Within a psychotherapeutic team, case delegation/client referral/redirecting a client to another professional is an organized process during which responsibility for a client’s care, or part of that responsibility is transferred to another professional within the team. This does not mean that the client is being “sent away,” but rather that the professional resources within the team are being used in the most effective way for the benefit of the client. This may also happen with a professional outside the team, in which case the professional also acts in the client’s best interest.

Common reasons and forms of case delegation within a psychotherapeutic team

Specialist expertise needs

  • Example: A child may initially be assessed by a clinician trained in family therapy as part of a diagnostic process. Once the diagnosis has been established, it may become clear that the child requires complex trauma processing, for which a trauma-specialized clinical psychologist, psychologist, or art therapist within the team would be the most suitable professional. In this case, the current case manager “delegates” the case to the appropriate therapist, who then begins the therapeutic work.

It may also happen that a child enters therapy with a clinical psychologist or art therapist, and during the process it becomes apparent that more extensive diagnostic assessment or psychiatric care is also necessary. In these cases, the clinical psychologist or art therapist “delegates” the case to the appropriate professional or professionals. In such situations, the therapeutic process does not necessarily stop, but rather becomes expanded.

  • Why delegate? Team members possess different areas of expertise and method-specific qualifications. Case delegation ensures that the client is matched with the professional best suited to their specific difficulties. If the expert team cannot provide the necessary expertise for the client, the client is referred to another care provider. Whenever possible, we already recommend targeted professionals during the intake and assessment process.

Phases of the Therapeutic Process

  • Example: At Murmó, clients generally first meet with a clinical psychologist or a methodologically trained art therapist who conducts the initial interviews and diagnostic assessment. If it later becomes clear that another therapeutic method, or not only that method, but a more complex program, would better to support the client, the case may be delegated further.

  • Why delegate? Different phases of treatment may require different types of interventions, and not every therapist is trained in every method.

Capacity and Workload

  • Example: A therapist may have reached their maximum client capacity when a new urgent case arrives. If another colleague within the team has available capacity, the case may be delegated to them in order to ensure faster access to care.

  • Why delegate? Flexibility within the team allows clients to access treatment more quickly and helps prevent overload among professionals.

Dynamics of the Therapeutic Relationship

  • Example: In some cases, an adequate therapeutic alliance may not develop between therapist and client (for example due to personality clashes or transference-countertransference difficulties). In consultation with the team leader, the case may then be delegated to another therapist who can establish a more effective connection with the client.

  • Why delegate? A successful therapeutic process fundamentally depends on a strong therapeutic relationship. If this cannot be established, delegation may be the best solution in the client’s interest.

The Delegation Process Within the Team

  • Case Discussion: Delegation decisions are always made collaboratively by the team during case discussions, taking into account the client’s needs as well as the expertise and capacity of team members. At Murmó, “delegation” typically takes place during Monday’s operational team meetings or designated case consultation times. Since only limited time is available for these discussions each week, we strive from the beginning of the process to guide clients toward the most appropriate form of care.

  • Information Transfer: When a case is delegated, a thorough and comprehensive transfer of information takes place regarding the therapeutic process so far, the diagnosis, the client’s characteristics, difficulties encountered, and the progress achieved.

  • Informing the Client and Obtaining Consent: Clients (and/or their parents) must always be informed about the reason for the delegation and about who their new treating professional will be. Without their consent, the case cannot be delegated. It is essential that the client feels safe and supported throughout the transition process.

  • Ongoing Collaboration: Collaboration within the team may continue even after delegation, especially in complex cases. The former and the new clinician may continue consulting with one another, and the team may continue supervising the progress of the case.

Case delegation is an essential component of psychotherapeutic teamwork. It provides flexibility, efficiency, and the best possible care for the client by ensuring that the appropriate expertise is involved at the appropriate time during treatment.

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