When and How to Refer Kids for Counseling

I can still remember the surprising question a senior pastor asked me during my first youth ministry job interview: “What will you do if one of the girls from the youth group tells you that she’s pregnant?” I didn’t see this one coming and had no idea how to respond. So we sat there in a booth at Denny’s, quietly staring at each other.

This awkward moment was followed by another surprise—that pastor offered me the job! And sure enough, it wasn’t long before my first “counseling” session with a student. The high school Sunday school class had just ended, and one of the girls who’d seemed distracted all morning asked if she could talk with me. She told me it was urgent, and she really needed my help.

We walked over to my office and before I could even sit down she said, “I think I’ve done something I shouldn’t have…I just don’t know if I’m ready for…what will Mom and Dad think… (long pause).” Suddenly I felt like I was back at Denny’s with my pastor. I braced myself. Finally, she looked me in the face and pronounced, “I’ve decided to run track instead of playing softball.”

You could hear me exhale in the next county.

After I successfully helped her with this minor problem, a foreboding set in. I knew I wasn’t yet ready to address the serious problems many of my kids must be facing. And I already knew from talking with other youth ministers that I wasn’t alone in this.

A Big Problem is Barreling Your Way

Since that first “softball” encounter, I’ve learned how integral counseling is to an effective youth ministry. I’ve had students with suicidal thoughts, substance abuse, and depression come knocking at my door. And through it all, I’ve learned that it’s more important to acknowledge what I don’t know than to pride myself on what I do know—to have a clear picture of my abilities and limitations. Really, this means I “know when to hold ‘em” (I can handle this) and I “know when to fold ‘em” (I need to refer this young person to a professional).

If you’re like me, you could use a little primer on “holding” and “folding,” so here goes.

Let’s use a hypothetical example to run through the steps you’ll need to take to determine whether you should hold or fold.

Let’s say Sally, a 15-year-old girl in my youth group, asks to talk with me. This time, instead of a “softball” issue like…softball, she confides that she’s been feeling persistently frustrated and sad. Furthermore, she tells me she feels better when she vents her frustrations by cutting herself. She shows me the scratches she made on her forearms just yesterday. I feel overwhelmed. What should I do?

When to Refer

Is Sally really trying to commit suicide? Is she crying out for help? Is this really a temporary reaction—nothing to be concerned about? After several years of graduate training in counseling and therapy practices, I’ve learned some rules of thumb that help me answer these questions.

1. Any time a young person is contemplating suicide or harming herself or someone else, it’s time to refer. Sally may not be trying to kill herself, but her cutting habit could lead to more dangerous behavior (because it often does). So it’s good to contact a mental-health professional in this circumstance.

Suicidal thoughts are fairly common among adolescents—even so, they should be taken seriously. Generally, if I’m in doubt over a student’s quasi-suicidal behaviors, I err on the side of safety. Kids like Sally use harmful behaviors like a megaphone—amplifying their cries for help. This is likely the case with Sally, but it’s better to get a professional opinion.

2. Operate from a place of humility when you’re assessing a teenager’s problem—if it’s over your head, admit it. If I don’t know how to handle an issue brought to me by a teenager, or I can’t readily find an answer for him, I’ll refer him to a counselor.

For example, I feel comfortable offering to pray with Sally and letting her talk about what’s bothering her, but her cutting behavior seems over my head. What if the scratches morph into deep gashes or an actual suicide attempt? I feel pressured to have all the answers for kids like Sally, but the truth is that someone else may have a lot more to offer her.

3. I consider referring to a counselor if I don’t have the time necessary to handle a student’s problems. Counseling offers us a powerful opportunity to express Jesus’ love to kids, but if I spend the lion’s share of my time doing this (and believe me, counseling can mean a huge time commitment), my other responsibilities will suffer.

Though I feel comfortable counseling young people on issues such as spiritual doubt or parental conflict, I know there won’t be enough hours in the day to give a teenager like Sally the attention she needs. If I refer her to a counselor, not only does she receive the professional help she deserves, but I’m free to minister more deeply to all my students.

4. I consider referring when my counseling has not resolved the problem. If I’ve been trying to get at the underlying catalysts for Sally’s harmful behavior by addressing issues about her family, but she continues to feel sad and keeps cutting herself, I’d seek additional help. When I see Sally’s problems staying the same or getting worse, that’s an indicator that it’s time to seek alternate intervention. I can still provide support for Sally at youth activities and make sure she keeps me updated, but she needs a professional “guide” to lead her where I cannot.

Where to Refer

Once I’ve decided to refer a teenager for counseling, I have to figure out where to send her. I want to know that the counselor will be competent and will operate from a Christian perspective (or at least treat Sally’s faith with respect).

The American Psychological Association (www.apa.org)(1) is a great starting point for determining a counselor’s competence. The APA suggests asking if the counselor is licensed by a state oversight board, how long the counselor has practiced, what types of treatments he or she uses, what (if any) specialty areas the counselor has, how long treatment might last, how much the counseling will cost, and how payment will be handled.

I’ve been tempted to overlook these pragmatic issues, but Sally is counting on me to make sure I connect her with someone who can truly help her. What if I send Sally to a counselor who fails to respect her Christianity? She may be told that her faith contributes to her problems. So it’s crucial to look first for someone who is “faith compatible” with her.

Some churches have counselors on staff. Others have an ongoing relationship with a Christian counseling practice outside the church.(2) When I’m unable to tap either of these resources, I consult with my senior pastor and other area youth ministers for ideas. If a Christian counselor is unavailable or unqualified to handle Sally’s problems, I then try to find a counselor who will at least respect Sally’s Christian values and beliefs. Finally, I’ll talk with the counselor directly to gauge his or her perspective (this is crucial when you’ve exhausted other resources and have to pick a counselor out of the phone book).

How to Refer

When I’ve decided that Sally needs more help than I can offer, and I’ve chosen a counselor who can help her, it’s time to think through how I plan to offer her the help she needs. My guidelines include church policy, Sally’s interests, her unique personality, and her family situation. Church policy may dictate that I talk with my senior pastor first for help with the referral. Or your church may have a counseling pastor who can help. Basically, I try to follow what’s worked in the past.

But what happens if I talk with my pastor about Sally’s situation and word leaks back to her via the “prayer chain”? Her trust is broken, maybe permanently. So I try to balance Sally’s need for privacy with her parents’ need to know what’s happening with her.

Once I’ve decided to refer Sally to a counselor, I’ll talk with her honestly about my concerns and encourage her to enlist the help of her parents. I avoid telling Sally that she must get outside help, but rather try to help her come to this conclusion on her own (unless it’s an emergency situation).

Telling Sally that she must get help may backfire—she might avoid me and rebel against my assessment (going to a counselor is likely not her idea of a good time). She might not want me to tell her parents that she’s been scratching her arms. But as a rule of thumb, it’s best to involve a young person’s parents when you’re making a referral. They’ll likely be footing the bill, and everyone will be better off in an environment of open communication.

I’d tell Sally that I think she should seek additional help, and I’d ask her how she would like to tell her parents (this gives her a say in the process). Does she want me to accompany her when she tells them? Will she do it on her own? If she decides to tell them on her own, I’d tell her that I’ll follow up to make sure they’re involved. Then I’d let her know what to expect when she sees a counselor so fear doesn’t drive her from therapy.

• • •

Proverbs 17:17 reads: “A friend loves at all times, and a brother is born for adversity.” When teenagers are in trouble and can’t find their own way out, they need a brother (or sister) who’s born for adversity. This is really the courageous core of youth ministry—the place where we most powerfully reflect the character and personality of a God who is, by nature, a rescuer.

*Randy Halberda co-wrote this article with Jamie Aten, John Christian, and Brent Tucker. They’re all doctoral students in clinical and counseling psychology at Indiana State University, and all of them have worked with youth in various capacities.

"I Know How You Feel… Yeah, Right!"

by Billy Mitchell

When I was 13, I was in a tragic car accident that killed my mom. I escaped with just bumps and bruises, but internally I was scared, shattered, and scarred. That Sunday afternoon was a defining moment in my life—it has shaped who I am and who I’m becoming. I’ve spent the past 13 years dealing with my grief, all the while attempting to help others through their own grief. I’d like to share with you a few things that I’ve learned through my experiences.

1. Ministering to grieving kids is one of the most important things you’ll ever do. Do you really want to impact teenagers? Do you want your ministry to last long after you’re gone? Then learn how to help your students through the grieving process.

I often browse Christian bookstores looking for books on grief. Maybe I’m going to the wrong stores, but I’ve yet to find a book written specifically for grieving teenagers. This is a gross oversight. Grieving students desperately need guidance. They need someone to walk with them—to offer comfort and support.

2. Listening is the most important “action” you can take. I once worked for a hospice. When I went out for my first post-death call, I learned this lesson the hard way. I was 22 years old and thought I had the family’s solution. I came in quoting Scripture and spouting clichés. Halfway through the visit my boss pulled me aside and gave me advice that I’ll never forget. He looked me in the eye and said bluntly, “Your words are meaningless right now. Be a spiritual presence and listen to their needs.”

We’re all basically control freaks, so we don’t typically know what to do with advice like this. But it’s quite true. Two years after they’ve experienced a death, a grieving teenager won’t remember your words, but he’ll remember your presence, and that you listened well.

3. You can’t “fix” a grieving teenager. This is a crucial truth to understand, especially for men—we’re driven to fix problems, and it drives us crazy when we can’t. Your grieving students need you to focus on them, not their problem. Matthew 5:4 does not read: “Blessed are those who mourn, for they will be fixed.” The blessing is in the comfort offered. Grief isn’t bad—it’s a natural response to a deep loss. We’re called to guide grieving kids to God, where they can find true comfort.

4. There’s no right way to grieve. Sure, it’s a cliché—but this little truth is paramount to a grieving teenager. Kids want to be “normal,” maybe more than anything else. After my mom died, I didn’t cry for years. I don’t know why, but I just couldn’t or wouldn’t cry. This worried me. Didn’t I love my mom? What was wrong with me? It took me a long time to let go and cry. Some people cry almost nonstop for several days, some don’t cry for years. Both paths are okay, and teenagers need to know this. As long as they’re not hurting themselves or others, any expression of grief is good.

5. Love is the main thing. Rational truth is important in a crisis, but nothing’s more powerful than love. Grieving kids have a portal that’s open to their souls like no other time in their lives. You dare not walk through that portal with anything less than unconditional love to offer.

6. Don’t put time limits on kids’ grief. Our North American culture has an unwritten rule that grief has a one-year “statute of limitations.” When the year is up, a grieving teenager should be “getting over” the death. That’s flat wrong. My mom died 13 years ago, and I continue to experience tough days. Grief is a marathon, not a dash.

• • •

Grief is like a succession of waves. Some of the waves are soft and pleasant; others will rise up and crush you. Who knows which wave your grieving students will face day to day? But they should know those waves will roll in to their “shore” for the rest of their lives. As time goes on, there will be fewer crushing waves. But the person your grieving student becomes depends largely on how the people around him enter into the crisis with him.

Billy Mitchell is a youth ministry veteran, a hospice chaplain, and founder of Healing Hearts, a ministry that helps teenagers through the grieving process. You can reach him at Mitchell_Billy@msn.com.

Footnotes

1. The APA’s Web site also has a wealth of practical advice for dealing with common psychological issues, including ADHD, anger, bullying, depression, divorce, the media’s influence, sexuality, and stress. Just go to www.apa.org and browse links under the Topics heading on the right side of the site’s home page.

2. If you need more options for a local referral, contact New Life Ministries (formerly known as the Minirth-Meier Clinic). Just go to NewLife and click on the Counseling link for options in your area. While you’re on the site, you can explore its vast online resources for counseling issues—just click on Free Tips or Questions & Answers.