Referring a client for psychotherapy

Aug 25, 2012 | For Practitioners, Thoughts from the therapy room | 3 comments

This article first appeared in the September 2012 on-line edition of Reflexions Extra published by The Association of Reflexologists. Stress comes in many guises and most clients who seek out reflexology come with the kinds of stresses which we are well able to support and manage. Every so often though, we will get clients whose story or response is beyond our personal or professional experience. Sometimes this will be the first time they have told anybody and you will need to be there holding and supporting them through it. As the treatment unfolds however, you may begin to realize:

  • That you don’t have the experience or training to contain this client.
  • That your client’s experience is very similar to your own and that working with them is becoming uncomfortable because of the emotions and issues it is bringing up in you.
  • You might know the client outside the therapy room and feel that given the nature of their experience, it would be better if they talked to somebody else.

Part of the reason I continued my reflexology training into psychotherapy was the number of clients presenting with issues which I felt ill- equipped to deal with. For me the problem was twofold:

  • How to speed up the recognition of clients who would benefit from more specialist support
  • How to tactfully suggest it to them.

Recognizing the Client

It might be helpful to create a questionnaire with some common Red Flag Signs which you could use if you suspect a client needs more specialist help than you are able to offer.

Here are some suggestions for identifying the stress, anxiety or trauma which may underlie the stories clients tell us:


  • I am reluctant to go to bed and often stay up late for no particular reason.
  • I have had at least one nightmare in the past week.
  • I wake up more tired than when I went to bed. Ask the client how many times this has happened in the past week.
  • I keep waking up in the night.
  • I feel exhausted and listless during the day despite having slept well.

Cognitive Functioning:

  • My mind goes blank and I can’t remember simple things.
  • I am having trouble communicating, I can’t seem to think straight.
  • My mind keeps wandering and I can’t concentrate for long.
  • On a few occasions recently, I’ve thought that I’d completed a simple task only later to discover that I had made elementary errors.

Physical Symptoms:

  • I have a symptom or a set of symptoms which get worse when I’m stressed.
  • Sometimes they get worse when I’m not feeling particularly stressed, and I don’t understand why.
  • I feel emotional – angry or upset – after a hot bath I feel exhausted in the days following relaxation including after Reflexology, yoga or massage.
  • I enjoy exercise, but I feel emotional – perhaps angry or upset – in the days following the exertion. I can feel emotionally drained, even though physically, I am fine.


  • I feel stuck, and no matter what I do, I stay stuck
  • There is nobody I can turn to when I need help.
  • I feel that it is all too much and I can’t cope.
  • I feel desperate, helpless or hopeless.
  • I can’t see any solution to my problem.
  • I can’t stop thinking about …….

Be alert for the clues which clients who are not handling their stress well may be sending out:*

  • Nervous stumbling speech
  • Temperature – clients can often feel cold
  • Giving the appearance of some strong emotion (e.g. anger) without seeming to be aware of it – voice, facial expression, eyes, choice of words can be key indicators .
  • An inability to relax.
  • Client may ‘pass out’ as soon as they lie on the couch.
  • They may be unduly sensitive, for example to foods, people, situations.
  • Signs of an exaggerated startle response (e.g. jittery movements; awkwardness)


While you are taking the client’s case history listen out for evidence of:

  • Rapid weight gain or loss
  • Overreaction to problems
  • Immature Behaviour
  • Any suggestion that they may have been bullied or suffered other traumatic experiences
  • Age – some people’s defences lessen as they get older and experiences which they have been successfully containing for years can suddenly spill over into daily life.
  • Suddenly moving from being very functional to being very dysfunctional

* From an article on Traumatic Stress by the same author published in the September 2011 edition of Reflexions Magazine – Pps 15-16

Common Client Concerns

How you broach the subject of psychotherapy will depend on you and your client and the kind of relationship you have built with them. You might find yourself having to address your client’s fears about psychotherapy. Here are some common ones:

‘I’m not mental, I don’t need psychotherapy’.

You haven’t got to be ‘mental’ to benefit from psychotherapy. Most people who consult psychotherapists enjoy good mental health and are troubled about or overwhelmed by something they are experiencing in their lives at the moment or by something from the past which is unresolved. Psychotherapists help people to understand and resolve their issues through building a safe, trusting relationship and talking things through. If clients have physical symptoms, they may wish to see a psychotherapist who includes body work as part of the treatment.

‘Once you start psychotherapy it goes on for years’.

This is not necessarily so. How long therapy lasts will depend on what the client is trying to achieve. Some psychotherapists offer short-term therapy. Some work with improving the quality of the client’s daily life and only delve deeper by agreement. Encourage the client to discuss their concerns with the therapist.

‘How do I find the right psychotherapist?’

Crucial to the success of psychotherapy is the relationship between the client and the therapist. Perhaps you could have a few cards or website addresses to hand and offer them as suggestions. It’s a good idea for clients to try out a few therapists before settling on one. 

I don’t know how I will cope if I open that can of worms’

Depending on their training, psychotherapists have different techniques to help strengthen and prepare clients before they begin to work on the bigger issues . Some therapists are trained to work with a little information at a time. Encourage your client to think about what they are looking for before they start to find a therapist.

‘But I want to stay with you’.

  • Discuss the progress you have and have not made.
  • Gently and firmly explain your reasons for suggesting a psychotherapist.
  • Be honest with your client.
  • Draw an analogy. For example, you might really like the person who repaired your DVD player, but you wouldn’t ask them to fix your computer if they didn’t have the training.
  • Tell them that your door will always be open and that they can come back at any time.

Nayna Kumari MAR is a psychotherapist with an interest in the effects of stress, anxiety and trauma on mind and body.

To discuss how you can refer a client to Nayna or for more information –

Please contact Nayna:

01297 444 561.