require a delicate touch. Keep it gentle. Warm up to it. \u2018Going in for the kill\u2019 risks alienating your client, especially if the relationship is not yet well-developed. While some clients will be receptive to the suggestion, others will have preconceptions about counselling and might take it as a sign that you think they aren\u2019t coping or that you think there is something wrong with them.
<\/p>\n\n\n\nShould a client seem unwilling to acknowledge a mental health problem that you have good reason to think exists, tread very lightly. Denial is a powerful protective mechanism that can become very helpful to people.
<\/p>\n\n\n\nIt is not our job to tear down our clients\u2019 protective factors.
<\/p><\/blockquote>\n\n\n\nWhere the client is able to acknowledge they have a problem, a useful question can be, \u201cDo you have someone you can talk to about that?\u201d
<\/p>\n\n\n\nIf the client says they usually talk to their partner, family members or work colleagues, you might ask, \u201cDoes it feel like that is helping?\u201d
<\/p>\n\n\n\nIf the answer is yes, it may be best to leave it there. If the answer is no, it may feel appropriate to suggest other avenues of support. You might introduce the idea of counselling with a question such as, \u201cHave you ever seen a counsellor before?\u201d or \u201cDo you think some counselling might help?\u201d
<\/p>\n\n\n\n\u2018Counselling\u2019 can be a less threatening word than \u2018psychotherapy\u2019 or \u2018psychology\u2019 but adequately describes what happens in all three.
<\/p>\n\n\n\nHelp the client make the decision<\/strong>
<\/h4>\n\n\n\nClients may want to look for a counsellor independently, or they may prefer your guidance. There are numerous ways you and your clients can look for good local practitioners. The following have online listings of registered counsellors:
<\/p>\n\n\n\n- Psychotherapy and Counselling Federation of Australia (PACFA)<\/a><\/li>
- Australian Counselling Association (ACA)<\/a> <\/li>
- Australian Psychological Society (APS)<\/a> <\/li><\/ul>\n\n\n\n
Other helpful sources include:
<\/p>\n\n\n\n- Australian Government\u2019s Health Direct website<\/a><\/li>
- Good Therapy Australia<\/a> <\/li><\/ul>\n\n\n\n
It\u2019s wise to keep on file the details of a number of mental health practitioners in your area, so that you can \u2018warm-link\u2019 your clients to someone you think might be well-suited. If you feel that this is outside your comfort zone, the best port-of-call for clients is their GP, who can diagnose a mental health problem and refer appropriately.
<\/p>\n\n\n\nCounselling outcomes can be better if the client has an expectation that the counsellor is well-regarded, competent and a good match. This is important because the therapeutic relationship in counselling is the keystone of change, not the counsellor\u2019s level of training, job title or the modalities they use. What matters most is that there is a strong bond between client and therapist. Clients may need encouragement to \u2018shop around\u2019 until they find someone who is a good fit.
<\/p>\n\n\n\nCounsellor, Psychotherapist, Psychologist or Psychiatrist … what\u2019s the difference?<\/strong>
<\/h4>\n\n\n\nCounsellors and psychotherapists<\/strong> are trained largely in the communication and relationship aspects of counselling and do not provide diagnoses or prescribe medication. Currently, they are not able to offer services covered by Medicare or private health insurance rebates.
<\/p>\n\n\n\nPsychologists <\/strong>may diagnose and are more likely to be engaged in clinical research. They are generally able to offer services covered by Medicare rebates but do not prescribe medication. There are many different types of psychologists according to specialisation (e.g. forensic, developmental, exercise) or the extent of focus on counselling (clinical psychologist versus counselling psychologist).
<\/p>\n\n\n\nPsychiatrists <\/strong>are trained medical doctors who offer clinical treatment to people whose mental health problems require medication and close monitoring. Massage therapists do not refer clients to psychiatrists.
<\/p>\n\n\n\nBefore settling on a therapist, it is worth finding out individual practitioners\u2019 rates. These rates can vary greatly and in some cases will be negotiable. Medicare rebates do not necessarily make it cheaper to see a psychologist, especially if treatment lasts more than ten sessions.
<\/p>\n\n\n\nMake the referral<\/strong>
<\/h4>\n\n\n\n![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/01\/psychology-1957259_1920-225x300.jpg?resize=202%2C269\")
<\/figure><\/div>\n\n\n\nIt may be adequate to simply give the client the counsellor\u2019s details and allow them to make contact, or you may wish to make a formal referral with the client\u2019s informed consent. If so, keep it brief. It is enough to say that the client reports feeling depressed, for example, or would like some help dealing with stress. Giving your assessment of the client\u2019s mental health or life situation (e.g. \u201cI think the client may be suffering PTSD\u201d) may prejudice the counsellor\u2019s view of the client, which can have an undesirable influence on the psychotherapeutic relationship. Regardless, the counsellor will perform a thorough intake assessment with the client.
<\/p>\n\n\n\nNot all clients<\/h4>\n\n\n\n
I don\u2019t write any of this under the assumption that all clients need to see a counsellor or that it is our job to ensure that our clients with mental health problems get to counselling. <\/p>\n\n\n\n
It is our job to help and care for our clients, and we do that within our scope of practice in whatever way we think is most clinically reasonable. <\/p><\/blockquote>\n\n\n\n
Even if we can plant the seed of an idea in a client\u2019s mind that they don\u2019t have to hold on to pain or that they could talk to someone<\/em> about a problem they\u2019re having, we\u2019re doing just that.<\/p>\n\n\n\n
*In this article, I\u2019ve use the general term \u2018counselling\u2019 to refer to services provided by qualified and registered counsellors, psychotherapists and psychologists.
<\/p>\n\n\n\nAbout the Author<\/h4>\n\n\n\n
- Good Therapy Australia<\/a> <\/li><\/ul>\n\n\n\n
- Australian Counselling Association (ACA)<\/a> <\/li>
- Clients who constantly apologise, and seem desperate to be the \u2018perfect client\u2019 or always put the therapist\u2019s needs before their own <\/strong>\u2013 This can be a sign of excessively high standards which often go hand-in-hand with stress and anxiety. That most destructive and hard-to-shake of feelings \u2013 shame \u2013 might also be involved.<\/li>
![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/06\/Tim-Clark-150x150.jpg?resize=142%2C142\")
<\/figure><\/div>\n\n\n\n