Routledge Handbook of Applied Sport Psychology

A Comprehensive Guide for Students and Practitioners

David Tod, Ken Hodge

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136966668
• Edition: 1
• Topic: Psicología
• Subtopic: Psicología aplicada

Now available in paperback, the Routledge Handbook of Applied Sport Psychology is a definitive guide to the theory and practice of applied sport psychology. It goes further than any other book in surveying the full variety of issues that practising sport psychologists will confront in their working lives. It introduces the most important tools and skills that psychologists will need to be truly helpful to their clients, and it also adopts a holistic definition of the role of the sport psychologist, explaining how effective counseling, assessment, and therapeutic models can add important extra dimensions to professional practice. The book is divided into seven thematic sections, addressing:

• counseling;
• assessment;
• theoretical and therapeutic models;
• issues for the individual athlete, from injury and overtraining to depression;
• issues for teams, from conflict resolution to travel;
• working with special populations;
• mental skills, such as imagery, goal setting, and concentration.

Moving beyond the traditional tracks of clinical psychology and performance enhancement, the authors in this book argue convincingly that psychologists would benefit from attempting to understand athletes' social and familial contexts, their health, happiness, and interpersonal dynamics in the broadest sense, if they are to serve their clients' best interests. With contributions from many of the world's leading sport psychologists, and with clear descriptions of best practice in each chapter, the Routledge Handbook of Applied Sport Psychology is essential reading for all serious students and practitioners of sport psychology, counseling, applied sport science, health psychology, and related fields.

Section IV Individual issues

DOI: 10.4324/9780203851043-25

22 Referring clients to other professionals

Judy L. Van Raalte

DOI: 10.4324/9780203851043-26

An athlete came to talk to the team’s sport psychologist saying that she wanted to increase her confidence during games. Most of the meeting was focused on talking about confidence, but the athlete also mentioned in passing that she had “issues at home” that she might want to discuss in the future. Some time later, the coach called the sport psychologist to express concerns about the athlete. Two team members had approached the coach and told her that the athlete had sent text messages talking about suicide. When the coach spoke to the athlete directly, however, the athlete said that she was fine and denied that she was suicidal. The coach and teammates are worried.

How should the sport psychologist proceed with this case? Should she continue to work with the athlete on confidence and performance enhancement? Should she push the athlete to talk about the “issues at home?” Should she discuss the information about suicide provided by the coach? Should the athlete be referred to another practitioner? If so, how should the athlete be referred and to whom?

The answer to these questions depends on a number of factors, many of which may be explored and addressed by the sport psychologist during supervision. The focus of this chapter is referral. Therefore, attention will be primarily directed to issues pertaining to referral. Specifically, when and why referrals should be made, how to make referrals, and what happens when needed referrals are not made. Applied sport psychology work is complex, involving individual athletes, teammates, entire teams, coaches, parents, and other support service providers. Understanding the referral process can facilitate the effectiveness of applied sport psychology practice in complex situations such as the one described above and can strengthen the relationships among all those involved in sporting endeavors.

What is a referral?

In the case of applied sport psychology practice, referral typically pertains to those situations in which a client, or potential client, is directed to another professional for services. These professionals often include experts in medical, nutritional, physical, psychological, or spiritual issues (Andersen & Van Raalte, 2005).

Why referrals are made?

At a basic level, referrals are made to meet ethical obligations pertaining to the treatment of clients. Sport psychology is a diverse field consisting of practitioners with a variety of backgrounds and training, but all applied sport psychology practitioners are subject to ethical guidelines of the profession. In their review of more than 200 ethics codes, Henschen, Ripoll, Hackfort, and Mohan (1995) identified seven key ethical principles essential to the practice of applied sport psychology. Of those ethical principles, two are directly related to referral: the principle pertaining to professional competence and the principle relating to professional and scientific responsibility. In both principles sport psychologists who are asked to work beyond their training and competence should make referrals to suitable colleagues. The referral process is an effective mechanism by which sport psychologists can serve their clients’ best interests and protect their welfare.

When should referrals be made?

Sport psychology consultants make referrals for a variety of reasons. For example, a sport psychology consultant may have too much business and not have the time to devote to working with a particular client. A practitioner may have the time, but simply not be interested in working with a client.

Referrals can be made when a sport psychology practitioner has limited knowledge about a particular behavioral, psychological, or spiritual concern (Andersen & Van Raalte, 2005). Referrals may also help ensure the provision of optimal services when a sport psychologist lacks experience with or does not have a full understanding of how to work with a client of a particular age, gender identity, race, ethnicity, culture, religion, sexual orientation, disability, or socioeconomic status (American Psychological Association, 2002). In these types of situations, referrals are made because another practitioner with a different set of skills and experience would be best suited to serve the client.

Why aren't referrals made when they should be?

The exact conditions that require a sport psychology consultant to refer are not completely clear (Etzel, Watson, & Zizzi, 2004). Before a referral can be made, a sport psychology consultant has to recognize that a referral is needed. Williams and Scherzer (2003) surveyed doctoral students in sport psychology and found that 44% of the students had encountered issues that were not related to sport in their applied work with athletes. Similarly, Leffingwell, Wiechman, Smith, Smoll, and Christensen (2001) found that 42% of students who sought the assistance of sport psychology consultants were dealing with personal and/ or mental health issues not directly connected to sport. There appears to be recognition among sport psychology practitioners that mental health and other issues that might require referral arise during consultation.

In 2006, Gayman and Crossman surveyed sport psychology professionals, all of whom were registered with the Canadian Mental Training Registry, about how often they made referrals to mental health practitioners (Gayman & Crossman, 2006). Results indicated that the sport psychologists surveyed rarely made referrals to such professionals. Etzel et al. (2004) assessed sport psychologists’ ethical beliefs and behaviors and found that the top two concerns identified by sport psychologists, who were asked to “list questionable ethical practices in applied sport psychology that you have recently observed” (p. 238), involved referral. Specifically, the Association for Applied Sport Psychology members surveyed expressed concerns about practitioners who did not refer clients even though the practitioners lacked sufficient training, competency, or supervision to meet client needs. Further, the members expressed concern about sport psychologists who misrepresented their credentials, skills, and training, thus confusing potential clients about their abilities and by extension the need for a referral for suitable services. Although, there appears to be recognition in the field of sport psychology that mental health and other issues arise during applied work, there seems to be little follow-through in terms of actually making needed referrals.

Why do some sport psychology practitioners not make needed referrals? There may be several reasons. Some practitioners simply do not recognize that a referral is needed. For example, sport psychology practitioners who do not recognize the signs of depression are unlikely to refer their depressed clients to mental health clinics. Ideally, sport psychology practitioners should both “know what they know” but also “know what they don’t know.” Continuing education can help practitioners gain knowledge of relevant issues outside of their areas of specific expertise, about intervention techniques, and about situations that require referral. The use of continuing education has been found to be nearly universally endorsed as an ethical sport psychology professional development behavior (Etzel et al., 2004). Therefore, it seems likely that many or even most sport psychology consultants are working to maintain their expertise. Reasons beyond simple lack of knowledge contribute to some practitioners’ not making needed referrals.

Some practitioners may not refer clients because they are not sure how or when to make a referral. That is, they do not feel comfortable making referrals. Reis and Cornell (2008) found that counselors and teachers who had been trained to recognize and refer students with suicidal tendencies using a “Question, Persuade, and Refer” program had greater knowledge of risk factors for suicide and had made more referrals nearly six months after the training program had ended than did those participants who had not received training. Because awareness of the referral process enhances the likelihood of making effective referrals, a detailed explanation of the referral process is provided later in the chapter.

Another reason why sport psychology practitioners may not refer clients is that they have a sincere desire to help their clients. Having established strong working relationships, these practitioners may feel that referrals will interrupt the progress being made with their athlete–clients. On the one hand, sport psychology consultants who have developed rapport with their clients and are having some success in their work may ethically continue working with their athletes in areas outside of their main skill set by “stretching” to meet their clients’ needs (Andersen &Van Raalte, 2005). Practitioners who take this approach should keep the best interest of their clients in mind and ensure that they are expert enough (Heilbrun, 2008) to provide appropriate services. Sport psychology practitioners who are “stretching” often benefit from extra supervision, study (e.g., reading texts on the issue), and from consultation with experts in the area of concern to strengthen the services they provide and to allow for the possibility of a future referral if needed (Andersen & Van Raalte, 2005).

On the other hand, the desire to help athletes and “stretch” can be confused with the desire to continue to work with a client for a number of less than ethical reasons such as the desire to bask in the reflected glory of a particular athlete (Haberl & Peterson, 2006) or the desire to maintain an income stream from the client. Sport psychology consultants who are self-aware and supervised are less likely to work when they are impaired (Andersen, Van Raalte, & Brewer, 2000) and are more likely to identify these sorts of ethical concerns and proceed appropriately (Anderson, Knowles, & Gilbourne, 2004).

Some sport psychology consultants may not refer because they do not know, or do not have relationships with, high quality practitioners to whom they can refer clients. This problem can often be addressed by the creation of a referral network, described in more detail later in this chapter. For some practitioners, the lack of a referral network is a reflection of the limited local resources rather than the effort on the part of the practitioner to create a referral network. Although a number of challenges with the delivery of telehealth services have been identified (Miller, 2007), recent research by Mitchell et al. (2008) indicates that telemedicine services for the treatment of bulimia, a challenging mental health issue, were essentially as effective as a face-to-face interventions. For practitioners in areas where face-to-face referrals are not possible, the use of telemedicine may be an alternative way to provide referrals for clients (see Chapter 44).

How effective referrals are made

Effectively managing the referral process is an issue that extends beyond the field of sport psychology. Goldberg and Gater (1991) studied patients at a general medical practice in the United Kingdom and found that approximately 25% of patients entering the clinic experienced anxiety, depression, or distress. The clinic doctors recognized only about 40% of the troubled patients. Fewer than 10% of the anxious, depressed, or distressed patients were actually seen by mental health practitioners. To provide effective service for sport psychology clients, multiple steps must be taken to ensure that a network of professionals to whom clients can be referred is established, the need for a referral is identified, a referral is made, and that clients follow up by meeting with the suggested practitioner or get other support.

Referral networks

The referral process often begins before a client is even seen, with the sport psychology consultant establishing networks of professionals to confidentially discuss challenging cases and issues and to whom clients can be referred when necessary. Members of the referral network might include experts in such disciplines as career counseling, coaching, exercise science, medicine, mental health, nutrition, and religious issues/pastoral care (Andersen & Van Raalte, 2005). Issues requiring referral may include but are not limited to: anger management, biomechan...