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PANDORA'S BOX

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The Need for Pandora's Box

What Is Pandora's Box?

In order to help family members obtain treatment, the health professional must recognize that the family has three tasks to master first: acknowledging the problem, recognizing the ways they are being affected and each individual’s need for assistance, and understanding that the other family members did not cause the problem and that many other families have experienced these same problems.

While most health care providers are extremely adept at making referrals to specialists for physical problems, few have extensive experience with referrals that offer assistance with psychosocial concerns. Below are a few tips to help maximize the effectiveness of referrals. While it might not be possible for the busy clinician to take all these steps him or herself, it can be helpful to enlist the support of others from the office. Medical professionals and their office colleagues can:

try to be familiar with the resources on their referral list. If a book, article, pamphlet or other publication is being recommended, it should be reviewed first to make sure it is appropriate and would help the patient.
let patients and their families know as much as possible about what to expect in a program, counseling situation or support group ahead of time. While getting help can be a relief, the first steps are often overwhelming. In some cases, help can seem so scary that a simple challenge, like having to transfer buses to get to a program, can seem insurmountable and contact is never made. Letting patients and families know what to expect in advance can ease the tension and make it more likely that they will follow through with referrals.
try to have names of contact people at a support group or counseling program. When an on-site contact person knows that a referral has been made, the patient is usually treated well. Many 12-step group meetings can be attended by the public, and mental health professionals are open to working with the medical community. If possible, visit the site yourself.
encourage the patient or parent to call the program while he or she is still in the office. For many people, getting help feels so daunting that making that first phone call is something to be avoided or delayed.
share with the patient or family how they might feel: nervous and anxious, or even eager and calmer.
try to stay neutral and non-judgmental when making a referral. Enthusiasm for a particular program or disapproval of behavior may be overwhelming and discouraging. Be open to negotiating options that are agreeable to the patient and family.
follow up with patients to see how the referral worked out. This supports the referral process and makes clear that the clinician is not abandoning the patient, which is often the underlying fear when a referral is made.

There are programs in virtually every community designed to assist families in need (Click here to access a comprehensive referral listing). A look through a local phone directory or a call to a nearby family counseling center can be good starting points for developing a referral list. Some resources that might be included on the list are:

child abuse prevention and treatment programs
school guidance departments and student assistance programs
psychotherapists with expertise in such issues as family violence or substance abuse
local councils on alcoholism and drug dependence
self-help groups that meet locally
family service agencies
nearby substance abuse treatment centers
municipal hotlines for family violence or substance abuse
social work departments of local hospitals
mental health centers
libraries or bookstores

Providers may also want to share with patients a list of books, pamphlets and other publications (Click here to view a list of resources).

When referred to other sources, patients and their families may need clarification about the clinician's long-term role and the purpose of the referral. Providers should emphasize their on-going commitment to the patient and continued relationship.