In my experience, most people aren’t professionals at hiding these types of feelings. I think that there is inate ability in each of us to be able to tell when something isn’t quite right with a friend or another person.
It usually mainifests itself in lack of concentration or despondency. I rely on good judgment to guide me in situations when clients are stressed. It can be hard to know when to ask and when not to ask if something is wrong. You never REALLY know how someone is going to react, depending on what’s going on. Generally, asking at the start of the session, “How have you been?” is enough to open that door.
I’m a firm believer that most people just want someone to listen and say to them “I’m sorry” or “It’s OK.” In a sense, you can offer “therapy” through exercise. That’s not what I’m advocating, I’m just saying that the word “therapy” seems to be the only word that fits into what I’m trying to say. The emphasis still has to be on the session. If you’re really into what you’re doing, you sometimes can quickly get your client’s mind off of what’s eating him/her up!
Sometimes having a positive attitude is enough to get the job done. Referral to a counseling psychologist would be needed, in my view, when the client has been consistently down or stressed for at least 3 sessions in a row, or for at least 1/4 of the total sessions. That referral would most likely start off with “What are your thoughts on counseling?” I would try to work that into a session as best I could. A lot of people get offended when you suggest counseling, so it’s never easy to bring that topic up. That might be when I open up to my client about my great experiences with counseling, without offering too much personal information. It’s a good thing to seek help from those who care, which counselors generally do, or at least they do a good job of convincing you that they do! =)