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When to Refer
"The thing that you are doing is not good. You are not able to do it alone" (Exodus 18:17–18). The wisest counselor knows the limits of his own calling — and refers without shame.
The Situation
Throughout this course, again and again, one note has sounded: this may be beyond what a pastor should carry alone. Now we gather that note into its own subject, for knowing when to refer is one of the most important skills a counselor can have — and one of the hardest for a caring pastor to practice. The pastor is genuinely called and equipped to help with a great deal; he is the shepherd of souls, and most of what his people bring him he can faithfully address. But he is not a physician, not a psychiatrist, not a licensed clinical therapist, and not a lawyer, and there are troubles that require exactly those. The temptation is strong to try to handle everything himself — out of love, out of a sense of duty, sometimes out of pride or the fear that referring means failing. But a counselor who works beyond his competence can do real harm: the depression that needed medication left untreated, the suicidal person not gotten to safety, the abuse not reported, the trauma mishandled. The mark of a mature counselor is not that he can handle anything, but that he knows what he cannot handle and loves people enough to get them to those who can. Referral, rightly understood, is not the abandonment of pastoral care; it is one of its most faithful acts.
Remember Jethro watching his son-in-law Moses. From morning until evening the people stood around Moses while he judged every dispute in Israel himself, alone, the whole endless line of them. Jethro, a wise older man, watched one full day of it and then spoke plainly: "What is this that you are doing for the people? Why do you sit alone?" And then the words every overextended servant of God needs to hear: "The thing that you are doing is not good. You will surely wear yourself out, both you and this people with you. For the thing is too heavy for you; you are not able to do it alone." Notice Jethro did not tell Moses to care less or to stop serving. He told him to share the load — to appoint able men, to handle the great matters himself and let others handle the rest, so that the work could actually be done and Moses would not collapse under it. Moses, to his credit, listened to his father-in-law and did so. Here is the founding wisdom of referral: even Moses, the greatest leader Israel ever had, who spoke with God face to face, was told by God's providence that he was not able to do it alone — and that admitting it was not weakness but wisdom. If Moses needed others, so does every pastor.
Signs That Referral Is Needed
Across the situations in this course, certain clear signals call for bringing in other help. The counselor should refer, or bring others alongside, when he sees: danger to life — any threat of suicide or of harm to others, which calls for immediate emergency and professional help and is never kept secret; signs of serious mental illness — a loss of contact with reality, hearing or seeing things that are not there, fixed false beliefs, or the wild swings of mania, which need psychiatric care; conditions that require medication or medical treatment — severe or long-lasting depression, crippling anxiety, and the like; the danger of withdrawal in addiction, which can be medically life-threatening; matters with legal weight — above all the abuse of a child or vulnerable person, which must be reported to the proper authorities, not merely counseled; deep trauma that is beyond his training to treat; and the simple, humble recognition that he is out of his depth or that, despite faithful effort, there is no progress. He should also refer where his own objectivity is compromised — when he is too close to the person, too emotionally involved, or in a dual relationship that clouds his judgment.
The Ten Steps and the Decision to Refer
The ten-step model itself guides the counselor to a wise referral. In Stage One — Identifying the Problem, the steps are exactly how he discerns whether a referral is needed: taking time and a good setting (Step 1), listening carefully (Step 2), clarifying what is really going on (Step 3), and investigating what has been tried and whether the trouble exceeds his competence (Step 4). It is chiefly in these early steps that the warning signs above come to light. Then in Stage Two — the Action Plan, referral becomes part of the plan itself: as he reviews the alternatives (Step 7) he names professional help as one of the real avenues; as he explores the outcomes (Step 8) he helps the person see that getting the right help leads somewhere good; he supplies information (Step 9) about where that help can be found; and he provides closure (Step 10) not by disappearing but by making sure the handoff actually happens and that he remains present alongside it. In other words, a good referral is not a departure from the ten-step model but one of its possible faithful conclusions.
How to Refer Well
A referral can be done badly or well, and the difference matters enormously to a hurting person. Done badly, it feels like rejection — "I can't help you; goodbye" — leaving the person feeling dismissed, too broken even for the church. Done well, it feels like love that is determined to get them the best possible help. Several things make a referral good. Frame it rightly: not "you are beyond me" but "I care about you too much to be your only help; let's get you to someone with the specific training this needs, and I will walk with you through it." Stay involved: referral is not a handoff that ends the pastoral relationship but a widening of the team; the pastor remains the shepherd — praying, visiting, supporting — alongside the doctor or counselor. Know your resources in advance: the wise pastor builds, before he ever needs it, a list of trusted local help — physicians, reputable counselors (ideally some who share the faith), psychiatric services, crisis lines, addiction programs, and agencies for abuse — so that in a crisis he is not searching blindly. Make the connection real: where possible, help the person actually make the appointment or call rather than leaving them a name they may never use, and in an emergency, act immediately and personally. Follow up: check that the person got the help and how it is going. A referral handled this way tells the person they are worth the trouble and that they have not been passed off, but surrounded.
The pastor's irreplaceable role. Referral is never an "either/or" but a "both/and." When a person goes to a physician, a psychiatrist, or a counselor, the pastor does not thereby become unnecessary — for there is a whole dimension of the human being that no secular professional is equipped to tend. The pastor brings what medicine and therapy cannot: the Word of God, prayer, the sacraments, the fellowship of the body of Christ, the assurance of forgiveness, and the hope of the gospel. A person can be medically stabilized and psychologically helped and still need their soul shepherded. So the faithful pastor refers and stays — like the Good Samaritan, who bound up the wounded man's injuries himself, then carried him to the inn and entrusted him to the innkeeper's care, paying for it and promising, "when I come back, I will repay you." The Samaritan did not abandon the man at the inn; he made sure of his care and remained responsible for him. That is the picture of referral done in love: do what you can, entrust what you cannot to those equipped for it, and remain faithfully present through it all.
Theory Lens — Hypnotherapy & Imagery as a Boundary Marker
Throughout this course, each unit has paired the Drakeford model with one of the approaches surveyed in Robbins' work, taking the genuine wisdom of each while noting where it falls short of the gospel. We close with two approaches — hypnotherapy and intensive guided imagery — that serve a different purpose here: they mark the boundary of what a pastor should attempt. These are specialized clinical techniques. Hypnotherapy seeks to place a person in a highly suggestible, altered state to address symptoms; intensive guided imagery and related methods guide a person through vivid mental scenes, sometimes to revisit memories or rehearse change. In trained and licensed hands, within proper ethical limits, such methods have their place in the clinical world. But they are precisely not tools for the untrained pastor to pick up, and they illustrate the whole point of this unit: there is real work that requires specialized training the pastor does not have, and the wise response is not to dabble but to refer.
The biblical caution. Here the caution is sharper than with the other approaches, for two reasons. First, regarding competence: techniques that deliberately alter a person's state of consciousness or reach into buried memory can do real harm in untrained hands — they can implant false memories, deepen confusion, or destabilize a fragile person. The pastor who attempts them because he saw them described is like a man performing surgery because he read about it; love refuses such recklessness. Second, regarding discernment: the pastor should be wary of any method that bypasses a person's conscious mind and will, or that shades toward the manipulation of the spirit, or toward practices with occult associations. Scripture calls us to sober-mindedness and self-control, not to surrendering the mind to another's suggestion; and it warns against trafficking in the hidden and the spiritually murky. None of this is to dismiss the legitimate, ethical clinical use of such methods by trained professionals — it is simply to mark, clearly, that they lie outside the pastor's toolbox. The pastor's own instruments are not clinical techniques at all, but the ones Christ has given His shepherds: the Word, prayer, the sacraments, presence, and the fellowship of the church. With those he is on holy and competent ground. Beyond them, his calling is not to reach for tools he was never trained to hold, but to do the humble, loving, deeply pastoral thing — and refer. So this final lens teaches by its very limits: know what is yours to do, know what is not, and love people enough to send them to the right help while you remain their faithful shepherd.
A closing word for the course. Across these thirteen situations, one shape has held: come near, take time, and listen; clarify the real trouble and learn what has been tried; help the person own what is theirs and model the way; review the alternatives and explore where each leads; bring the Word of God to bear; and provide closure that keeps the door open. Through every situation runs the same double commitment — real wisdom gladly used, but the gospel always supreme; genuine care for the whole person, but never beyond the limits of the calling. The pastor is not the savior; he points to the Savior. He is not able to do it all alone, and he was never meant to. He is a shepherd under the Good Shepherd, and his highest service in every situation is to bring the hurting to the One who said, "Come to me, all who labor and are heavy laden, and I will give you rest."
Unit 12 — Assessment
The short-answer questions are for your own reflection: write your answer, then press Reveal model answer to compare. Unit completion is based on the multiple-choice questions.
M.Div. and Th.M.: all five assigned readings are part of the course. Their separate exam is required after activation; see its page for the current rule. Honors remains optional and does not replace the exam.
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