Determining the correct level of care ensures that clients receive the most effective treatment. For cases in which a client needs additional structure and support beyond outpatient treatment, it’s useful to refer them to a more intensive, structured, and supervised program.
Some common reasons for a higher level of care:
- Medical concerns
- Need for more structure
- Poor insight
- Suicidality/self-harm
- Lack of social support
Yet, clients have the right of self-determination and can choose the care they want (aside from risk). While they may not be ready to commit to a higher level of care, we can always encourage an assessment to rule out treatment options. While we cannot make the client get an evaluation, sign a release, or attend therapy, we can discuss their concerns about these steps and process the anxiety they may have around them. It’s unfortunate that some clients seek to terminate their treatment rather than meet up to talk over these concerns. Yet again this is the client’s decision. We can reach out and invite a discussion about this situation and possible paths forward. We are on the same side. We want them to be healthy. We can honor their choice, even if it leads them to another provider. Ultimately, they are coming to see a therapist to get our recommendations, and that is what we are providing. As a final note, always be sure to document your recommendations, their refusal/acceptance of them, and any other outcomes.
Aaron Karmin, LCPC, is a licensed clinical professional counselor who earned his master’s degree through Roosevelt University in Chicago, IL. In addition, Karmin is a certified clinical hypnotherapist, and holds an advanced certification in stress management. He is author of The Anger Management Workbook for Men, and his approach focuses on identifying physical cues, recognizing thoughts, considering consequences, implementing solutions, choosing behaviors, and promoting expression.
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