The Referral

James, a psychotherapist, is seeing Gary, a twenty-four year old patient since he was sixteen. Over the years, he heard about Gary’s significant other, Dan. Gary and Dan had an on-again off-again relationship. Many times, Dan would go with Gary to his appointments, waiting patiently in the waiting room. James heard about Dan from Gary’s point of view, but James never had a conversation with him. Dan calls James and matter-of-factly asks for a referral. “Do you want a man or a woman?” James asks. “A woman,” Dan replies. James is not sure whether to probe further, so he decides not to. He is also not sure whether he should bring up this conversation with Gary. Again, he decides not to. James gives Dan three names; all respected colleagues.

Nine months later, one of the respected colleagues, Nadine, calls James to say “thank you”. James is happy that Dan made the connection; not surprised that it took a long time. Maybe Dan called the other two people and they did not work; maybe Dan took nine months to make the phone call. Nadine suddenly seems to be more friendly with James. James is uncomfortable, not with Nadine’s friendliness, but with the possibility that Nadine is being particularly nice in the hope of getting more referrals from James. James tells himself that he is being cynical. James and Nadine have been colleagues for over ten years. James trusts Nadine; hence the referral. Still, James has a nagging feeling. James also knows that he has no right to know what happens between Dan and Nadine, as this is a private relationship. Nadine knows that too.

Making a referral to a colleague is a layered experience. James’ first concern is to protect his patient Gary. Dan’s phone call does not seem to disrupt that relationship. James’ second concern is to help Dan. James does not know Dan well, but he knows the therapists, and he trusts that his referrals can deal with a variety of issues which might arise in the treatment. James’ third concern is to help out his colleagues. A referral supports a practice; it also reinforces the bond between therapists. On the other hand, if the referral results in disappointment, by the therapist ,the patient, or both, then James is going to get the heat.

Giving and receiving referrals is the backbone of psychotherapy, yet James wonders if there is a framework to think about this process. “Is every interaction with a colleague a show-off event to continue to stay in practice?” James wonders. Perhaps being humble, is actually a mock humility to prove to one’s colleagues that one is able to look at himself; as if to show-off even further. The thought process behind a referral seems to be secretive; a secret even from the person making the referral. Maybe there is a secret, or not so secret wish for reciprocation. Maybe there is a secret, or not so secret wish, for attention from the colleague. James’ nagging feeling continues. He needs to seek consultation; he needs a referral. The irony is not lost on him.