When Should Therapists Refer a Client for ART?
Many therapists have clients who are doing good therapy.
They show up.
They reflect.
They understand their patterns.
They can name their attachment wounds, trauma responses, family dynamics, coping strategies, and protective behaviors.
They may have a strong relationship with their therapist.
They may be benefiting from weekly therapy.
And still, something remains stuck.
A memory still feels charged.
A grief image keeps coming back.
A betrayal keeps replaying.
A medical experience still lives in the body.
A trigger takes over before the client can use the insight they have worked so hard to develop.
This is often where adjunctive Accelerated Resolution Therapy, or ART, may be worth considering.
Not as a replacement for good therapy.
Not as a magic cure.
Not as a promise.
But as a focused trauma therapy that may help a client work with a specific stuck point while remaining connected to their primary therapist.
ART can be adjunctive, not competitive
One of the most important things for referring therapists to know is that ART does not have to replace ongoing therapy.
In many cases, ART can be used adjunctively.
That means a client may continue working with their primary therapist while seeing an ART-trained clinician for focused work around a specific memory, trigger, emotional response, or trauma-related image.
This can be especially helpful when the primary therapy relationship is strong and clinically important.
The goal is not to disrupt that relationship.
The goal is to support it.
A client may continue doing weekly therapy for insight, relationship work, identity, coping, boundaries, emotional support, and integration, while using adjunctive ART to focus on a particular area that has not shifted enough through talk therapy alone.
When a client has insight but still feels stuck
A common referral situation is the client who understands the pattern but still cannot change the reaction.
For example:
They know the betrayal was not their fault, but they still feel ashamed.
They know they are safe now, but their body still braces.
They know their parent was emotionally immature, but they still feel responsible.
They know the relationship is over, but the image still intrudes.
They know they want to speak up, but they freeze in conflict.
They know they survived the medical event, but appointments still feel terrifying.
They know the grief is real, but one scene keeps replaying.
These clients are not lacking insight.
They may need a different kind of therapeutic access point.
ART may be helpful because it works directly with distressing memories, images, sensations, emotions, and meanings in a structured way.
When weekly therapy is helping, but not reaching one specific target
Weekly therapy can be excellent.
It offers continuity, depth, relational safety, and time.
But sometimes one specific target keeps showing up again and again.
A client may be making progress overall, but one area remains highly activated.
That might be:
a single trauma memory,
a grief image,
a betrayal discovery,
a medical procedure,
a panic-associated memory,
a public speaking image,
an intrusive replay,
a body sensation,
a shame memory,
or a relationship moment that still feels unresolved.
When the issue is clear enough to identify, ART may offer a focused way to work with it.
This can be especially useful when weekly sessions keep returning to the same material without significant reduction in emotional charge.
When a client does not want to retell the trauma
Some clients avoid trauma work because they do not want to describe what happened in detail.
They may feel ashamed.
They may feel protective of the details.
They may fear being overwhelmed.
They may not want to see another person react to the story.
They may have already told it too many times.
They may be able to say, “I know what we need to work on, but I do not want to talk about it again.”
ART can be appealing because it does not require the client to retell every detail of the experience.
The therapist needs enough information to understand the focus of the work and assess clinical appropriateness, but ART does not depend on repeated verbal narration.
For some clients, that makes trauma work feel more possible.
When the client has a specific image that will not leave them alone
ART may be particularly relevant when the client is distressed by a specific image or scene.
This may show up after:
sudden loss,
betrayal,
medical trauma,
an accident,
assault,
public humiliation,
relational rupture,
or a frightening event.
The client may say:
“I can’t stop seeing it.”
“That image comes up all the time.”
“I know it’s over, but my brain keeps replaying it.”
“I don’t even think about the whole story. It’s just that one moment.”
“This scene still feels unbearable.”
When the distress is organized around a specific image, ART may be worth considering as a focused adjunctive intervention.
When grief includes traumatic images
Grief therapy and trauma therapy can overlap.
A client may be grieving in a natural, meaningful way while also carrying traumatic images connected to the loss.
For example:
the moment they found out,
the final days,
a hospital scene,
an image of suffering,
a phone call,
a funeral memory,
a decision they keep questioning,
or guilt about what they did or did not do.
ART is not intended to erase grief.
That is not the goal.
But it may help reduce the traumatic charge around specific grief-related images so that the client can continue grieving without being repeatedly pulled into the most distressing scene.
For therapists working with grief, adjunctive ART may be useful when the trauma around the death seems to be blocking or complicating the grieving process.
When betrayal trauma keeps replaying
Betrayal trauma can become consuming.
Clients may replay the discovery, the confrontation, the timeline, the lies, the messages, the images they imagine, or the moment trust collapsed.
They may understand cognitively that the betrayal was not their fault, but still feel ashamed, foolish, enraged, obsessed, or unable to stop scanning for danger.
Weekly therapy may be very important for helping the client understand attachment, boundaries, grief, self-trust, and decision-making.
But ART may help target specific images, moments, or body responses that continue to feel highly charged.
This can be especially helpful when the client is not simply trying to “move on,” but trying to stop being overtaken by intrusive replay.
When medical trauma is affecting the client’s relationship with their body
Medical trauma is often under-recognized.
Clients may present with anxiety, avoidance, anger, body scanning, panic before appointments, mistrust of providers, or a sense that their body is unsafe.
They may have experienced:
a frightening diagnosis,
emergency care,
surgery,
hospitalization,
invasive testing,
fertility treatment,
birth trauma,
chronic illness,
medical dismissal,
or loss of control during treatment.
The client may not identify it as trauma.
They may say, “I know it was medical, but my body still reacts.”
ART may be useful when there is a specific medical memory, image, sensation, or future fear that remains emotionally charged.
When the client’s body reacts faster than their insight
Some clients can explain their experience beautifully.
They can name the trigger.
They know the origin.
They understand the relational pattern.
They can identify the younger part.
They can describe the nervous system response.
But in the moment, their body still reacts before they can access that insight.
They freeze.
They shut down.
They panic.
They fawn.
They become flooded.
They avoid.
They lash out.
They collapse.
This is not a failure of therapy.
It may mean that the work needs to include the emotional, sensory, imaginal, and physiological layers of the memory or trigger.
ART may be helpful when the client’s body response is outpacing their cognitive understanding.
When the client is highly functional but privately suffering
Many clients who may benefit from ART are externally functional.
They work.
They parent.
They lead.
They manage.
They perform.
They take care of other people.
They may not look like they are falling apart.
But internally, they may be carrying intrusive memories, shame, anxiety, grief, or emotional reactivity that takes enormous effort to contain.
These clients may not want open-ended therapy forever.
They may want focused work that respects their insight, intelligence, privacy, and schedule.
For some high-functioning clients, an ART intensive can feel more aligned than adding another weekly therapy hour.
When a client needs focused work before a specific event
Sometimes clients seek help because a specific event is approaching.
For example:
a court date,
medical procedure,
public speaking engagement,
family event,
anniversary,
memorial,
confrontation,
work presentation,
or unavoidable encounter.
If the client has a specific trigger or feared image connected to the event, ART may be worth considering.
The goal is not to guarantee that the event will feel easy.
The goal is to help reduce the emotional charge that may be interfering with the client’s ability to stay present and grounded.
When therapists may want to refer for an ART intensive
An ART intensive may be especially useful when there is a clear focus and the client has enough stability to engage in deeper work.
A therapist might consider referring for an ART intensive when:
the client has a specific trauma target,
the client is stuck around a memory or image,
the client has insight but remains emotionally activated,
weekly therapy is helping but moving slowly around one issue,
the client does not want to retell every detail,
the client is seeking focused short-term trauma work,
the client wants adjunctive support while staying with their therapist,
or the client would benefit from a longer, private block of therapeutic time.
The intensive format can create more room than a standard weekly session for preparation, ART processing, integration, and follow-up planning.
When ART may not be the right fit
ART is not appropriate for every client or every clinical situation.
A client may not be ready for ART if they are actively unsafe, in acute crisis, significantly unstable, or needing a higher level of care.
ART may also not be the right fit if the client needs stabilization, substance use treatment, psychiatric support, or ongoing weekly containment before engaging in focused trauma work.
Additional clinical factors may need to be considered, including significant dissociation, psychosis, active mania, seizure history, traumatic brain injury, or medication-related concerns.
This is why assessment matters.
ART should not be oversold.
A good referral is not “this client has trauma, therefore ART.”
A better question is:
Is there a specific target, sufficient stability, and a clinically appropriate reason to use this modality now?
What therapists can tell clients about ART
Therapists do not need to explain ART perfectly in order to refer.
A simple explanation may be enough:
“ART is a focused therapy that uses eye movements and a structured process to help work with distressing memories, images, and emotional responses. You do not have to retell every detail. It may be worth exploring for this specific stuck point while we continue our work together.”
That kind of framing helps avoid overpromising.
It also reassures the client that the referral is not abandonment.
For clients with strong attachment to their therapist, this matters.
They need to understand that adjunctive ART is meant to support the work, not replace the relationship.
How adjunctive ART can support ongoing therapy
When adjunctive ART is a good fit, the client may return to ongoing therapy with less emotional charge around the target.
That can create more room for integration.
The primary therapist may then continue helping the client make meaning, practice boundaries, explore relationship patterns, grieve, deepen self-trust, and live differently after the stuck point has shifted.
ART may help move something that has been blocking progress.
Ongoing therapy may help the client integrate that movement into daily life and relationships.
Both can matter.
What referral sources should look for in an ART therapist
Therapists considering a referral may want to know:
Does the ART therapist understand adjunctive work?
Will they respect the existing therapy relationship?
Do they know when ART is not appropriate?
Can they work with trauma without overselling outcomes?
Are they comfortable with complex grief, betrayal, medical trauma, shame, and relational trauma?
Do they communicate clearly about fit, structure, and limitations?
Do they understand that the client is not simply a “case” but someone already held in an ongoing therapeutic relationship?
For referral sources, trust matters.
A referral should feel clinically thoughtful, not transactional.
Referring to Laura Geftman, LCSW for adjunctive ART
I offer adjunctive ART and therapy intensives for adults who are seeking focused support around trauma, grief, anxiety, betrayal, medical trauma, emotional triggers, shame, and feeling stuck despite insight.
Clients may continue with their primary therapist while working with me for focused ART or intensive therapy around a specific target.
I am licensed in Pennsylvania, New Jersey, New York, and Florida.
In-person therapy intensives are available in Ardmore, PA, on the Main Line near Philadelphia.
Virtual ART may also be available for adults located in Pennsylvania, New Jersey, New York, and Florida when clinically appropriate.
A referral does not mean the therapy failed
When a therapist refers a client for adjunctive ART, it does not mean the therapy has failed.
It may mean the therapy has been thoughtful enough to identify what kind of support the client needs next.
Some clients need the depth and continuity of their ongoing therapy relationship.
Some clients also need focused work around a specific memory, trigger, image, or emotional response that remains stuck.
The two can work together.
For therapists, referral is not a loss of the client.
It can be an extension of good care.
Interested in referring a client for ART?
If you are a therapist considering whether ART or a therapy intensive could support one of your clients, you are welcome to reach out to discuss whether adjunctive ART may be clinically appropriate.
Laura Geftman, LCSW offers focused ART and therapy intensives for adults in Pennsylvania, New Jersey, New York, and Florida.
In-person intensives are available in Ardmore, PA, near Philadelphia, and virtual ART may be available when clinically appropriate.
Suggested Reading
If you are a therapist or client considering whether ART or therapy intensives may be a good fit, these related articles may be helpful:
Can ART Be Used Adjunctively While a Client Stays With Their Primary Therapist?
What Therapists Should Know About Accelerated Resolution Therapy
Therapy Intensives in Ardmore, PA for Philadelphia, Main Line, and NYC Clients
FAQ
When should a therapist refer a client for ART?
A therapist may consider referring a client for ART when the client has a specific memory, image, trigger, grief scene, betrayal, medical trauma, or emotional response that remains charged despite meaningful therapy and insight.
Can ART be used while a client stays with their primary therapist?
Yes. ART can often be used adjunctively while the client continues ongoing therapy with their primary therapist. The goal is to support the existing therapy, not replace it.
Does ART require the client to retell the trauma?
No. ART does not require the client to retell every detail of what happened. The therapist needs enough information to understand the focus and assess fit, but ART does not depend on repeated verbal narration.
What kinds of clients may benefit from adjunctive ART?
Clients who may benefit from adjunctive ART often have a clear stuck point, enough stability for focused work, and distress connected to a specific memory, image, trigger, grief scene, betrayal, medical trauma, or body-based response.
When is ART not appropriate?
ART may not be appropriate when a client is actively unsafe, in acute crisis, significantly unstable, needing a higher level of care, or requiring stabilization before trauma processing. Clinical factors such as significant dissociation, seizure history, traumatic brain injury, psychosis, or active mania may also require careful assessment.
How can therapists refer a client for ART?
Therapists can refer a client for ART by encouraging the client to schedule an initial consultation or by reaching out directly to discuss whether adjunctive ART may be clinically appropriate.