Clients Who Are Reluctant to See a Physician

By Ben Benjamin, PhD

Question: How do you get people to see a doctor to screen for serious conditions when they don't want to?

Answer: As I mentioned in a previous column (September 2009), whenever a client comes to me with an injury or pain condition, I make sure the person goes to see a physician if they have not already.

I recommend this policy to all the practitioners I have trained around the country, and believe it is one of the most important steps we can take to protect our clients, our profession, and ourselves. However, it's not uncommon for clients to put up some resistance. Many individuals have had bad experiences with doctors and other health care providers. This isn't surprising; outside the mental health field, medical professionals often receive very little training in how to develop therapeutic relationships. They may never receive instruction in communication skills, relationship building, conflict resolution, customer service, and building a safe environment -- all crucial skills to have when dealing with something as personal and private as the human body.

In your first session with a client, you're taking a major step in building a therapeutic relationship. As you greet them for the first time, take a history, perform an assessment, and then open up a dialogue about what the client wants from the work you do together. The person will get a good sense of whether he or she feels safe and comfortable with you.

Your confidence, your presence, your voice tone, your gentleness and kindness, and your clear boundaries will give the client reason to trust you and to believe what you say. If you have done all of this well, it may be much easier than you think to influence the person to see a doctor.

It also really helps to have one or more excellent physicians in mind. Whenever I set up a practice in a new location, the first thing I do is go in search of good doctors. I ask people, whose judgment I trust, who their doctor is. I invite the doctor to breakfast or lunch (they have to eat sometime!) to discuss their work and to see how I feel being with them. If I have a good experience, I begin to refer patients to that physician for medical screening.

I have sent hundreds of clients to doctors who don't rush them, speak in plain English, and do a thorough job. When clients persist in their reluctance to see a physician, I set a clear and kind boundary. At the end of my assessment session, I might say something like: "You have a serious injury in your neck and I would very much like to see if I can help you with it. In order to treat you in a responsible manner, I will need you to see a physician before I begin the treatment process. My training and knowledge are limited to certain areas of expertise, so I rely on physicians to screen out conditions that are outside of my scope of practice. Once you've seen a physician, whether it's one I'm recommending or one you choose on your own, I would be happy to treat you."

I've found this approach to be successful in the vast majority of cases.

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