When to Refer a Client On (And When to Say No)

When would you say no to a client enquiry? Or, having started therapy, when and how would you refer a client on? Most training courses (and all the good ones) will give you a list of contraindications, meaning circumstances in which you shouldn’t work with a client. These do vary, but you’ll usually find psychosis, certain medications, and safeguarding issues on the list. Sometimes, there can be other reasons you need to refer a client on to another therapist or reasons why you should stop working with a therapy client altogether. 

In this article, we’re going to look at when you should refer a client on, or say no to working with them altogether, and how you should handle it. 

When Referring a Client Can Be the Best Move for Both of You

Ogrodniczuk et al. (2005) looked at why clients end therapy early, and one of the biggest factors was a lack of rapport with the therapist. Essentially, the client was feeling misunderstood or judged. That’s usually thought of as something to “fix” on the therapist’s side.

But it’s not just clients who can feel they need to end therapy early. Sometimes it’s the therapist who doesn’t believe things are working out, and that matters just as much. Referring a client to another therapist, deciding to stop working with them, or turning them away at first contact doesn’t happen that often. But it is part of responsible and ethical practice.

6 Signs You Should Stop Working with a Client

It’s outside your comfort zone or competence

This one’s honest and, in my opinion, completely legitimate. I don’t work with sexual issues. It’s not an area I enjoy, and I don’t think I do my best work there. If I’m asked about it, I say so and help the client find someone who specialises in it. That’s not a weakness on my part; it’s good practice. Ethically, referring a client to another therapist because an issue sits outside your competence or interest is entirely appropriate, so long as you’re honest about the reason and you support the handover.

Poor rapport

Sometimes you and a client just don’t click. Or it may turn out that your client has strong political or religious views or prejudices that you’re uncomfortable with. If you’ve done your best to build rapport but it isn’t there, and you don’t think things are going to improve, it may be best to call a halt.

You feel you’re getting nowhere

You’ve tried your usual approaches, adapted them, tried again, and there’s still no movement. That’s not automatically the client’s fault, but it might mean this particular combination of techniques, or this particular therapeutic relationship, isn’t the right fit for their issue. If you struggle when therapy isn’t working, or you’re reluctant to pass a client to another therapist because you worry about letting them down, I have some tips on dealing with those feelings in my blog on coping with failure.

Lack of commitment

If a client doesn’t do any between-session tasks or listen to recordings, or turns up week after week reporting no improvement, you have to ask what’s actually happening. A bit of resistance to change is normal and can be worked with. Continued lack of engagement, or an assumption that change will “just happen”  without any action on their part is different.

They’ve reached their goals but don’t want to leave

This one’s sometimes trickier to spot. But if a client keeps finding new (generally vague) reasons to keep coming, it’s worth asking yourself whether this is a real therapeutic need or overdependence. You’ll find a lot of information about handling this type of issue in my article on transference.

The “Vibe” 

This is the hardest one to justify because, on paper, there’s often nothing wrong. But you get a feeling, often in that first phone call or session, that something’s off. Learn to listen to it.
Interestingly, there’s a body of research on this in general practice. Stolper et al. (2009) describe what GPs call a “sense of alarm”. It’s an uneasy feeling that something isn’t right, even without clear indications why.
It’s not magic or mind-reading. What’s happening is pattern recognition built from experience, operating faster than you can consciously explain. Your personal safety and your professional confidence both matter, and neither has to come with a fully developed justification attached.

Referrals Can Happen at Any Stage of Therapy

It’s tempting to think these decisions only come up during that first phone call, before any commitment’s been made on either side. Sometimes that’s the case. You get a feeling, or the presenting issue turns out to be something you don’t work with. Then, it’s easy to be upfront from the start. But at other times, problems only become obvious as the sessions progress. 

I learned this from working with a 14-year-old client. The sessions went really well, and we built a good relationship. Unfortunately, despite their initial enthusiastic agreement to support the therapy, their parents wouldn’t change their approach at all. They focused on and punished failure rather than encouraging signs of improvement. Every step forward we made in sessions was followed by two steps back at home. I felt I couldn’t be of any help in that environment, and we agreed to part ways.

At other times, the client turns out to have no intention of leaving once their goals are met. Perhaps they enjoy the relaxation, or chatting to you. Or maybe the commitment that seemed solid at the start slowly evaporates. None of these things announce themselves on day one. It’s wise to stay alert for these signs throughout, and not just at the first session.

How to Tell a Client You’re Ending Therapy or Referring Them On

The best way to handle this depends on where you are in the therapy process and why you’re stepping back.

If it’s the first contact, and it’s a competence or scope of practice issue

This is the easiest situation to deal with, because you haven’t started any work together yet. There’s no contract or agreement in place.

Just be straightforward and honest. “This isn’t an area I tend to work in, but I can help you find someone who does.” Offer a name or two if you can, or point them at a reputable resource. Your professional body’s website or the Hypnotherapy Directory are usually good options.

I feel it’s better to help where you can, rather than to say “Sorry, I don’t work with this” and leave it there. Often, it takes courage to make that first move, and you don’t want to leave the client with no way forward. And, of course, clients generally respond well to honesty. Over my 20+ year career, I had the most word-of-mouth referrals from a client I turned away because I didn’t think he was ready to make the changes her talked about. He reassured all his friends that if I couldn’t help, I would say so rather than booking them in anyway.

If it’s the first contact and you get “the Vibe” 

This can be a bit harder, because you don’t have a clear reason to give the client. Having said that, don’t make up excuses: your professional judgement is enough. Keep it brief, and don’t get drawn into trying to justify your decision. “I’m not really the right person to work with this, but I can help you find someone who is” is all you need.
Especially if it’s a potential safeguarding issue, consider whether you can ethically refer the client on to another therapist. Or perhaps suggest another form of therapy if you feel it will suit them better.

If you’re already working together, and there is a lack of progress

Focus on progress rather than the client. Ask them to help you review how they think the sessions are going and what results they have had so far. The client should feel as if reviewing your work is routine, not as if they’re being judged.
If the client agrees there is a lack of progress, you can say something like, “You’re right, we’re not as far on as I’d hoped for at this stage.” Then suggest a referral to someone who works differently.
If they are wary of this, point out that it’s a waste of everyone’s time and their money if they’re not reaching their goals, and both would be better spent elsewhere.
This honesty comes across as very professional, and it’s kinder than implying the client is somehow to blame.

If the client is keen to continue but you’re not, validate the way they feel, but again, don’t feel you have to justify yourself. Something like, “I understand you feel [whatever they have said], but I still believe you’d do better with another therapist. I’m happy to help you find someone.”
Don’t be drawn into arguments or negotiations. If the client persists, acknowledge that it’s normal to feel disappointed or upset in the circumstances. Repeat that you will help them find someone more suitable. 

If it’s overdependence once goals have been met

Ending well is part of good therapy, but a few clients can find it difficult when the moment comes.
Sometimes they worry that they won’t be able to keep up the new habits without regular support. So, start by acknowledging the progress they’ve made. Going back to session one and comparing where they are now with where they were when they arrived is a good way of doing this. If you’ve used assessment forms, like GAD7, repeat them and compare the scores. Help the client to see that ending therapy is a sign of success. Give them a clear way to return if they genuinely need to, as that safety net often makes it easier to let go.

If it’s a lack of commitment

Lack of commitment can show itself as failure to complete support tasks at home, frequent changes of time and date to attend, and sometimes in things the client does or says. The best example of this I’ve come across was a supervisee’s client who said, “I waited for something to happen, and nothing did.” This client had had the usual chat about realistic expectations and therapy being a joint process between client and therapist, but clearly hadn’t taken it to heart.

If this happens to you, have an open conversation with the client before you make the final decision to end therapy. Things might still be salvageable. For example, find out what’s getting in the way of them doing tasks at home. Make allowances for genuine obstacles, and help the client to prioritise the tasks more if needed. If listening to your audio every day doesn’t work for them, how often does?
Think about whether your client is struggling because of sabotage from family or friends, secondary gain, or learned helplessness, and perhaps work with that before moving back to the original goal.
If the lack of engagement continues, then you can always discuss with your supervisor whether there might be something you missed. If not, the chances are that it’s time to refer the client on.

When to refer a client on

Whatever the reason you are considering ending your work with a client, or turning them away before working with them at all, the same principles hold.

Be honest, keep the client’s wellbeing and dignity in mind, and offer a next step wherever you can. There’s a lot of research that tells us the most important indicator for successful therapy is the client’s relationship with the therapist. You aren’t doing them or yourself any favours by taking on people for whom that’s likely to be less positive than it should be. 

Frequently Asked Questions on Referring or Ending Therapy

Is it unethical to refer a client to another therapist? 

No, definitely not. It can be hard, especially in the early years of practice when you’re not so experienced or confident in your judgement. And it’s tempting to take on everyone who contacts you when you need to get clients into a new practice. But referring a client because an issue sits outside your competence, interest, or capacity is good, ethical practice. Provided you’re transparent about the reason and support the client in finding the right person if it’s not you.

How do I know if I should stop working with a client? 

In most cases, there should be a pattern rather than one bad session. A consistent lack of engagement, no progress despite varying your approach, a rapport that never quite develops, or a client who’s maybe not as ready as they thought to move on. A strong, unexplained gut feeling in the first session is also worth trusting. And I would always suggest discussing things with your supervisor if you can, before making the final decision.

Why should I refer therapy clients on?

Hypnotherapy, like any talking therapy, depends on the relationship at least as much as the technique. Sometimes the most professional thing you can do isn’t to carry on regardless. It’s about being open and honest with your client and helping them find what they actually need. As always, trust your training, trust your experience. And don’t be afraid to trust that feeling in your gut too.

None of this is about being unsupportive. Or passing on your failures to others.

It’s about recognising that you’re always a step on the client’s journey; you’re just not always the last step. 

References

Ogrodniczuk, J.S., Joyce, A.S. and Piper, W.E. (2005) ‘Strategies for reducing patient-initiated premature termination of psychotherapy’, Harvard Review of Psychiatry, 13(2), pp.57–70.

Stolper, E., Van Royen, P., Van de Wiel, M., Van Bokhoven, M., Houben, P., Van der Weijden, T. and Dinant, G.J. (2009) ‘Consensus on gut feelings in general practice’, BMC Family Practice, 10(66).

Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.