Life can be extremely challenging at work and at home. It can get the better of us all at one time or other. As a result the World Health Organization says that depression and anxiety disorders, including stress-related psychiatric issues, are set to become just as prevalent as cardiovascular diseases.

As a coach, you’ll probably find yourself working with clients who might need more than your excellent coaching support. They might actually be suffering from a mental health issue, in which case they’re likely to need therapy as well as or more often instead of coaching.

How do you know when someone would benefit from seeing a therapist? Because there’s still a considerable stigma around mental health problems, coaches need to be sensitive around referring people onwards for different professional support. Knowing when to refer your client to someone like a psychotherapist or counsellor is essential.

It is all about knowing your client. If you have been coaching your client for a while noticing when they seem to have changed is crucial. Is there an obvious heightened level of distress or continuing low mood being expressed in the sessions?

They might start to present themselves in new ways, looking and behaving differently. As their coach, whether you’re face-to-face or meeting remotely, you might notice they’re either very agitated and full of high energy or unusually low in energy, even depressed. When you see signs like this happening over more than one session, you can begin to assume it might be a developing pattern or an old one that is resurfacing. That deeper issues may be causing this change of appearance or mood. They might be flipping between extreme moods or confused, distant and foggy in their thinking.

Perhaps your usually-positive client just can’t seem to get past a particular issue or problem. When you mention it, they tend to ruminate on it and spiral down into it. It absorbs all of their attention. There’s a powerful emotional element to it, and you can’t seem to either help them get out of it or find a solution. Their problem-orientated stance can easily move into an even less helpful ‘poor me’ syndrome, or they might take a blame stance, all of which is reflected in their use of language and tone of voice. They seem to have become stuck in this frame of reference and ruminate or perseverate on the problem repeatedly.

For clients experiencing caught in this thinking loop, time also shrinks. The here and now absorbs them completely and the past seems to move into the present very strongly. They have very little appetite for future planning other than digging around in the negatives they’ve become fixated on.

When someone feels this level of distress they find it hard to look at the issue from an outsider‘s point of view. When you ask them coaching systemic or reflective questions, they struggle to see things from other peoples’ perspective. It might be challenging for them to explain how the person or people at the centre of the issue – the boss, the colleague, the family is feeling about the way they’re acting. Sometimes they’ll emerge to briefly to answer a question, then they’ll turn matters back to themselves.

Your client might reveal a past history of unresolved emotional issues which stop them from moving forward. Sometimes their current life circumstances are creating barriers to progress. In this state people can neither see themselves clearly nor understand the impact their emotional highs or lows are having on those around them.

High degrees of anxiety, depression, eating disorders, excessive worry, being constantly on edge, feeling isolated, obsessive thinking, post-traumatic stress disorder, substance abuse, addiction, suicidal ideation, and thought disorders are all clear indicators of someone in distress.

These feelings express themselves as irritability, hopelessness, worthlessness, anger, guilt, self-harm, anxiety, sadness, poor performance, a withdrawal from relationships and activities, mood swings, weight loss or gain, anger, restlessness, a lack of energy, problems with concentrating, neglecting personal hygiene, paranoia, delusions, hallucinations, and sleep problems.

Often there’s more than one sign that your client is struggling to manage strong, persistent negative emotions and responses to their current context.

It’s your job to know when the limit of your skills has been reached. When your own qualifications, experience, and client contract no longer fit the bill, it’s a sign you need to make a referral. The more indicators you notice, the more likely it is your client needs support from a different type of expert. It is not a failure to suggest another person with different, more relevant training, experience and capabilities might be better support for your client. It can be the most caring and responsible intervention you could make for them.

This is where having regular coaching supervision sessions can provide you as a coach, with a safe forum to discuss your client’s well-being. To explore whether you are the best person to serve your client at this time or whether encouraging them to find a skilful therapist would be a positive next step.

As you’ll already know if you have struggled with mental health issues yourself or others in your family or close network have, sensitively handling the subject is key. You need to treat your client with care and kindness, never rejection. Never judgement. Nobody is immune from mental health issues. Under extreme stress, bereavement, trauma or cumulative exhaustion, everyone is susceptible.

It’s very helpful to have the contact details of good people to hand, therapists you’re happy to recommend to clients. It’s all part of being a responsible, trustworthy, professional coach. If you happen to be an internal coach, your company will have the necessary support services in place. You need to have the information easily to hand so you can offer suitable options.

When you give your client the choice of getting different help, you’re taking a vital, positive step. There’s no need to be directive. It’s important to normalise therapy, that many people have it and find it really helpful. In this way, the counselling can be considered without embarrassment and will be more like to be taken up by your client. It is always best to give your client a choice about moving ahead with counselling or therapy. It is their decision at the end of the day. That ‘choice’ in itself can feed and support their general sense of agency. This is so important given their how they are feeling anyway.

Here’s some ideas about how to refer a client on with kindness and care.

• Meet somewhere private, safe, and quiet where you can’t be interrupted
• Bring the subject up when you’re both feeling relaxed and unrushed
• Start by making it clear you’re concerned about the client’s welfare, staying positive and calm
• It’s important to be supportive, be honest, hopeful, and patient
• Never be judgemental
• Stay focused
• Be specific – deal directly with the issue
• Use open questions to get answers and insight
• Use active listening and always validate what your client says
• Let silence happen, leaving space for feelings and thoughts to clarify
• Ask how your client feels about seeing a therapist
• Be concerned and caring at every stage
• Share information about the therapist or therapists you can recommend, and explain the benefits
• End the session in a way that makes it clear your client can re-open the subject at any time
• Stand back if the client doesn’t seem receptive to the idea of therapy – don’t force it
• If they accept therapy, follow things up by talking about what happened

If you’re a coach who’d like to better understand the complexities of this aspect of your practice, contact us to explore our coaching supervision sessions.