When and How to Refer
Imagine this. You are a massage therapist with a wonderful and very consistent client who has been coming to you for two years. She tends to chat on the table and you know a great deal about her life, which is tremendously stressful through no fault of her own. You know that her chronic pain and muscle tension is greatly aggravated by the stress, as well as her own mental state. Your work alleviates the muscle tension and gives her some relief, but it does not last very long. You are familiar with another complementary care technique that could potentially reduce her pain to near zero. The problem is that you know she cannot afford both this treatment and your massage. What do you do?
Until insurance companies are willing to pay for the majority of complementary care, this is an ongoing consideration. In my experience, it is an unusual person indeed who goes to more than one complementary care practitioner at a time, and the reality is that you can lose a client by referring them out. The balance to this is your relationship with other practitioners. Ideally, your client will eventually have several wellness professionals to help them live to their full potential, and you become part of that team.
There are some situations in which you must refer out. Any acute or chronic condition that the practitioner is not qualified to treat must be referred to an appropriate professional. Acute conditions must be referred immediately. If you are not qualified to treat the condition, get your client to someone who can as quickly as possible. The woman who ran my massage school told us a story of a long-term client of hers that came back from a trip with a badly swollen foot. He arrived at her office for a massage and she promptly packed him off to a doctor. She found out later that the condition had been life threatening and if she had allowed him to wait, there would have been dire consequences.
If a client has a chronic condition that is not showing improvement from your treatment within 3 or 4 sessions, that is also a good time to refer. My husband is often told how lucky he is to be married to a massage therapist, and I am usually able to help him with his various aches and pains. But some things are beyond me. He was having a persistent pain in his wrist. Although I was able to find and relieve a number of trigger points in his forearm, the pain did not go away. After some nagging, he finally took himself off to an acupuncturist and was much improved after two sessions.
Finally, we return to the situation from the first paragraph. Your work is helping, but in the long term, your client maintains the same level of not-quite-well-being. In this situation, the best thing is to ask a few questions, and then really listen to the answers. Does your client feel your work is beneficial? Are they getting what they expected from their relationship with you? Are there results they are not getting? Remember there are many reasons why people go to complementary care. Some clients are referred by their doctors for stress reduction. Some have chronic pain that standard medicine has been unable to help, and some have just had wonderful experiences with your modality and want to do something nice for themselves by having another session. Before you can refer effectively, you have to know your client and why they are coming to you.
Once you have decided that referring is a good idea, the next step is to determine to whom you should refer. Simply reading the information in this book will give you a better picture of the different modalities. To help you determine which type of client you might refer to which type of practitioner, I have created some client profiles.
Profile 1: A 75-year-old man is coming to you for Reflexology. He loves having his feet worked on, and comes to you because he feels he deserves it. He is generally active but confesses during one of his session that lately his balance has been off and he is becoming afraid of falling. You suggest Feldenkrais or Tai Chi, both of which have been shown to improve balance in elderly people.
Profile 2: A 46-year-old woman is coming to you for massage, primarily for stress reduction. She is a little over-weight and quite stiff. She tells you she knows she needs to exercise more but just hates weights and treadmills. You can see that she needs the mental skills to deal better with her stress as much as she needs the physical activity. You recommend yoga or tai chi, knowing that either of these will teach her to center herself while adding gentle and unintimidating movement to her life.
Profile 3: A 40-year-old man is coming to you for Reiki. He has not had consistent medical care because he utterly distrusts Western medicine. Recently he has been having digestive disturbances but does not want to go to a doctor. You recommend a Naturopath, explaining that this sort of doctor uses only natural methods for healing and can be a partner in his ongoing health care.
At some point, you are likely hear back from the professional to whom you have referred your client. At this point, you may not discuss your client without their express written permission. Not only is it unethical, but it can lead to serious legal problems. Even if the state where you live does not regulate your profession, be sure to take care of your client and yourself by maintaining their privacy.
Referring to the right practitioner earns you the high regard of both your client and the other professional.
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