Interview Questions for Trauma-Focused Eye Movement Therapy

EMDR therapy unfolds in eight phases, a structured approach designed to systematically process traumatic memories. Think of it as a carefully orchestrated journey, guiding the client through each step to achieve lasting relief.

• Phase 1: History Taking: A thorough assessment of the client’s history, including past trauma, current symptoms, and overall well-being. This phase lays the foundation for the entire treatment process.
• Phase 2: Preparation: Educating the client about EMDR, establishing a therapeutic alliance, and preparing them for the process. This involves managing expectations and addressing any anxieties they might have.
• Phase 3: Assessment: Identifying a specific traumatic memory, or ‘target,’ to be processed. This often involves pinpointing a particularly distressing image, negative thought, physical sensation, and emotional response.
• Phase 4: Desensitization: The core of EMDR, where bilateral stimulation (eye movements, taps, or sounds) is introduced while the client focuses on the target memory. The goal is to reduce the emotional intensity associated with the memory.
• Phase 5: Installation: Reinforcing positive thoughts and beliefs after desensitization. The therapist helps the client internalize a more adaptive understanding of the event.
• Phase 6: Body Scan: Addressing any remaining physical sensations related to the trauma. This ensures that the client’s physical experience aligns with the emotional and cognitive shifts achieved during earlier phases.
• Phase 7: Closure: Summarizing the session and preparing the client for the next session. This phase reinforces the progress made and provides a sense of closure.
• Phase 8: Evaluation: Assessing the client’s progress and determining if further treatment is needed. This involves evaluating both subjective and objective indicators of improvement.

For example, a client experiencing anxiety related to a childhood car accident might begin by identifying the most distressing image from the accident (Phase 3). Through bilateral stimulation (Phase 4), the intensity of the associated fear and anxiety would gradually decrease. The therapist would then work to replace negative thoughts with more adaptive ones (Phase 5).

The Adaptive Information Processing (AIP) model is the theoretical framework underpinning EMDR. It posits that traumatic memories are often improperly processed and stored in the brain, leading to ongoing distress. Imagine a computer with a corrupted file – it can’t function properly until the file is repaired or replaced.

AIP suggests that through bilateral stimulation, the brain is stimulated to process these maladaptive memories, ultimately leading to improved information processing and a reduction in emotional distress. The brain naturally works to resolve information inconsistencies, and EMDR facilitates this process by helping clients access, process, and integrate traumatic memories into their existing cognitive framework. A key aspect is the shift from intense negative emotions and beliefs associated with the trauma to more balanced and adaptive ones.

For instance, a client might initially associate a past assault with feelings of helplessness and self-blame. Through EMDR, the client may reprocess the memory and develop a more adaptive narrative, acknowledging the trauma while recognizing their own strength and resilience. This shift reflects the AIP model’s core principle of resolving informational discrepancies within the brain’s memory system.

Assessing readiness for EMDR involves a multifaceted approach, ensuring the client possesses the necessary psychological resources to benefit from the therapy. It’s crucial to avoid overwhelming or retraumatizing the client. The process begins with a thorough clinical interview, psychological testing if deemed necessary and a careful evaluation of the client’s stability.

• Emotional Stability: Clients should be able to manage their emotions relatively well and not be in the midst of an acute crisis. A client experiencing severe suicidality or psychosis would typically not be considered ready for EMDR.
• Cognitive Functioning: Clients need adequate cognitive abilities to understand the process and participate actively in the sessions. Severely impaired cognitive function could hinder their engagement with the therapy.
• Ability to Focus and Follow Instructions: EMDR requires a degree of concentration and the ability to follow instructions. Clients with significant attentional deficits may require additional support or alternative approaches.
• Motivation and Willingness to Participate: Client engagement and cooperation are vital for EMDR’s success. The therapist should ascertain the client’s genuine desire to engage in this form of therapy.

For example, a client struggling with significant PTSD symptoms but also experiencing severe depression might require addressing the depression first before commencing EMDR. Similarly, a client with severe dissociation might benefit from stabilization techniques before attempting to process traumatic memories.

Contraindications for EMDR primarily focus on situations where the client’s current state could be negatively impacted by the processing of traumatic memories. It is crucial to prioritize safety and well-being.

• Uncontrolled psychosis: EMDR could exacerbate psychotic symptoms in clients experiencing active psychosis.
• Unstable dissociation: Severe and uncontrolled dissociation can interfere with a client’s ability to participate effectively in EMDR.
• Suicidal or homicidal ideation: Clients actively considering self-harm or harming others require immediate crisis intervention before considering EMDR.
• Substance abuse: Active substance abuse can significantly impair a client’s ability to process trauma and engage in therapy effectively.
• Lack of capacity to participate: Clients with significant cognitive impairments or other conditions that prevent them from actively participating may not be suitable candidates.

A client exhibiting severe dissociation, for example, might be better served by focusing on stabilization techniques first before introducing EMDR. Similarly, a client with active substance abuse would require treatment of their addiction prior to initiating EMDR.

Resistance in EMDR can manifest in various ways, from avoidance of specific memories to difficulty focusing during bilateral stimulation. Addressing resistance requires sensitivity, collaboration, and a flexible therapeutic approach. The therapist acts as a guide, understanding the client’s hesitations.

• Explore the source of resistance: Openly discuss the client’s concerns and address any anxieties or fears related to the processing of traumatic memories.
• Collaboratively adjust the treatment plan: If a particular target proves too overwhelming, the therapist and client may adjust the pace or choose a less intense target for processing.
• Use grounding techniques: Grounding techniques help clients regain a sense of presence and stability, particularly if they feel overwhelmed or dissociated during bilateral stimulation.
• Enhance the therapeutic alliance: Building a strong therapeutic relationship is crucial for addressing resistance. Trust and rapport are essential for clients to feel safe enough to share their experiences.
• Use alternative approaches as needed: In some cases, incorporating techniques like relaxation exercises, breathing exercises, or other coping skills might be helpful to address the resistance and prepare the client for EMDR.

For example, if a client experiences strong emotional distress during a session, the therapist might pause the bilateral stimulation and employ grounding techniques before resuming. Openly addressing the client’s concerns about reliving the trauma can also greatly reduce resistance.

Proper preparation in EMDR is paramount for treatment success and client safety. It’s the foundation upon which the entire therapeutic process is built. Think of it like carefully preparing the soil before planting a seed – you need fertile ground for the seed to grow.

• Establishing rapport and trust: Building a strong therapeutic relationship is key for creating a safe space for the client to explore their trauma.
• Educating the client about EMDR: Providing clear and comprehensive information about the process, its phases, and what to expect can help manage client expectations and reduce anxiety.
• Teaching coping skills: Equipping clients with coping mechanisms like grounding techniques or self-soothing strategies helps them manage potential distress during processing.
• Assessing the client’s readiness: A thorough evaluation of the client’s psychological stability and emotional readiness ensures they can safely and effectively engage in EMDR therapy.
• Developing a treatment plan: Collaboratively creating a plan that aligns with the client’s needs and goals increases engagement and commitment to the therapeutic process.

A client who fully understands the EMDR process and feels prepared to face their traumatic memories is more likely to experience positive outcomes. Conversely, inadequate preparation could lead to increased anxiety, resistance, or even retraumatization.

Bilateral stimulation is a core component of EMDR, designed to engage both hemispheres of the brain simultaneously, facilitating the processing of traumatic memories. Different forms of stimulation cater to various client preferences and needs.

• Eye movements: The therapist guides the client’s eye movements back and forth using a finger or light, while the client focuses on the traumatic memory. This is the most common form of bilateral stimulation.
• Auditory stimulation: Alternative sounds are presented to each ear, such as alternating tones or clicks through headphones.
• Tactile stimulation: Alternating taps are applied to each side of the body using hand-held devices or even light touches.

The choice of bilateral stimulation technique often depends on the client’s preferences and comfort level. Some clients might find eye movements easiest, while others might prefer auditory or tactile stimulation. The important factor is that the stimulation is rhythmic and consistently alternating, helping the brain process information more effectively.

Dissociation is a common response to trauma, where a person detaches from their emotions, memories, or even their sense of self. In EMDR, we address dissociation by gently guiding the client back to a grounded state before processing traumatic memories. This involves techniques like grounding exercises— focusing on the present moment through sensory awareness (e.g., noticing the feeling of their feet on the floor, the temperature of the room) – and stabilization strategies. We might use breathing exercises, mindfulness practices, or even sensory activities to help the client feel more anchored in their body and present.

If dissociation becomes severe during processing, we immediately pause the EMDR protocol and focus on stabilizing the client. We might switch to a different therapeutic approach temporarily, like grounding techniques or somatic experiencing, until they feel safe and able to continue. For example, if a client starts experiencing depersonalization during a memory recall, we would stop the bilateral stimulation and help them ground themselves by focusing on physical sensations, perhaps by holding a comforting object. The key is to approach dissociation with patience and support, recognizing it as a protective mechanism rather than a resistance.

While EMDR is generally safe and effective, potential side effects include temporary increases in anxiety, sadness, or vivid recall of traumatic memories. These are often referred to as ‘processing’ or ’emotional upsurge’. It’s crucial to emphasize that this isn’t a negative outcome; it signifies the therapeutic process is working. We address these side effects through careful preparation and pre-processing, establishing a strong therapeutic alliance, and utilizing coping skills and stabilization strategies.

For example, if a client experiences increased anxiety after a session, we’ll discuss it openly, review their coping mechanisms, and possibly schedule a shorter, more focused follow-up session. We might also modify the EMDR protocol to reduce the intensity of the stimulation or incorporate additional grounding exercises. It’s vital to maintain close communication with the client and adjust the treatment plan accordingly. Careful case formulation and assessment to rule out contraindications are vital. We may refer to other professionals like a psychiatrist should medication be deemed necessary.

Client safety and well-being are paramount. We begin by conducting a thorough assessment to identify potential risks, including suicidal ideation, self-harm tendencies, or substance abuse. A strong therapeutic alliance built on trust and mutual respect is essential. We work collaboratively with the client to set realistic goals and establish safety plans. This might involve identifying support systems, developing coping skills, and establishing clear communication strategies.

Throughout the EMDR process, we monitor the client’s emotional state closely. We regularly check in with them to assess their comfort level and willingness to proceed. If the client expresses distress or feels overwhelmed, we immediately pause the session and employ stabilization techniques. We also emphasize the client’s agency – they have complete control over the pace and content of the therapy. The session stops if they want it to stop. This approach fosters a sense of safety and empowerment.

EMDR is not a stand-alone treatment and often works well in conjunction with other modalities. For instance, we might integrate EMDR with Cognitive Behavioral Therapy (CBT) to help clients identify and challenge negative thought patterns related to their trauma. We can integrate mindfulness techniques to enhance self-regulation and emotional awareness. Somatic experiencing can help address body-based symptoms of trauma that often present alongside PTSD.

For example, a client with PTSD and co-occurring depression might benefit from EMDR to process traumatic memories, CBT to address negative cognitions, and mindfulness practices to manage anxiety. The integration of different modalities is often personalized to the client’s needs and circumstances, allowing a comprehensive and holistic approach to healing. A good working knowledge of various approaches is critical for effective integration.

I have extensive experience working with diverse trauma populations, including individuals with PTSD, childhood trauma, and complex trauma. PTSD often manifests as flashbacks, nightmares, and hypervigilance. In EMDR, we address these symptoms by processing the underlying traumatic memories that contribute to them. With childhood trauma, we consider the developmental context of the abuse and its impact on the client’s sense of self and relationships. Complex trauma often involves multiple traumatic experiences, making it crucial to prioritize stabilization and safety before beginning processing.

For example, a client with childhood sexual abuse might experience somatic symptoms alongside emotional distress. In this case, I might integrate somatic experiencing alongside EMDR, addressing both the emotional and physical manifestations of the trauma. Each case is unique, requiring a tailored approach that respects the client’s pace and individual needs. A thorough understanding of developmental psychology and attachment theory is vital for effective treatment of these populations.

Maintaining detailed clinical records is crucial for ethical practice, legal protection, and treatment effectiveness. These records document the client’s history, presenting problems, treatment plan, session summaries, and progress notes. In EMDR, this includes specific details about the targeted memories, the client’s response to bilateral stimulation, any side effects experienced, and the coping mechanisms utilized. Accurate record-keeping enables effective communication with colleagues, facilitates continuity of care, and supports clinical supervision.

For instance, recording the client’s subjective units of distress (SUDs) and vividness of imagery (VOI) scores before and after each EMDR set provides a quantifiable measure of treatment progress. This detailed documentation allows clinicians to track the effectiveness of the therapy over time and make informed adjustments to the treatment plan as needed. Adherence to HIPAA regulations and other relevant legal guidelines is paramount when maintaining client records.

Measuring the effectiveness of EMDR involves both quantitative and qualitative measures. Quantitative measures include self-report questionnaires like the PTSD Checklist (PCL), the Impact of Event Scale (IES), and the Depression, Anxiety and Stress Scale (DASS-21). These scales provide numerical scores that track changes in symptoms over the course of treatment. Qualitative measures include client feedback, observations of behavioral changes, and improvements in daily functioning.

For example, a client with PTSD might initially score high on the PCL. Throughout EMDR therapy, we would regularly administer this questionnaire to track the reduction in PTSD symptoms. We would also monitor qualitative changes, such as improvements in sleep quality, reduced avoidance behaviors, and enhanced emotional regulation. A multi-method approach to assessment provides a holistic picture of the client’s progress and the effectiveness of the EMDR therapy. Combining client-reported outcomes with clinical observations is vital for a thorough assessment of treatment success.

Setting treatment goals in EMDR is a collaborative process, crucial for ensuring therapy’s effectiveness and the client’s active participation. We begin by identifying the client’s most distressing memories or current challenges related to past trauma. This involves a thorough assessment, exploring the impact of trauma on their daily life, relationships, and overall well-being.

We then collaboratively prioritize targets based on their intensity, frequency, and impact. For example, a client might initially focus on a specific traumatic event, then later shift to processing its associated negative beliefs or distressing physical symptoms. These goals are always SMART: Specific, Measurable, Achievable, Relevant, and Time-bound. For instance, instead of a vague goal like “feeling better,” we might aim for “reducing anxiety related to the car accident from a 9/10 to a 4/10 on a scale of 1-10 within 8 sessions.”

Regularly reviewing and adjusting these goals throughout therapy ensures the treatment remains relevant and effective. This flexibility allows us to adapt to the client’s progress and emerging needs, making the process more personalized and empowering.

Complex trauma, involving multiple traumatic events or prolonged abuse, requires a more phased and tailored approach within EMDR. We can’t simply tackle all traumas at once. Instead, we prioritize targets based on a hierarchy of needs, focusing first on stabilizing the client’s emotional state and enhancing their coping mechanisms. This often involves teaching grounding techniques, self-soothing strategies, and developing a strong therapeutic alliance.

We might start by addressing the most easily accessible memories and gradually work toward more complex or overwhelming ones. This approach minimizes re-traumatization, allowing the client to process traumatic experiences at a manageable pace. For example, if a client experienced childhood neglect and later a violent assault, we might begin with less emotionally charged memories related to the neglect before moving to the more intense assault memory. We might also incorporate other therapeutic techniques like mindfulness or somatic experiencing to complement the EMDR process, promoting a holistic approach to healing.

Throughout the process, close monitoring of the client’s emotional state is crucial, providing adjustments and breaks when needed. The emphasis is on building resilience and empowerment, enabling the client to gradually navigate their past experiences and develop healthier ways of relating to themselves and the world.

Emotional dysregulation is often a significant hurdle in EMDR therapy. Many clients experiencing trauma struggle with intense emotional fluctuations, making it challenging to process traumatic memories effectively. We address this using a multi-pronged approach that integrates EMDR with other evidence-based techniques.

Before initiating EMDR processing, we focus on equipping clients with effective coping skills for managing intense emotions. This often involves teaching techniques like deep breathing, mindfulness meditation, and progressive muscle relaxation. We might also incorporate dialectical behavior therapy (DBT) skills, particularly focusing on distress tolerance and emotion regulation modules. These skills help clients self-soothe and manage overwhelming emotions that may arise during processing.

During EMDR sessions, we carefully monitor the client’s emotional state, adjusting the intensity of the processing based on their capacity to tolerate emotional arousal. If the client becomes overwhelmed, we pause the bilateral stimulation and use the previously learned coping skills to help them regain their composure. This gradual approach ensures a safe and effective processing experience, fostering emotional stability and resilience.

Building rapport and trust is foundational to successful EMDR therapy. It’s about creating a safe and empathetic space where the client feels comfortable sharing their most vulnerable experiences. This starts from the very first session.

I begin by actively listening to the client’s story, validating their experiences without judgment. I demonstrate empathy and understanding, making sure they feel heard and seen. I explicitly discuss the EMDR process in a clear and straightforward manner, ensuring the client understands the procedure and their role in therapy. Transparency and open communication are vital here.

I also emphasize the collaborative nature of the therapy, making it clear that they are in control of the process and can stop at any time. Regular check-ins about their comfort level and experience ensure that the process feels safe and manageable. Creating a collaborative partnership fosters a strong therapeutic alliance, making clients more open to processing and ultimately achieving better outcomes.

The EMDR history-taking process is more than just gathering information; it’s a crucial step in identifying the target memories and associated beliefs that will guide therapy. It’s a delicate process that requires sensitivity and careful consideration.

We begin with a detailed timeline of the client’s life, exploring significant events and relationships to gain a comprehensive understanding of their history. This helps us identify potential trauma and its impact on their life. We then collaboratively select specific memories to target, focusing on those that are currently most distressing or interfering with the client’s daily life.

For each target memory, we meticulously explore the associated thoughts, feelings, images, sensations, and beliefs. This in-depth exploration helps us understand the complex interplay of trauma and its manifestation in the client’s present life. It allows us to formulate specific, measurable goals for the EMDR processing phases, ensuring targeted and effective therapy.

Processing traumatic memories in a controlled environment is essential for the client’s safety and well-being. Uncontrolled processing can be overwhelming and potentially re-traumatizing. The therapeutic setting offers a crucial sense of safety and support that is often lacking in the original traumatic experience.

The therapist’s role is paramount in providing this safe space. This includes creating a comfortable and supportive atmosphere, using techniques to regulate the client’s emotional responses, and pausing or stopping the processing as needed. The controlled environment allows the client to process their traumatic memories at their own pace, feeling empowered and in control, rather than overwhelmed and re-traumatized. Think of it as carefully guiding a hiker up a steep mountain, rather than pushing them to the summit unprepared.

Furthermore, the structure provided by the EMDR protocol helps manage the intensity of emotional arousal. The use of bilateral stimulation and the planned breaks allow the client to process emotions in manageable doses, preventing emotional overload and supporting adaptive processing.

Ethical considerations are paramount in providing EMDR therapy. The client’s safety and well-being should always be the primary concern. This involves adhering to strict professional guidelines and ethical principles.

• Informed Consent: Clients must fully understand the process, its potential benefits and risks, and their right to withdraw at any time.
• Confidentiality: Maintaining client confidentiality is crucial, except in cases where mandated reporting is required (e.g., child abuse).
• Competence: Therapists should only provide EMDR if they have received adequate training and supervision. They need to be properly equipped to handle the complexities of trauma and potential emotional distress.
• Appropriate Referral: Recognizing limitations and referring clients to other professionals when needed (e.g., for co-occurring disorders) is ethical and responsible practice.
• Dual Relationships: Avoiding dual relationships to maintain objectivity and prevent conflicts of interest is essential.

By meticulously adhering to these ethical standards, therapists ensure the safety and integrity of EMDR therapy, fostering trust and maximizing the potential for positive outcomes.

My understanding of EMDR literature and research is extensive. The foundational research by Francine Shapiro, demonstrating the efficacy of eye movements in processing traumatic memories, is crucial. Subsequent research has expanded on this, exploring the neurobiological mechanisms underlying EMDR’s effectiveness. Studies consistently show EMDR’s benefit in treating PTSD, anxiety disorders, and other trauma-related conditions. This research includes randomized controlled trials comparing EMDR to other therapies, showing its comparable or superior efficacy in many cases. For example, many studies have focused on the reduction of PTSD symptoms like intrusive thoughts, nightmares, and avoidance behaviors following EMDR treatment. The research also explores variations in EMDR protocols and their application to diverse populations and trauma types. I regularly consult peer-reviewed journals such as the Journal of Traumatic Stress and the Journal of Consulting and Clinical Psychology to stay abreast of the latest findings and best practices.

Beyond the quantitative data, I also pay close attention to qualitative research that explores the client’s subjective experience during EMDR. This helps me understand the therapeutic process from the client’s perspective and tailor my approach accordingly. Understanding the theoretical underpinnings, including the adaptive information processing model, is essential to effectively utilize EMDR.

While EMDR shares some similarities with other trauma therapies, key differences exist. Many therapies, like Cognitive Behavioral Therapy (CBT) and Prolonged Exposure (PE), focus on cognitive restructuring and/or gradual exposure to trauma-related stimuli. EMDR, however, incorporates bilateral stimulation (eye movements, taps, or sounds) alongside the processing of traumatic memories. This bilateral stimulation is believed to facilitate the neurological processing of traumatic memories, allowing for a quicker integration and reduction of distress. Think of it like this: CBT might help you understand your fear of spiders, while PE helps you gradually get used to being around spiders. EMDR, however, might help you reprocess the original traumatic experience with the spider, allowing you to face the fear with less anxiety. Furthermore, unlike some therapies that may focus solely on cognitive or behavioral changes, EMDR addresses the emotional and physiological components of trauma through the integration of the memory network.

Other therapies may take a longer time to work through the various layers of trauma, while EMDR often utilizes a more focused approach to targeting specific memories and their associated emotional charge. The use of bilateral stimulation is the most significant differentiator, setting EMDR apart from other trauma-focused interventions.

Adapting my EMDR approach for clients with diverse cultural backgrounds is paramount. I prioritize cultural sensitivity by first understanding the client’s unique cultural context, beliefs, and values. This includes being mindful of potential cultural differences in expressing emotions, understanding trauma, and seeking help. For example, some cultures might have different notions of personal space or eye contact, which I would need to adjust for during the bilateral stimulation phase. Furthermore, I am careful not to impose Western-centric views on trauma or healing. I carefully consider the client’s worldview when framing the treatment goals and choosing the appropriate therapeutic language. For some clients, talking directly about traumatic experiences may not be culturally appropriate, so I would explore alternative ways to access and process the trauma. This might involve the use of metaphors, storytelling, or art therapy in conjunction with EMDR. Establishing a strong therapeutic alliance built on trust and respect is crucial in this context.

I continuously educate myself on cultural competency and consult with colleagues and supervisors experienced in working with diverse populations to ensure I am providing culturally sensitive and effective care.

Maintaining professional competence in EMDR is a continuous process. I actively participate in EMDRIA (Eye Movement Desensitization and Reprocessing International Association) approved trainings and workshops to stay updated on the latest research, best practices, and advancements in the field. I regularly attend conferences and seminars to network with other EMDR therapists and learn from their experiences. I also engage in regular supervision with experienced EMDR clinicians, discussing cases and receiving feedback on my techniques. This ensures I’m always refining my approach and working within ethical guidelines. In addition, I maintain detailed records of my client sessions, which I review periodically for self-reflection and improvement. This includes reflecting on my own clinical decision-making process and identifying areas where I could refine my approach for better client outcomes.

Emotional breakthroughs during EMDR sessions are common and expected, signifying progress in processing traumatic memories. My experience has taught me that these breakthroughs can range from sadness and anger to feelings of relief and hope. I approach these moments with empathy and careful guidance. My role is to provide a safe and supportive environment where the client feels understood and validated. I utilize a range of techniques to support the client through these intense emotions, which may include offering reassurance, grounding techniques (such as focusing on the present moment), and providing emotional regulation skills. I ensure I keep the pace of the session attuned to the client’s capacity and needs.

For example, if a client becomes overwhelmed with sadness, I might gently encourage them to focus on their breathing or to use positive self-talk. I always prioritize the client’s safety and comfort and ensure they don’t feel alone or judged in their experience.

Managing strong emotional reactions during an EMDR session requires a calm and measured approach. The first step is to assess the client’s level of distress. If they’re overwhelmed, I would immediately pause the bilateral stimulation and use grounding techniques to help them regain a sense of stability. This might include focusing on their breath, their body sensations in the present moment, or using positive self-statements. I would then engage in a dialogue with the client, offering validation and support. Understanding the nature of the emotional reaction is crucial. Is it related to the targeted memory, or is there something else contributing to the distress?

If the emotional reaction is intense or prolonged, it may be necessary to adjust the processing approach. This could involve reducing the intensity of the stimulation, shifting to a less emotionally charged aspect of the memory, or even postponing the processing of that specific memory for a future session. Collaboration with the client is key throughout this process. Together, we reassess and adjust our approach as needed. Client safety and comfort always take priority, and if needed, I would utilize my professional network to ensure the client gets all necessary support, including making a referral if needed.