Why I Say No To Referrals

The other day I tried to refer someone to my colleague Susan Giurleo and she said no.  In the process I got to learn more about what she focuses on, and I was reminded that I never wrote this post.  So here goes..

I say no to a lot of referrals.  It’s easier to do that with a full practice, but I used to do this even when I was starting out.  Here’s why:

1. In life and work I try to face my fear. 

Like most people, I have had adversity in my life, and one thing I have learned is that I am my best self when I am not thinking or acting out of fear.  When I first started my practice I just wanted referrals.  Heck, I just wanted the phone to ring.  And I noticed that.  I realized that I was about to recreate a fear-based work environment similar to one I’d just left.  And hadn’t I turned down some interviews and a job offer because I wanted to go into business?  I needed to calm down and not get desperate.  Nobody wants a desperate therapist.

I also knew that if I became focused solely on filling up my office hours I’d have a harder time setting limits on what I did in therapy.  In fact that would in my opinion contaminate the treatment relationship, because I’d be worrying that patients would leave rather than paying attention to them, and avoiding difficult conversations because I didn’t want to “lose them” and lose money.  If I wasn’t able to contain or face my anxiety, how could I help anyone else contain or face theirs?

2. I’m a good enough therapist to not try to be good enough for everyone.

When I was in grad school, it was the perfect storm.  As students, we social workers had it drilled into our heads that we had to help everyone.  This was a natural fit with my yearning to help everyone that I came into contact with, in order to prove I was good at what I did.  Remember the phrase “a Jack of all trades is a master of none?”  That’s where I’d be if I kept on the road if my ego and my grad school had held sway.

But after a short amount of time I realized that there was plenty of work to go around, AND that different people enjoyed working with different types of patients.  So now I am confident enough to know that I can do the work and enjoy it.

3. I’m an excellent therapist with some patients.

After a few years, I had done enough good work, and enough medicore work, to begin to notice when I was doing excellent work.  I do good enough work with couples, depression and anxiety.  I do mediocre work with eating disorders drug addiction and alcoholism.  Where I am an Epic Therapist is with gamers, geeks, LGBT individuals, adolescents and trauma.

By saying this I am not diminishing any of the issues or groups I am less than Epic with.  Nor am I trying to say I am the best therapist in the world, there are lots of people who do just as good or better treatment than I do.  What I am saying is that I am a specialist and a thought leader in very specific niche, that’s what makes me Epic.  Think of what that work is for you, and that will be what makes you Epic.

Since I do the traditional 45-50 min psychotherapy hour, and since I need to sleep sometimes, I can only see a finite number of patients in a week.  Saying no to referrals allows me to continue providing therapy at the most optimal level, and I can honestly say that my work is often enjoyable and always gratifying and meaningful.

4.  Saying no to referrals allows me to have a socially just practice.  Let’s talk money for a minute.  After all, that’s one of if not the main reason one wants a full practice, to make money.  I need to make a certain amount of it to support my family and contribute to our household.  But I have always been clear that I want a diverse practice, and that includes working with low-income patients.  So I always have a certain number of hours that I offer PB+5 or 10 appointments.  In order to provide those I need to be thoughtful about the patients I begin working with for reasons financial as well as clinical.  This means being thoughtful about referrals for reasons financial as well as clinical, and that means saying no to referrals.

5. Saying no can be a networking opportunity.

When I don’t take a referral, I usually try to make a referral for the caller.  Just because I say no to a referral doesn’t mean I can’t be useful in recommending someone else.  This keeps me engaged with my colleagues and understanding who might be a good referral for any given person.  I can be more informative than a list from an HMO, and hopefully it gives a more educated referral for the person.

This is also good business, because it helps me continue to talk with my peers about who they enjoy working with, and what their expertise is.  It also has generated more informed referrals for me, both for patients and supervisees.

So these are some of the reasons I often say no to new referrals:  To say no to fear, to stay clear with myself about my strengths and weaknesses, to do the best clinical work, make enough money to do pro bono work, and to be a part of a professional network.  It’s OK to say no to referrals, even when you’re starting out.  Especially when you’re starting out.