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Setting Clear and Ethical Boundaries with Clients

Section 12
Kentucky Administrative Regulations: 201 KAR 23:080
Referral and Termination

Question 12 | Test | Table of Contents

     Section 12. Referral and Termination. (1) A social worker shall make a timely and appropriate referral of a client for a social work or other service if:
     (a) The social worker is unable to provide the work or service; or
     (b) The client's need exceeds the competency of the social worker.
     (2) A social worker shall terminate a social work service if a client:
     (a) Has attained his stated goal or objective; or
     (b) Fails to benefit from the social work service.
     (3) A social worker shall communicate the referral or the termination of a social work service to a client.
     (4) A social worker shall not terminate a social work service or refer a client for the purpose of entering into a personal relationship with the client, including:
     (a) A sexual, romantic relationship;
     (b) A financial or business relationship; or
     (c) Other activity that might serve a personal, political, or religious interest of the social worker.

- Kentucky Legislature. Title 201, Chapter 23: 080 Board of Social Work. 2018 Kentucky Administrative Regulations. Section 12. Referral and Termination.

Let's look at boundaries as they relate to the referral process. Just as you cannot be all things to all people, so there is no one social institution that will serve all the needs of a complex individual in a complex society. Failure to refer can have tragic consequences in cases when the physical health of the client is in question or when physical factors may play a potential role in the client's quality of life.

For example, the possible physical complication of a client with anorexia nervosa requires the monitoring of physiological consequences by a physician. This example of the boundary of referral to a physician in the case of anorexia nervosa is pretty clear cut.

♦ 4 Questions to Explore Referrals
But let's look at a more complicated example. What if you have been seeing a client for several years and you feel a colleague who specialized in, for example Gastault training would be of benefit to your client. As you know being referred usually carries with it elements of rejection, anger, hope, and expectation.
-- 1. How do you introduce the idea of a referral to alleviate your client's feeling of being rejected?
-- 2. How do you handle possible anger from the client regarding your suggestion concerning a referral?
-- 3. How do you introduce the idea of a referral to another therapist, while not raising false hope in the client?
-- 4. How do you bring your client's expectation level regarding the new therapist into line with reality…so he or she does not view the new therapist as a cure-all for their problems?

Think over your current or past clients whom you felt may have needed a referral. Think of a client you referred to another agency or professional. Now think of client you did not refer to another agency or professional that possibly could have benefited from the treatment or services of another. Where and how did you draw this boundary in your mind? Was a referral not made as a measure to avoid dealing with you client's possible feelings of rejection, anger, hope, and expectation?

♦ 3 Key Test Questions Regarding Ethical Referrals
Thus, three boundary questions are proposed here.
The first question is, when to refer and when not to refer?
The second question is, when does referring or not referring serve to meet my own needs and not the needs of my client?
To find an answer to these two boundaries ask yourself the following three questions:
1. What is the context of the situation for considering a referral?
2. Would my client's goals be better served by a referral?
3. What is the potential harm resulting from referring or not referring to another?
- Clapton, Kerrin. Developing professional boundaries guidance for social workers. Journal of Adult Protection. 2013. Vol. 15 Issue 1. Pg. 37-44.

Peer-Reviewed Journal Article References:
Bhatia, A., & Gelso, C. J. (2017). The termination phase: Therapists’ perspective on the therapeutic relationship and outcome. Psychotherapy, 54(1), 76–87.

Birky, I., Sharkin, B. S., Marin, J., & Scappaticci, A. (1998). Confidentiality after referral: A study of how restrictions on disclosure affect relationships between therapists and referral sources. Professional Psychology: Research and Practice, 29(2), 179–182.

Cox, J. R., Martinez, R. G., & Southam-Gerow, M. A. (2019). Treatment integrity in psychotherapy research and implications for the delivery of quality mental health services. Journal of Consulting and Clinical Psychology, 87(3), 221–233. 

Hill, C. E., Lu, Y., Gerstenblith, J. A., Kline, K. V., Wang, R. J., & Zhu, X. (2020). Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists. Psychotherapy, 57(2), 263–272.

Hilsenroth, M. J. (2017). An introduction to the special issue on psychotherapy termination. Psychotherapy, 54(1), 1–3.

Rowe-Johnson, M. (2018). Achieving ethical mentoring and mentee professional integrity through formal mentor training for practicing psychologists. Training and Education in Professional Psychology, 12(3), 203–209.

QUESTION 12
What are four possible reactions your client may have when a referral to another professional or agency is suggested? To select and enter your answer go to Test.

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