AlTORNEY REFERRAL OF CLIENTS FOR COUNSELING.

Mark R . Roth'

Introduction

Frequently, persons seek professional con- sultation from their attorney during a crisis period in their lives. "Crisis" may be defined as a major turning point or decision time in life and/ or as a period in which the person's normal modes of experiencing and functioning are disrupted. Family and relationship issues fre- quently precipitate such crises for persons. Sometimes when individuals are facing the pos- sible dissolution of a marriage into which both partners may have invested much of themselves and years of their lives, those persons also are in need of psychological or counseling services. The way in which an individual handles the crisis and the decisions which are made may affect his/ her life for years. For example, a spouse may act out of a tremendous sense of anger but not in his/her best interests in the long term. In this paper 1 will outline some of the conditions in which an attorney's referral of clients to a professional therapist might prove beneficial and help the client to meet the crisis in a positive way. I also will discuss some of the kinds of resistance which may arise from such a referral for counseling and some alternative ways of ap- proaching those responses.

Kinds'of Referrals

of 1.

2.

3.

4.

In summary, referrals may be made for any the following reasons: Counseling, either separately or together, to help improve a marriage. Individual counseling to facilitate decision- making for marriage, separation, etc. May involve resolution of internal conflicts and ambivalence. Adjustment to separation or divorce. Growth in new life style. Adjustment of children. Help in coping with stress, dealing with de- pression, anger, etc.

5. Support during crisis. 6. To facilitate settlement issues. 7. Other family-related problems.

Under some circumstances, the referral of a couple or spouse for marital counseling makes good sense. Marital counseling might be sug- gested when there seems to be some interest in improving the marital relationship even if the prospects of such improvement seem dim. Sometimes when questioned, the client or cou- ple may reveal some interest in or wish for im- proving the marriage rather than ending it. How- ever, they may have been so frustrated in their previous attempts on their own that this interest has eroded and has been replaced by indiffer- ence. Sometimes the spouse seeking a divorce feels like he/she would like to do all that is rea- sonably possible to salvage the relationship be- fore taking that final step. Counseling may prove beneficial in such cases, even when it is ineffec- tive in improving the relationship because in the process, certain needs in the individual are satis- fied, e.g., that all reasonable efforts have been made to make the relationship work. Some- times, the counseling is seen as a last resort in which divorce appears inevitable. In such cases, therapy may help to alleviate guilt and to make more clear that dissolution of the mar- riage is the most prudent course. Thus, in the long term, failure of counseling as a "last ditch effort" to save a relationship still may offer ben- efits for the individual/s involved. A case comes to mind in which a young woman finally acted on her decision for a divorce after joint marital counseling revealed that her husband was un- yielding and unwilling to compromise. Had not these traits been so clearly underlined to her through the sessions, she might not have reached that wise decision or else might have been haunted by doubts and regrets afterwards. Of course, it goes without saying that when joint couseling is successful in improving a relation- ship, both clients usually feel that the venture was well worth the time and investment.

Sometimes a client feels torn and conflicted inside and Professional COflSUltatiOn Often

"Mark R. Roth, Ph.D. isa counselor at the Buchanan Coun- seling Center, a pastoral Counseling service of the Chap laincy Department of Methodist Hospital, Indianapolis, . . Indiana. proves helpful. The client may show serious am-

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bivalence, i.e., that he/she feels in conflict. such that one "part" of the person seeks to act in one way and another "part" wishes to act in the opposite way. This is often the case in a marital crisis involving conflicting loyalties. At times, the client may wish to give up on the relationship, seeking freedom from it while at the same time, he/she feels the years of invest- ment in the relationship and longs to restore it. Often the ambivalence represents a conflict be- tween feelings versus thinking. A rational analy- sis may point to one decision, while feelings point in the opposite direction. For example, in- tellectually the individual may know that she is maintaining a destructive relationship, but may feel too afraid or too guilty to end it. An opportu- nity to resolve some of this ambivalence with a therapist prior to making a decision would be helpful and would likely contribute to the best long-term interest.

Death of a spouse or divorce represents one of the most stressful events that one can experi- ence. Such stress may be extremely difficult for the person to handle or may precipitate more serious psychological maladjustment. In such cases, referral to a professional clearly seems desirable. For example, anticipating a divorce and the alteration in life style which it brings may trigger severe depression or anxiety, partic- ularly in persons already emotionally vulnerable, highly stressed or interpersonally dependent. Some of the signs of depression might include wide fluctuations in mood, prolonged crying spells, withdrawal from others, loss of weight and sleeping and appetite disturbances, diff icul- ties in concentrating at work, or generalized apathy and loss of interest in that which was formerly enjoyable. The presence of these signs may alert the attorney that his client may need professional help in order to adjust successfully to the changes. In some cases, if help is not received during the crisis, patterns of withdraw- al and depression may persist or become ingrained. Difficulties dealing wi th intense feelings of anger may require professional con- sultation. Sometimes one facing a divorce has a sense of intense outrage and indignation (e.g., perceived betrayal by mate or injustice of settlement), which can be destructive for the individual or to others if these feelings are channelled poorly. If the client can learn to ef- fectively deal with the anger during the crisis,

he/she might be well served in future crises when faced with possible loss of control.

Related to the adjustment issue is the fact that persons tend to require more support dur- ing times of crisis than they do otherwise. The individual may reveal that he/she has few sources of support from friends, relatives, etc. Nevertheless, the client may have heightened need for affirmation from others, for guidance, or for someone with whom to share a lot of troubled feelings and fears. Some of these needs might be met by an empathetic therapist who can help the client through this difficult period. When the crisis has passed, the person may or may not require additional therapy.

In some cases, couples seeking divorce need to process a number of detailed settlement issues, not only involving the intricacies of divid- ing material wealth but custody issues around which there are naturally intense feelings. Sometimes emotional needs or conflicts may in- trude and impair the settlement process. The settlement process may be used as a battle- ground for the acting out of angry feelings or for exploitation. In any case, anger, threats and recriminations retard the settlement process and make it more difficult to reach feasible agree- ments. In such cases, referral to a professional therapist to assist in resolving some of these difficulties and learning how to deal with feel- ings in ways that are more mutually beneficial may be indicated. In some cases, the opportu- nity to ventilate angry feelings and to have mis- interpretations of personal behavior clarified by a behavioral scientist may be sufficient.

The instance where an overly dependent client is using or demanding an inordinate amount of the attorney's time with endless de- tails, prolonged ventilation of feelings, or the verbalizing of conflicts may alert the attorney to the client's likely need for counseling. The attorney may become frustrated at points with the client. In any case, coming to grips with conflicts and feelings which surface when a major relationship is in the balance is time-con- suming but ofteri necessary. If the person does not have an opportunity to process these feel- ings, conflicts, etc., in constructive ways, chances are increased that they will lead to de- layed maladjustment, acting in immature or harmful ways, and the inability to profit from mistakes made in the past.

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Other family-related personal or profes- sional problems sometimes are best solved with the aid of a professional. For example, a case in point involves a bright, competent president of a company who was having serious difficul- ties dealing with his father who was chairman of the board. The client gradually learned how to relate more assertively with his father and to feel less intimidated by him. This needed to hap- pen in order for the transfer of power and au- thority in the company to occur effectively.

Helping the Client Accept Referrals

It is important that the client accept that the referral is in his/ her best interest and is not a rejection by the attorney. In some situations, the need for counseling may be clear and the clientls receptive to it. In those cases, a simple suggestion by the attorney that the client seek counseling and perhaps appropriate recommen- dations as to where the person might obtain such services are sufficient. In such cases, the client frequently will take the referral and usually benefit from the counseling, as client receptivity to and motivation for therapy are correlated with successful outcomes. In other situations and with other persons, the attorney may need to provide some explanation for his suggestion for counseling. For example, the client may have a vague sense that he/she needs help, but it may require some help or encouragement from the attorney in whom he/she has trust in order to sufficiently motivate the person to obtain that help. On the other hand, if the client is adamant- ly against counseling, particularly in a rigid per- sonality, attempts at persuasion or recommen- dations may fall on deaf ears.

An explanation might include a rationale for the counseling, i.e., how it might benefit the client. Depending on the circumstances, the at- torney may wish to emphasize any combination of the following benefits: 1 .

2.

To help improve a relationship in which much has been invested and the potential rewards of such improvement to all parties involved including children. Alternatively, it would seem beneficial to process carefully any major decision with regard to the rela- tionship so as to increase the chances that wise decisions eventually are made. To help reduce the pain level for all con- cerned. The deterioration of or severing of

3.

a relationship and/or of a family often brings much internal pain to al l involved. The pro- fessional may help those involved in adjust- ing to and reducing that level of pain. To increase the likelihood of successful ad- justment and fulfillment in the future. Often, there are intense feelings of guilt and of fail- ure at the time of a divorce, especially if chil- dren are involved. The loss of self-confidence and sense of failure may promote feelings of inadequacy, of doubts about one's capa- bility of loving or being loved in the future, etc. An opportunity to review actions in the past and to help build positive interpersonal skills for the future may go a long way to restore hope and self-esteem.

Clients sometimes feel threatened by .the recommendation that they begin counseling. Sometimes they construe such a suggestion as a sign of personal weakness or personality defi- ciency. When appropriate, some of these per- sons need reassurance that the focus of such therapy would be on treating a dysfunctional relationship, i.e., relatively healthy individuals may be embroiled in a disturbed and painful marital interaction. Sometimes a "personal growth" or educational approach is much more appropriate than the "medical" model. That is, clients sometimes need reassurance that the focus of therapy will be on changing self-defeat- ing patterns in relationships and enhancing the person's personal fulfillment in life rather than on treating "sick" individuals.

Often the fee issue will act as a deterrent to entry into counseling. That is, clients will re- port that they cannot afford the cost of the ser- vices. Sometimes objections to counseling on the basis of fee is genuine and represents a real lack of financial resources whereas, in other cases, fee issue is really secondary. Objections may represent resistance to counseling for a va- riety of reasons, e.g., emotionally threatening, sign of weakness, etc. Again, there is a middle ground. That is, with some clients, therapy could be afforded but only if the investment in it is seen as very important and of high priority. Thus, the person may need to decide if the counseling is worth sacrificing some material goods or other services for a period of time. Ultimately, this becomes a matter of personal values.

In any case, counseling can become afford-

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able to a wider number of persons under cer- tain conditions. Sometimes the attorney may wish to discuss that with his/ her client. Some mental health or counseling agencies in the community, as well as some private practi- cioners, have "sliding" fee scales, in which ad- justments from a standard fee can be made based on the client's income/or ability to pay. Under some circumstances, short-term counsel- ing, i.e., less than ten sessions, can be effective in reaching goals. It is sometimes productive for client and therapist mutually to set specific goals to be met in a limited number of sessions, e.g., reducing confusion, recovering from depres- sion, etc. In any case, short-term counseling need not be highly expensive. Another option might be entry into a counseling group after initial rapport has been established with the therapist. Group fees often are lower than fees for individual counseling and in many cases, offer the client the benefits of emotional sup- port, role models, and opportunity for identifica- tion with others with similar concerns. In any case, the client needs to feel convinced that suc- cessful counseling involving more satisfying re- lationships, greater self-awareness and fulfil l- ment, or whatever hislher goals might be, is really worth it in order to be willing to invest the necessary time and money.

In making a referral to a professional thera- pist, it is appropriate for the attorney if he/she

wishes to make contact by phone or in writing with the referral source. It is also reasonable for the referring attorney to expect some form of feedback from the therapist regarding the eval- uative and/or counseling services provided for the client. A standard procedure is for the client initially to sign a record release authorization, giving his/ her permission for two-way com- munication between the therapist and the attorney.

Closing

I have attempted to review some of the times in which the attorney's referral of his/ her client to a professional therapist might prove beneficial. Some of the issues and difficulties related to such a referral were also discussed. There are crucial moments in the lives of every- one. Often the attorney sees his client in a time of crisis. The crisis may be construed as a two- edged sword. It can lead to personal growth, a more abundant life, and greater realization of one's objectives or it can precipitate gradual per- sonal deterioration, both emotionally, socially and vocationally. The client's attorney often rep- resents a very potent force in his/her life. Like- wise, competent psychological assistance in crucial moments can help to tip the balance in one direction or another, influencing the path of an individual's life for years to come.

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