Chapter 20
When to Refer Athletes for
Counseling or Psychotherapy
David Tod & Mark B. Andersen
Canst thou not minister to a mind diseas’d, Pluck from the
memory a rooted sorrow, Raze out the written troubles of the
brain, And with some sweet oblivious antidote Cleanse the stuff’d
bosom of that perilous stuff Which weighs upon the heart?
—Macbeth, act V, scene iii
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consent of McGraw-Hill Education.
Performance Consulting
• Provides help for issues such as competition anxiety,
motivational problems, negative self-talk, & concentration
difficulties
• Services are education based
• Not uncommon for athletes to bring up personal issues
• may or may not affect performance
• need to address, assuming one is qualified to do so
• Separating “performance” from “personal” issues is a false
dichotomy
• performance is a personal issue
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Depression
• “The common cold” of mental health
disorders among the general population
• Athletes often experience depressed moods
following losses or failures to perform as
hoped or expected
• May need help to get through the sense of
loss or disappointment
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Depression (cont.)
SIGNS
• Social withdrawal
• Hopelessness
• Loss of self-esteem
• Lethargy
TREATMENTS
• Psychotherapy
• Antidepressant medication
• Referral to another professional
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When to Refer and What to Do
• When a sport psychologist is faced with an athlete or coach
whose presenting concern is outside the practitioner’s realm
of expertise or in need of medication
1. Refer the client to another therapist or physician for
treatment
2. Consider upskilling to become competent to work with
future athletes presenting with the issue
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McGraw-Hill Education.
Performance Enhancement Versus
Problematic Personal Issues
• This is a false dichotomy!
• Problems in performance are related to issues like
competition anxiety, motivational problems, poor
self-talk, and lapses in concentration BUT other
factors may be involved
• There are always interrelated issues between the
personal and performance
• Getting athletes to talk about their lives can lead to
understanding their performance or motivational
problems, as well as the whole person
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Indicators for Referral
1. Problem is severe, has existed for long time, and affects
many aspects of the person’s life
2. Unusual or extreme emotional reactions
•
e.g., depression, anxiety, anger, aggression
3. Traditional interventions not working
•
determine if the problems are related to other
deeper/stronger issues
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How to Start the Referral Process
• Instead of referring out, refer in
• Bringing in a qualified professional and having all three
parties sit down and discuss a plan may be less threatening
to the athlete
• All referrals are complex and sensitive in nature
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Problems When Referring
• Lack of a good working relationship between sport
psychologist and athlete
• Athlete might think consultants are trying to get rid
of them
• Athlete might infer they are damaged goods
• Athlete may feel unsupported
• Practitioners may not have prepared athletes
adequately for the referral process
• Begin preparation right from the start by signaling to
athletes in their first sessions together that referral
might be a possibility in the future
• Athletes might never contact the recommended expert
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McGraw-Hill Education.
Specific Athlete-Related Issues
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Identity Issues
• Sense of self has revolved around their roles as athletes
• Overidentification
• Major threats to identity can come through athletic injury and
through career terminations
• Also negative identities
• The acceptance and valuing of an identity that is generally
disapproved of by society
• Dumb jock
• Tough jock
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Sexual Orientation and Abusive
Environments
• LGBT athletes may struggle with the “coming out” process,
but sexuality is not their primary issue…abuse and
discrimination
• Fears about getting less playing time, being kicked off
teams, being harassed, and being physically abused if
their orientations were made public
• Can result in anxiety disorders, relationship problems,
depression, and even suicidal ideation
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Sex-and Health-Related Issues
• Athletic careers start seriously sometime during adolescence
and usually end somewhere in the mid-20s to late 30s…prime
time periods of experimentation, exploration, and finding out
about oneself
• Risk-taking behavior in the realm of sex
• Athletes in general engage in sexual behavior more
frequently and have more partners than their nonathlete
peers
• STD risks
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Eating Disorders
• Affects men AND women
• Men usually control weight via saunas, steam baths, and
exercise, and women more often use purging, diet pills, and
laxatives
• Central feature is often disturbance in body image
• Warning signs: weight loss or preoccupation, avoiding food
social functions or eating little, visiting bathroom after meals,
bloodshot eyes, decrease in energy or concentration,
gastrointestinal complaints, increased emotional swings
• EXTREMELY DIFFICULT TO TREAT
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Alcohol and Substance Abuse Issues
• The association between masculinity and
drinking may make some athletes more
vulnerable to developing problems in this area
• Student-athletes are a high risk group
• “Sensation seekers”
• Given denial and defensiveness around alcohol
and drug use, coaches or sport psychology
practitioners concerned about these issues
can note their concerns, but not in lecturing or
threatening ways.
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Anger and Aggression Control
• Someone going through a personally difficult time may be
less able to control anger or aggression
• On or off the field
• Alcohol and drug use may also be related to such
behaviors
• Roid rages
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Romantic and Family Relationship Issues
• Many athletes have to be away from friends or family for
extended periods of time
• Can cause loneliness, anxiety, and depression
• There may be conflicts in the relationship
• Practice and competition place demands on the athlete’s time
at home
• Lost of pressure
• Intrateam romantic relationships
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Professional Development
• Develop knowledge about:
• Psychopathology
• Psychopharmacology
• Performance enhancement substances
• Read biographies of athletes who have experienced mental health
issues
• Develop a network of various individuals
• To refer for both psychological and sport and exercise sciencerelated issues
• Psychiatrists, clinical &counseling psychologists, social
workers, pastoral care providers, marriage & family therapists,
substance abuse counselors, and career guidance experts
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Professional Development (cont.)
• Engage in regular supervision and peer consultation
• Role play referrals for a variety of issues and types of
athletes
• Engage in self-reflection and examination to find out how
your experiences, needs, etc. might influence the referral
process
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reproduction or distribution without the prior written consent of
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