when to refer athletes for counseling or psychotherapy canst thou not minister to a mind diseas’d,...

Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

When to Refer Athletes for Counseling or Psychotherapy

Canst thou not minister to a mind diseas’d, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuff’d bosom of that perilous stuff Which weighs upon the heart?

—Macbeth, act V, scene iii

David Tod & Mark B. Andersen

Chapter 20


Performance Consulting• Provides help for issues such as competition anxiety,

motivational problems, negative self-talk, & concentration difficulties• Services are education based• Not uncommon for athletes to bring up personal issues• may or may not affect performance• need to address, assuming one is qualified to do so

• Separating “performance” from “personal” issues is a false dichotomy• performance is a personal issue


Depression• “The common cold” of mental health

disorders among the general population• Athletes often experience depressed moods

following losses or failures to perform as hoped or expected• May need help to get through the sense of

loss or disappointment

Depression (cont.)

SIGNS• Social withdrawal• Hopelessness• Loss of self-esteem• Lethargy

TREATMENTS• Psychotherapy • Antidepressant medication• Referral to another professional

Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written

consent of McGraw-Hill Education.


When to Refer and What to Do• When a sport psychologist is faced with an athlete or coach

whose presenting concern is outside the practitioner’s realm of expertise or in need of medication

1. Refer the client to another therapist or physician for treatment

2. Consider upskilling to become competent to work with future athletes presenting with the issue


Performance Enhancement Versus Problematic Personal Issues• This is a false dichotomy!• Problems in performance are related to issues like

competition anxiety, motivational problems, poor self-talk, and lapses in concentration BUT other factors may be involved• There are always interrelated issues between the

personal and performance• Getting athletes to talk about their lives can lead to

understanding their performance or motivational problems, as well as the whole person


Indicators for Referral

1. Problem is severe, has existed for long time, and affects many aspects of the person’s life

2. Unusual or extreme emotional reactions• e.g., depression, anxiety, anger, aggression

3. Traditional interventions not working• determine if the problems are related to other

deeper/stronger issues


How to Start the Referral Process• Instead of referring out, refer in • Bringing in a qualified professional and having all three

parties sit down and discuss a plan may be less threatening to the athlete

• All referrals are complex and sensitive in nature


Problems When Referring• Lack of a good working relationship between sport

psychologist and athlete• Athlete might think consultants are trying to get rid

of them• Athlete might infer they are damaged goods

• Athlete may feel unsupported • Practitioners may not have prepared athletes

adequately for the referral process• Begin preparation right from the start by signaling to

athletes in their first sessions together that referral might be a possibility in the future

• Athletes might never contact the recommended expert


Specific Athlete-Related Issues


Identity Issues• Sense of self has revolved around their roles as athletes • Overidentification

• Major threats to identity can come through athletic injury and through career terminations • Also negative identities• The acceptance and valuing of an identity that is generally

disapproved of by society• Dumb jock • Tough jock


Sexual Orientation and Abusive Environments• LGBT athletes may struggle with the “coming out” process,

but sexuality is not their primary issue…abuse and discrimination • Fears about getting less playing time, being kicked off

teams, being harassed, and being physically abused if their orientations were made public

• Can result in anxiety disorders, relationship problems, depression, and even suicidal ideation


Sex-and Health-Related Issues• Athletic careers start seriously sometime during adolescence

and usually end somewhere in the mid-20s to late 30s…prime time periods of experimentation, exploration, and finding out about oneself• Risk-taking behavior in the realm of sex• Athletes in general engage in sexual behavior more

frequently and have more partners than their nonathlete peers• STD risks


Eating Disorders

• Affects men AND women• Men usually control weight via saunas, steam baths, and

exercise, and women more often use purging, diet pills, and laxatives• Central feature is often disturbance in body image• Warning signs: weight loss or preoccupation, avoiding food

social functions or eating little, visiting bathroom after meals, bloodshot eyes, decrease in energy or concentration, gastrointestinal complaints, increased emotional swings• EXTREMELY DIFFICULT TO TREAT


Alcohol and Substance Abuse Issues• The association between masculinity and

drinking may make some athletes more vulnerable to developing problems in this area• Student-athletes are a high risk group • “Sensation seekers”• Given denial and defensiveness around alcohol

and drug use, coaches or sport psychology practitioners concerned about these issues can note their concerns, but not in lecturing or threatening ways.


Anger and Aggression Control• Someone going through a personally difficult time may be

less able to control anger or aggression• On or off the field• Alcohol and drug use may also be related to such

behaviors• Roid rages


Romantic and Family Relationship Issues• Many athletes have to be away from friends or family for

extended periods of time • Can cause loneliness, anxiety, and depression

• There may be conflicts in the relationship• Practice and competition place demands on the athlete’s time

at home• Lost of pressure• Intrateam romantic relationships

Professional Development• Develop knowledge about:• Psychopathology• Psychopharmacology• Performance enhancement substances

• Read biographies of athletes who have experienced mental health issues• Develop a network of various individuals • To refer for both psychological and sport and exercise science-

related issues• Psychiatrists, clinical &counseling psychologists, social workers,

pastoral care providers, marriage & family therapists, substance abuse counselors, and career guidance experts



Professional Development (cont.)

• Engage in regular supervision and peer consultation• Role play referrals for a variety of issues and types of

athletes• Engage in self-reflection and examination to find out how

your experiences, needs, etc. might influence the referral process

when to refer athletes for counseling or psychotherapy canst thou not minister to a mind diseas’d,...

Documents

athlete athlete

professional copyright

written troubles

nature copyright

personal issue copyright

disappointment copyright

person copyright

future athletes