I believe that we end up with the clients we are meant to have at every stage of our development as a clinician. Somehow the therapist fit is surprisingly good for many of our clients. The real mystery is how does this occur? Divine matchmaking? Yes, probably, and some other factors as well.
Let’s suppose you have a client who requires clinical skill beyond your own. Or maybe you just do not connect well with a particular client. In either case, you would in all likelihood have some “tells,” i.e., some behavioral signals that would betray your lack of comfort in working with that client. Most clients will pick up on these signs, even if only subliminally. So what do clients do with that awareness?
Sometimes they will stay with you, hoping you find a way to help them. Sometimes they leave with a loud and explosive outburst. But most commonly, in my experience, is that they leave quietly and without a verbal complaint.
No matter what the style of leaving, we do best to trust our clients’ wisdom and discernment to get what they need. Clients are generally pretty savvy about therapists’ capabilities and generally will make the right decisions for themselves. If my clients feel like I am not able to help, I should want them to find a way to leave to get what they need, preferably in a healthy way.
I believe there may be an even better way than trusting our clients to discern what they need and make the moves to get it. As the client’s therapist, I should do some discerning myself. If I conclude that my sense of a mismatch is based on reality and not my general sense of insecurity, I should initiate a transfer to a better-fitting clinician. It is never easy to face one’s limitations, especially in front of a client one really likes and would love to impress, but in my experience having the courage to refer out those who are not the best fit can do several positive things.
Better for clients
First, finding a better fit for the client increases the likelihood that the client will get healthier quicker. It is hard for clients to leave a therapist and then initiate a relationship with another. Each ending is a disappointment, and usually there is a part of the client that believes that the disappointment is somehow their own fault. And if they do find the courage to seek out another therapist, how can they be sure that the new therapist will be any better suited? Finding a therapist that fits is really hard for some. I do my clients a favor by helping them get settled with a better fitting therapist, should that be appropriate. Referring out can be just another way of caring for my clients.
Better for receiving clinician
Secondly, referring a client who fits another clinician better helps the receiving clinician find the right cases that fit his or her style. Referring to other good clinicians also builds goodwill with other clinicians, and that goodwill will come back to you. When receiving clinicians have ill-fitting clients, they will likely consider you for those referrals. As they say, “what goes around, comes around.”
Better for referrers
Thirdly, we are doing our referral sources a favor by finding the best resource for the clients they sent to you. Referrers are primarily interested in seeing that the clients they send receive care that pleases the client. The referrer looks good when the client is pleased, even if there was a transfer in the process. Additionally, I think referrers will see us as more confident in our own self-knowledge when we demonstrate that we recognize the cases that fit and the ones that don’t.
Retention Part III: How to retain clients