Referrals, or, Flossing the Gift Horse

Image Courtesy of Open Education

A lot of my colleagues complain about not being able to build up their practice. I don’t get it. I am usually as booked as I want to be, and the phone rings pretty much daily. But when I talk to colleagues, I often begin to glean why they might have a difficult time getting their practice full. They don’t want to do anything outside of the therapy appointment to bring in referrals, and worse, some of them are actually hard to refer to.


I will often try to offer some overflow referrals to these peers. It becomes like twenty questions: “Do they plan on using insurance?” “What kind of insurance do they have?” “How did they get your name?” “Did you tell them to call me?” “Did you tell them I’d be calling them?” “What kind of therapist are they looking for?” “Are they looking for Saturdays? I don’t do Saturdays.” The list goes on. These folks are sending very mixed messages: They want referrals but they don’t want to do any of the work for them. They are concerned about the vacancies in their practice but don’t seem to want to make a phone call and ask some questions.

Look, I know that your time is valuable. Mine is too. And when I give you a referral isn’t it worth your time to make the call even if it turns out not to be a fit? The narrower the opening you leave in your referral process, the fewer referrals can get in!

The reason I have so many referrals is because I worked long and hard to develop multiple referral streams. I join EAPs on the other side of the US so I could be their only provider in MA. I advertise in every free online venue I can. I have a presence online in Psychology Today, on Google and HelpPro. And in real life I am constantly talking with my colleagues, networking, sending out newsletters and giving workshops. This all occurred during those hours I had vacant in my practice to start with, and still occurs, sometimes at 2:00 AM! I’ve got my own hell to raise, so when I pass along a referral, don’t expect me to do your footwork for you.

We therapists need to cultivate our aggression when it comes to getting patients. No, I don’t mean going out and clubbing them on the head to drag them to our office. I mean that we need to be willing to spend hours marketing ourselves, refining our strategies; hours and dollars on consultants and coaches if we need to learn how to do this. We undervalue that part of the business, worse, we sometimes act as if we think it is below us.

Let me give you an example. If you are someone who provides private supervision, what do you do when someone walks up to you at a workshop or meeting and says, “so I have this difficult patient and I want your perspective.” And then they launch into the case presentation right there. Would you begin supervision on the spot? Of course not. You’d say something diplomatic like, “I’ll be happy to set up a time to talk and think about this with you.” Because you value the importance and the seriousness of clinical supervision. And you’d most likely never walk up to someone in a similar situation and presume to do the same in reverse. But I can’t tell you how many times people approach me and other practice consultants I know as if growing their practice is a 5 minute conversation topic. How devaluing!

Learning to build and market a private practice is a process, and those who have expertise in it have a skill set just like the other skill sets that go into running a therapy business. None of the successful psychotherapists I know are waiting in their office like film noir gumshoes for their phones to ring. We don’t have time for that. So bring your laptop to work, brush up that LinkedIn profile, ask that senior colleague out for a coffee and network, or plan that public workshop that can give potential patients a look-see at you. If you want your practice to grow be ready and willing to invest your own time, money, and energy into it. Consult experts and do the footwork. And if someone offers you a referral with just a name and a number take it, and assess the referral on your own time.

I know that this sounds like a tirade, and please don’t think I begrudge helping a colleague out. That is one reason I offer you these blogs and concrete suggestions. Just keep in mind that the reason you don’t work in an agency anymore is because you wanted to own your own business, and that means you have to do much much more outside the 45 or 50 minutes with patients. So this week, what are you planning to do outside the therapy hour to grow your practice?


  1. AMEN!!

    Like you, my practice is full and I was up at 5 AM this morning posting to my blog and sending out a newsletter. Those two realities are not a coincidence.

    And I don’t pass on referrals. Why? Because when I used to do that EVERY time the therapist I referred to let the client down. No word to a lie I would get feedback that the therapist never returned their call, wasn’t in the office at the time of their appt (!), took months to return a report or write a letter, the list goes on.

    In the office, out of the office if you want business you need to behave like a professional and mean business.

    And I do Saturdays.

  2. Really useful post, Mike, and also for non-therapists such as myself who is a coach, consultant, facilitator and supervisor of coaches/consultants.
    Having been in business for 18 years and very busy for nearly all that time, I would endorse everything you say and also add that if you can see the ‘networking’ and ‘marketing’ which many people dread and say ‘I’m not very good at’, as instead just pursuing intriguing often synchronistic connections which arise in daily life and following natural curiosity, then it becomes not only tolerable but also one of the best parts of working life. One contact leads you somewhere else, often unexpected, and that’s what keeps you and your practice alive. Also the hardest part as with so much else is often just taking the first step; and changing your mental outlook as you suggest.

    • Karin, great point! Often when I hear therapists say “I am not very good at that,” they are really saying I have no interest in that. That just won’t cut it if you want to run a business. And your point about the natural connections arising via synchronicity is so true. This very morning at brunch I was chatting with a colleague to catch up on things, and his partner nudged him to ask me a “Skype” question. I was happy to answer and enjoyed the conversation, and then without any prompting he asked to buy some consultation time with me. If only our colleagues would get that by sharing things they already know and have passion about, they will reap great synchronous rewards!

  3. Yes, in this time of economic and employment instability it takes investment of time and energy, and other resources, to maintain a successful counseling/psychology business. I have found we need to keep a flexible mind-set, adjust and adapt to the current conditions – just like we need to meet a client where he/she is at when we start therapy.
    One thing not mentioned in this blog: when we find a dependable referral source or colleague, who is also intelligent, ethical, open-minded and energetic it is so very valuable. I believe one aspect of my life that has helped immensely is that when I discover such a wonderful professional, I keep in touch and want the best for them. An active network of like-minded professionals magnifies the referrals and ideas that translate to energy and more referrals – and to successful therapy and business.

    • TJ, thank you for bringing that point up–Nurture those referral sources!! They are like gold, and they are often folks who become strong professional friends, colleagues and advocates for your practice. And I think flexibility is key, wouldn’t we say that to our patients in many cases as well? I think there are so many creative ways of practicing psychotherapy in the 21st century, if we can escape being rigid.

  4. Al good points. Thanks for the insight.

  5. Michael, I totally agree with you. I have been in private practice for 5 years and have worked my behind off getting on panels, networking, giving workshops, attending community meetings, networking, networking, networking. I just built my website, created business cards, letterhead and coming soon, brochures. It’s been a lot of hard work. I work all the time, even on weekends and holidays to get myself out there. The problem is people have all kinds of excuses like: I don’t want to take insurance, it’s a pain, or I don’t want to work Saturdays and evenings. In order to bring in the clients you have to be willing to bend a little and see what the client’s need. Most of my client’s need evening appointments and Saturdays. I also work with Medicaid and low income. A lot of therapists don’t want to touch this population. Well they bring in good money. Once you have a good billing/office program the job is much easier. As you said, we have to invest time, money, energy and love into our businesses in order for them to be successful. Thanks for a great post.

    • Lorrie, thank you for weighing in. It is great to see how different people integrate social justice and marketing into their business. I have a earlier post about this you may find of interest. The irony is that after several years, your practice may be or arrive at a point where it makes good business sense to start getting off some of those panels to maximize income. At least that is what happened to me. But the good news is it is YOUR business, so you get to decide! Hope you subscribe and retweet if you liked the article.

  6. I couldn’t agree more.

    I have had an astronomic rise in my practice, I’m full, have a waiting list. I refer but very carefully. But it didn’t happen by magic. I have the LinkedIn profile, PT profile, website, blog, Twitter and Facebook page. It all takes time so I see clients M-Th and do the online work on Fridays and Saturdays.

    Yes, I saw Saturday clients when I first started, I’d see anyone at any time, now it’s 8-8, M-Th. I can go to seminars on Fridays, meet with collaborative agencies and colleagues on Fridays. Just because I’m not “in the office” doesn’t mean I’m not working. I accept 2 insurances and plan to eliminate them someday and return to self-pay, but it’s working right now.

    Thank you for these posts, I’ll look forward to more.

    Mine is at


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