How Do I Know When My Client Needs Residential Treatment?

Recommending a client for residential treatment can be stressful. You want to know you’re making the right choice by talking to them about a higher level of care. In private practice, clinicians feel a considerable amount of responsibility for their clients. After all, there is only one of you making important decisions for them. Yet, there doesn’t have to be. 

If you need some clarity on choosing the initial referral, this list of warning signs can help.

7 Signs Your Client Needs Residential Treatment

Seven signs your client may need residential treatment include:

 #1 They Are No Longer Able to Care For Themselves

Perhaps they are not using coping mechanisms, aren’t tending to their daily needs, or are actively endangering themselves or others. Self-harming and risky behaviors indicate an immediate need for a higher level of care.

#2 They Are Engaging in Substance Abuse

Whether your client is relapsing or coping with drugs or alcohol for the first time, substance abuse requires treatment intervention. SAMHSA compares substance dependence to other long-term conditions like asthma, high blood pressure, or diabetes. These conditions can’t go untreated by professionals certified to treat them, and neither should substance abuse disorder.

#3 They Are Lying During Sessions or Dodging Appointments and Phone Calls.

Combined with other concerning behaviors, dodging your efforts to get in contact may indicate a decline in stability or renewal of dangerous habits. Without the accountability that comes with your sessions, they may be making risky decisions. Additionally, if you can’t get a straight answer out of them, they may be covering for the fact they are spiraling.

#4 You Feel Out of Your Depth Providing Them Care

Your client may be honest with you. However, they may be bringing up issues that you frankly don’t know what to do with. If you don’t feel equipped to help a client based on your current specialties or abilities, it is a good idea to issue that recommendation.

#5 The Client Admits to Their Social or Family Life Falling Apart

Relationships falling apart could be an indicator that their behaviors at home are threatening to others. If you have reason to believe the client is not the cause for these systems breaking down, then insulating them in a new support system could be life-saving.

#6 Their Assessment Results Are Cause for Concern

It could be your client is brand new to you, or you followed an instinct that their behaviors weren’t baseline. When in doubt, use the SBIRT process to assess your client’s level of risk. When you see the results, if alarm bells are ringing, don’t ignore them.

#7 It Feels Like Your Sessions Aren’t Long Enough to Help Them

Clients who show distress at the end of a session are longing for help, and the private practice system may not be able to provide the in-depth treatment they need to continue in a healthy way.

The most effective way to make a recommendation for transition into a treatment facility comes down to knowing your limits, knowing the limits of your client, and reading their behaviors accurately. However, talking to them about this transition may spark fear and anxiety about how they will react. How would you even start that conversation? 

Conversation Stems for Talking With Your Clients About Residential Treatment

It’s a delicate process telling your client they need more help. The best way to handle this conversation is with honesty, transparency, and compassion. As someone who cares about their success, you know this, but perhaps knowing what to say is more challenging.

Here are some examples of conversation stems that encompass those requirements:

  • “You know that, as your therapist, I only want what is best for you. I see you have a need that I do not have the tools or skills to satisfy. That is why I would like to recommend something that would be of more help to you.”
  • “During the last several weeks, I’ve noticed things that concern me about your behavior. Because I want you to stay healthy and safe, I wanted to start a conversation about a new means of treatment that could be a better option for what you are struggling with.”
  • “I wanted to talk to you about your assessment results. Your answers indicate that you are struggling deeply with something I fear I cannot handle effectively. How would you feel about moving to a more comprehensive type of treatment?”

Keeping the conversation about their health, treatment that will benefit them, and your unconditional concern for their success will motivate them to listen with an open heart and mind.

Broaching the subject of residential treatment with your clients can be challenging, but as their mental health care provider, you know you want what’s best for them. When you’re unsure if they need residential care, look out for behavior that indicates they can no longer care for themselves. They may also be a threat to their social and familial relationships. In addition, substance abuse and self-harming behaviors are immediate causes for residential treatment recommendations. Remember to approach them with kindness, understanding, and genuine concern for their well-being when you initiate this conversation. Speak objectively but kindly. When they are receptive to a higher level of care, call Casa Recovery at (888) 928-2272. We are equipped for inpatient and outpatient care to match your client’s needs wherever they are in their mental health journey or we will provide the most appropriate referrals to meet their individualized needs. Our individualized treatment programs can provide them with the therapy modalities, community, and enrichment they need.

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