WHEN TO REFER? A checklist for what situations requires referral. Prov. 1:1-3

 It is essential that pastors working with the mentally ill: 1) get enough clinical pastoral education—or attend workshops with other professionals—where you will discover the usual reasons that a referral must be made, and 2) discover by experience or in a clinical course the amount of anxiety that will prompt a referral.
One of the quickest ways to feel confident about a referral is to analyze your own anxiety. Remember, in your first meeting with a person in trouble, it is not only the counselee’s anxiety that must be managed but also your own anxiety as well.
What are the areas of living in which you feel more comfortable in discussions with someone who needs help, and other areas in which you must make a referral to a more specialized or professionally competent helper? When a church staff of 20 people considered areas of personal concern, they made the following distinctions:

Almost always refer:

  • Questions about the mysteries of life that have medical implications, such as abortion, unplugging a life support system, or deciding whether or not to get pregnant against medical advice.
  • Behavior or situation that is scary or really peculiar like the young man who sat staring at the ceiling for a few minutes, then said he was finished with life. His father was with him and said the son had just bought a 38-caliber revolver.
  • The husband who says there’s nothing wrong with him sexually, even though his wife is sitting right there and says that he demands a separate bedroom, and spends every weekend and all his vacation time with an unmarried friend down the street.
  • The daughter who starts yelling at her mother, “You’re ruining my life,” when the mother says in anguish that she just wants to keep her daughter out of a known drug dealer’s “safe house.”

Often refer:

  • People who say they keep waking up with a nameless dread that weighs on them all day long.
  • Couples who ask for prayer to keep their marriage together and then hurl verbal abuses at each other until you get one of them out of the room.
  • A single mother who confesses that she spends most of the nights in tears, most of the day avoiding people at work, and yelling at her children in the evening.
  • Lonely and pious church members who say they have committed the unpardonable sin, or behave like they have.
  • People who raise questions in areas where they need help now, but we may not be experts in areas such as legal matters, what kind of job to look for, or how to get on welfare.

Sometimes refer:

  • People who ask about the meaning of life but aren’t able to be more specific about their concerns
  • People who say they can’t forgive.
  • Pain and suffering beyond anything we have ever been called on to bear.
  • A friend who says she prays and prays but has no hope for the hereafter.


  1. How has your own anxiety impacted previous counseling relationships? How would you go about analyzing and managing your own anxiety before entering a counseling situation?
  2. Do these distinctions of when to always, often, and sometimes refer match up to your experience? Which would you place in different categories? What kinds of situations would you never or rarely hesitate to serve as the key counselor?
  3. Are these kinds of distinctions communicated to others in your ministry who counsel or refer people? If not, what is your plan for discussing and communicating these distinctions?

—Roger Hesuer and Samuel Southard are professors of Church Leadership Studies at Vanguard University of Southern California; adapted from Caregiving Leadership (CMR Press, 1999); © 1999 CMR Press. Used by permission.


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