One of the most common mistakes made by counselors is to forget to encourage their clients to get specific medical work-ups. There are three key reasons for this problem.
1. Most clients describe their struggles with causes already in place. “I’m depressed because I have a bad marriage, because life isn’t going the way I had hoped.” We counselors accept their initial diagnosis and fail to dig further.
2. We know that counseling works. And so we help them work on their thinking, feeling, and behaviors. We do what we do best
3. When we do send someone to the doctor, we rarely get a clear answer.
Nonetheless, it is essential that your clients have had recent blood work. Case in point. Low thyroid levels often leads to experiences of confusion, mental dullness, and depression. (FYI, overactive thyroid may lead to irritability and anxiety). While there may be real counseling work to be done (everybody needs some help), it would be a tragedy to miss real mercy care (i.e., a better functioning thyroid).
Check here for some info on hypothyroidism: http://www.endocrineweb.com/hypo1.html
Musings on Faith and Psychology 
I like the way the Remuda Ranch program puts it. The bio-psycho-social-spiritual assessment.
You might want to recommend the “correct” blood work, which the TSH and T4 are not and which most doctors are taught to do. Read this page from an excellent patient-to-patient website: http://www.stopthethyroidmadness.com/recommended-labwork That website also teaches that many of your patients with depression are on T4-only medications, and those medications are inadequate…and depression is the result. Better treatment is with Armour and dosing it by the removal of symptoms, not the TSH. Patients you see might also have adrenal fatigue: http://www.stopthethyroidmadness.com/adrenal-info It’s all too common with thyroid patients.
Phil,
Here’s a good book on thyroid diseases & how it affects the mind: “The Thyroid Solution: Mind-Body Approach” by Ridha Arem M.D.
My sister and I who both suffer from thyroid problems came to understand our conditions much better after reading it. Also contains good information on the mind-body connection which is often neglected in clinical practice.
We have been blessed with a good endocrinologist who believes in treating patients, not diseases. She understands thyroid patients’ mental faculties and moods are intricately linked to their physiological condition and makes sure her patients are given the appropriate psychological/psychiatric/counselling help from the professionals.