As a counselor, it’s natural to want to hold on to your patients as long as possible. After all, you chose this career because you want to help people. But, it’s important to remember that there are hundreds of other counselors that have your same passion and drive–and that might be a better fit for your current patient. Here are some things to keep in mind to ensure that you and your patient are the right fit for each other.
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You don’t specialize in the therapy they need
It’s great to be familiar with several forms of therapy, but being a jack-of-all trades type of therapist will only scare patients away. A patient dealing with trauma might benefit more from EMDR, and one with borderline personality disorder might benefit more from DBT. Know what you can offer, and try to have recommendations for other counselors that might be able to offer better service. (Bonus: you can create reciprocal relationships with those counselors so they can refer patients back to you too!)
This can also apply when you originally thought the patient was there to discuss one issue or diagnosis, but it turns out there are issues like trauma or substance abuse that the patient needs to work on in order to heal. If you are not experienced in or comfortable with treating the changed needs of the patient, it’s OKAY to admit that someone else would be able to do a better job. Your patient will likely thank you for it.
You don’t agree about the course of treatment
You are the expert in how to deal with a patient and their needs. However, many patients often show up completely attached to their own research and agendas. For instance, they may have heard that CBT worked for a friend, and they therefore insist that CBT is the only treatment they will accept.
Sure, part of your job is to convince the patient why you can help them, but if they ultimately think they’re better off with another approach, fighting them is not going to solve their problems. Better to send them to a therapist that they’re likely to agree with.
You don’t have a positive relationship
It’s best not to take this personally, but not everyone can get along. Just because a patient doesn’t learn best with your teaching methods doesn’t mean that you have in any way failed as a counselor. If you sense that your patient does not fully trust or open up to you, or if you feel you spend more time in opposition with your patient than working together with them, you may need to suggest someone with whom they might have a better working relationship.
The patient isn’t making progress
On the other hand, sometimes an incredibly positive counselor-patient relationship can be inherently unproductive. It’s great to be on friendly terms with your patients (e.g. to play games or make jokes with them if it’s appropriate,) but if your time together is all play and no work, you either need to find a way to get your therapy sessions back on track, or you may need to find someone that can better meet their needs.
The patient doesn’t want to be there
It is, of course, possible for the patient to exhibit a lack of progress due to their own flaws. If the patient refuses to open up to you, misses or often reschedules appointments, shows up egregiously late, and/or refuses to do any work outside of your therapy sessions, it may be time to address these issues.
If this is something you can work on together, that’s great! Perhaps being held to a higher standard is exactly what your patient needs. However, if the patient continues to hold back from treatment, it may be best to find them a therapist that can reach them in a different way. (Don’t take this personally, either; we all learn differently.)
Boundaries have been crossed
No one wants to think about this possibility, but it remains a real possibility. If your patient is trying to befriend you outside of work (including on social media,) or expresses an interest in you that is beyond professional (i.e. too familiar, romantic, or sexual,) it is in the best interest for both of you that you terminate the therapeutic relationship immediately and refer the patient to a new counselor.
How to break it off
When it’s time to break up with your patient, how do you do it in a way that does not leave them more overwhelmed or isolated?
- Be empathetic. Understand that this may be difficult for the patient to hear.
- Offer a referral. Underline that just because you aren’t the right fit for your patient, it doesn’t mean they are untreatable.
- Take care of yourself. It’s normal for a counselor to feel a healthy amount of attachment to their patients–or at least an attachment to seeing them recover and thrive. Be sure you have your own coping mechanisms to rely on after a client breakup. Remember that it wasn’t your fault, reflect upon what you have learned from the experience, and reach out to a friend or colleague if you need a chat.