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  • Writer's picturePiper Harris

When to Refer Out: The Skillful Art of Recognizing the Limits of Counseling



As mental health counselors, our primary aim is to support and empower our clients on their journey towards emotional well-being. However, it is important to acknowledge that we do not always have all the tools and expertise necessary to help every individual who seeks our assistance. Ethical guidelines dictate that we must practice within our area of experience, even when it means admitting our limitations to ourselves and our clients. In this blog post, I would like to share a story that highlights the challenges and growth I experienced as a mental health counselor.


I had the privilege of working with a client battling Borderline Personality Disorder (BPD) for almost a year. Throughout our sessions, I witnessed her strength, resilience, and determination to overcome the difficulties that BPD presented in her life. Our therapeutic relationship was built on trust, respect, and a genuine desire for her well-being. As we delved deeper into her struggles, it became increasingly clear that my ability to assist her was limited.

Borderline Personality Disorder is a complex mental health condition that requires specialized treatment. Although I had received some education on BPD, the depth and complexity of her needs exceeded my professional capacity. It was an incredibly difficult realization to admit to myself and even more so to express to my client. I lacked the capacity to dedicate additional time and energy to studying and applying to another area. It was necessary for me to acknowledge my limitations.


Saying goodbye to a client is never easy, especially when you have invested so much time and energy in building a therapeutic relationship. In this case, it was particularly challenging as our connection had grown. The moments we shared, the tears we shed, and the triumphs we celebrated together touched my heart and forever transformed me as a clinician.


However, with complete honesty and guided by ethical principles, we acknowledged that my assistance was no longer sufficient for her unique needs. We parted ways, but not without mutual understanding and respect.


Months later, we reconnected, and she was armed with an array of phenomenal resources she had discovered along her journey. She had built her own support system, connecting with clinicians specializing in BPD, joining support groups, and advocating for herself. The impact she had on my life as a clinician was immeasurable. Witnessing her strength and resilience inspired me to continue learning, growing, and seeking new ways to improve my skills as a mental health counselor.


She shared a response with me that exemplifies the profound healing that can occur when individuals engage in the difficult process of counseling and apply the skills and tools they learn. She has given her permission to share below.


In Her Words: Borderline Personality Disorder


Here is her poignant message:


"I have come to realize that there is a deep-seated stigma surrounding Borderline Personality Disorder (BPD). From my perspective, BPD exists on a spectrum, and the majority of individuals who suffer from this disorder are actually kind, loving, and caring individuals who simply need to hear the truth. We who have BPD experience life in an emotional reality rather than an actual reality due to our high sensitivity and intensity. Sadly, because of this stigma, I have encountered many people who have suffered needlessly for years simply because some clinicians have been taught to fear us. They've been told that BPD is an untreatable condition and that we are inherently unstable and unpredictable. However, there is a wealth of new research indicating that it is highly treatable and not a chronic disorder.


As individuals with BPD, we often struggle with an underdeveloped theory of mind, social deficits, cognitive empathy, and mentalization. Essentially, our emotional mind operates at a developmental level similar to that of a 9-14-year-old. But the good news is that we are capable of learning the skills we were never taught during our childhood. While our intentions are often good, we can lose ourselves in the emotional mind, causing our actions to misalign with our original intent due to emotional delay.


What sets Rose's {therapist she found} approach apart is that she grounds it in truth -- the harsh realities of how BPD affects those around us. These are things that few are willing to admit due to the shame associated with them. Her approach also involves building an identity based on a moral compass that remains steady despite our fluctuating emotions. It requires recognition that our intense temperament necessitates intense outlets, as well as learning emotional regulation, empathy, and understanding that others have their own thoughts, feelings, and emotions. Moreover, we need to acknowledge our hyperbolic personality and dial it back in order to understand and respect the neurotypical point of view, thereby helping us connect with the people around us.


Personally, I have experienced tremendous growth by learning about the neurotypical mind or the perspective of the "average" person. It is more empowering for me to gain this perspective rather than expecting others or the world to cater to my needs.


The unique aspect of Rose's treatment approach is that she has lived through BPD and has overcome the obstacles associated with it. She is a living embodiment of someone who no longer suffers. She teaches people that there is another way of life and that it doesn't have to be a painful existence. It's a choice, and the only way to discover that there is another choice is by being told the truth -- even if it is a harsh truth.


For anyone looking to support their clients or other clinicians in this area, I highly recommend listening to Rose's podcast, "From Borderline to Beautiful." She has also created a community to help individuals begin their journey. In the recent podcast episodes, she provides information on how to join and which platform it is offered on. Her licenses and credentials are MA, LPC, PN2.


This community is truly amazing. It is filled with people who have hope and a desire for a better quality of life. Rose and her husband run it, and having her husband's perspective is invaluable as he has been on the receiving end of the disorder. He also offers support to loved ones in relationships with individuals who have BPD. They have been together for many years and met while she was still in the throes of the disorder.


Within this community, they offer weekly live streams with an open chat for questions, weekly Zoom book club meetings, and categories that cover nutrition, mindset, fitness, and spirituality. They have made it their life mission to serve others and help break the stigma.


I want to express my gratitude for the skills you taught me. I continue to use them regularly in my life. Once I discovered that I was suffering from BPD, it brought new meaning to everything. I was finally able to clearly see how to apply what you taught me. I refer to the realization of my diagnosis as my "key"; it opened the door to truth, to reality, and to the real world happening around me. Before that day, I was not living in the real world. It was heartbreaking to realize that I had been creating problems that didn't exist and the damage the disorder had caused throughout my life. Once you see that truth, you can never unsee it. Looking ahead, I hope to have the opportunity to share my story with others so they know there is another way of life.


Thank you for providing me with a safe space to explore myself. You helped me separate myself from the monster I believed I was. I now know my true self, who I am. Through my journey, I have found freedom and the tools to build the life I want and deserve."


Transformative Power of Counseling


Her words capture the transformative power of counseling and the incredible impact it can have on an individual's life. It is a testament to the resilience and growth that can be achieved when we confront our challenges head-on.


As mental health professionals, we have an obligation to continually educate ourselves about the latest research, interventions, and therapeutic modalities. However, it is crucial to recognize that there will always be limits to our expertise. Admitting these limits, seeking appropriate referrals, and maintaining open communication with our clients are fundamental aspects of our ethical code. This is a core reason why we have created our Holistic Provider Network; I do not believe in the old adage "Jack of all trades" as this leads, I believe, to a "Master of None" and why I fully embrace referring clients to providers for all areas of their lives.


My experience with a client battling Borderline Personality Disorder taught me the importance of humility in mental health counseling. It highlighted the boundaries of my knowledge and expertise and reinforced the need for ongoing personal and professional growth. While I couldn't provide her with the help she needed at that time, the impact she had on my life taught me invaluable lessons. I am forever grateful for the courage and tenacity she displayed, reminding me that even as mental health counselors, we are not infallible, but we can still make a difference in someone's life.



 

Exploring counseling is truly transformative. If you would like to learn more, please visit the link below to schedule a complimentary consultation to learn more about how we can partner together in your healing and success.




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