What It Means To Make A Referral

referral cartoon

To speak with a relative stranger about the most intimate details of one’s life is an incredibly daunting prospect for many psychotherapy patients.  No matter how guarded a patient may be, she or he is daring to be incredibly vulnerable as well.  Often the only thing that can make this beginning possible is an appropriate therapy referral.  And yet never before has it been so easy for us to make a horrible or thoughtless referral to these brave souls.

It was hard enough when managed care began to shape the behavior of therapists to focus on insurance as being the number one or only criteria to make a referral.  But now technology has made it even worse.  Readers of this blog know that I am a great fan of technology in general and social networking in particular, so it may come as a surprise to hear me say this; an explanation is in order.

Recently I began to get emails from various therapists with the subject heading “Are you accepting new referrals?” or “Referral for you.”  In the past I have found those questions a nice compliment.  But these emails were actually invitations to join something called Referral Key, a small business referral network.  The message went like this:

If you’re taking on new clients, I’d like to include you in my private referral network to send you business leads.

Please accept my invitation below. Thanks!

Here’s the problem, none of the people who sent me these emails knew me in a professional capacity as far as I can tell.  We had never shared a patient, attended a fellowship together, worked at the same agency or supervised trainees at the same place.  The only qualification these people would know I had if I accepted their invite was that I wanted more business.

That’s not how you make a good referral.

Look, referring a patient to someone is risky enough when you do know the therapist or the patient.  Risky because we have never experienced what it is like to sit with the colleague as a patient.  But at least we have some other information to go on.  The nature of therapy requires that we be as thoughtful about referrals as possible.

In my experience with trainees and consulting to therapists I have come across a lot of marketing information on how to get referrals, but not a lot of clinical info on how to make them.  So here are my suggestions on when and how to make a good referral.  Keep in mind that these tips are a combination of my experience, opinions and pet peeves.  Between emails, listservs, social networks, etc., I see a lot of different ways therapists do it.

1. Don’t treat a referral as a consolation prize.  If you get a call from a patient who says they were referred to you by their insurance, and you are not accepting new patients, don’t feel pressured to offer them another name.  Ideally, if you have time to offer them an initial consult you may get enough information to make a suitable referral.  If they can come in, you can discuss their presenting problems, therapist preferences in terms of gender, experience, etc.  If you offer free phone consultations (which I discourage in general,) you can speak with them over the phone at enough length to get a sense of the patient’s needs.  For a thoughtful referral, my experience is that this takes 30-45 minutes.  looking online and saying, “Jane Doe appears to be in your network and I’ve heard good things about her” may be sufficient to assuage your conscience but is not sufficient to be a solid referral.  Jane may be a whiz at adult ADHD, but if the patient was referred to you for your expertise in PSTD you may have no idea whether Jane has interest or expertise in both.

2. Avoid referring to therapists who “do it all.”  I never refer to a therapist who treats ages 3-80 for issues ranging the breadth of the DSM-V.  The USDA deals with chunks of meat on a conveyor belt, we don’t.

3. Disclose the extent or limitation of your knowledge of the referral to the patient.  If you trained with the person and think highly of them from the way they discussed their work, say that.  If they are someone who responded to a listserv request you made and you know nothing about them or their work, say that.  Patients trust us to give them expert opinions, and if your expertise is limited the burden of disclosing that is on you.

4. When soliciting a referral, keep it brief and salient.  Don’t pepper the listserv or discussion boards with identifying information or your subjective impressions.  Age, presenting problem and therapist preferences (gender, takes X insurance, CBT) are enough.  So often I see referrals for someone seeking a therapist for a patient who is “a lovely, very insightful young man who would be a delight to work with.”  This is more of a sales pitch than salient data.  None of your colleagues are probably hoping to work with horrid, clueless people who are a misery to work with, now are they?  Nor do we really need to know that the referral is for the daughter of a good friend of yours.  If this is a referral that will involve collaboration (such as one member of a couple you are seeing) by all means offer to share more information if the referral works out.  But in the meantime, just the facts.

5. When possible, get feedback and use it to inform your future referrals.  If you referred to a colleague to treat one of your individual patients for couples therapy, ask them how it is going or went.  Please take this information seriously and do not dismiss it as transference.  It may be transference, but remember your alliance is with the patient and erring on the side of caution.  In my time I have had folks give me feedback that the people I referred to didn’t listen, feel asleep during a session, took their spouse’s side, smelled of alcohol, and a myriad of other concerning statements.  Do I know for a fact that any of these stories were true? No.  Do I plan on risking referring a patient to one of those people again, absolutely not.  If the person you refer to is difficult to reach or collaborate with, bear that in mind for future referrals.

6. Talk to your colleagues.  Ask them whether they are taking referrals, or what kind of patients they see.  Ask them what their expertise is if you are unsure.  Send them an email with brief and salient information asking if this sounds like someone they’d enjoy working with.  And absolutely send them a note if you give their name as a possible referral.

7. If you don’t have or want to take the time to make a solid referral, then don’t make one at all.  Too often our colleagues try to come up with a name rather than say, “I’m sorry I can’t help you.”  Our graduate programs rarely train us to say that.  But better you say that than misunderstand what a referral truly is.  A referral is a thoughtful recommendation to a patient for a clinical treatment of serious concerns.  If you don’t have time to give it sustained thought, understand the concerns or help needed, don’t give a referral.

Above all, please keep in mind that social networks are great for many things, and referring patients is not one of them.  If the only thing you know about a therapist and their work is that they are in your “network,” what kind of qualification is that?  Don’t confuse networking, marketing, or chatting with referring someone to therapy.  If you were looking for a therapist and someone said, “I got an email the other day from someone saying they are taking on new patients,” would that be sufficient for you to make an appointment?  Just because I’m in your Contacts or LinkedIn group doesn’t mean I am any good at therapy in general or for a patient in particular.  I could be a complete wingnut.

Do you really want to take that chance with someone’s mental health care?

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Mike Langlois, LICSW

Mike consults, writes and teaches about online technologies, video games & psychotherapy. He provides private supervision for psychotherapists who seek to start, grow, & market their private practice.

Latest posts by Mike Langlois, LICSW (see all)

About Mike Langlois, LICSW

Mike consults, writes and teaches about online technologies, video games & psychotherapy. He provides private supervision for psychotherapists who seek to start, grow, & market their private practice.

Comments

  1. Hello Mr. Langlois,

    I am a substance abuse counselor intern (LCDC I). A friend of mine shared this post with me and I am glad she did. I am working towards my license and preparing to take the certification exam. I am studying everything I can and reading all kinds of information related to the counseling field. I like your article. I published a few posts about referrals and service coordination on my blog. I like how you described everything and it does not sound like coming from a book or a manual, but from your experience.

    Your work is very creative. Combining online technologies with psychotherapy. I can see myself doing what you described in your Youtube video. In the future, when I am fully licensed and have more experience as a counselor, I would like to help people all over the world. Many people read my blog from places I did not know existed!

    I will start following you on some social networks. Have a great 2013!

  2. Mike, I’ve been away from your blog too long and am so happy to find you addressing “Referral Key” in particular and referrals in general. Thank you!

    I have also had several mental health attorneys insist that we are to some extent legally and ethically responsible for the referrals we make. If we refer to a snake oil salesman because we didn’t take time to vet the “professional,” my understanding is that that may be construed as failing to work below the professional standards of care. That’s just one more reason I don’t refer to folks I don’t know.

    And, from a marketing perspective, if you don’t know who to refer to for X then that’s a perfect reason to focus your networking on X – so that you do have someone to refer to in the future!

    This is an excellent post, Mike, and I’ll be directing my colleagues and readers to it. Thank you.

  3. Susan Kehaya says:

    Thank you, Mike, for your very thoughtful, concise expression on a really important subject. I have lost opportunities because I refused to be ‘encouraged’ to work with a group or individual with whom I didn’t feel fully qualified to work and never looked back. We are in a very delicate position with the work we do. We can either help or be helpful — or we can do more harm than good by not knowing precisely what we’re doing. Thank you for bringing that fact to light.

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