TL;DR: Some ideas for you to consider
You can read the full post below, but these are my key recommendations/suggestions. Some of these aren’t for everyone – lots of folks don’t like the idea of offering free consultations. Many people don’t want to specialize. Some people hate “networking.” None of this is intended to be either prescriptive or universal. Rather, it’s what’s worked for me, and what I’ve heard has worked for others.
- Make Referrals: Regularly refer potential clients to other clinicians to stay top-of-mind.
- Free Brief Consultations: Offer brief initial consultations to assess fit and make referrals.
- Specialize: List yourself as a provider in niche areas to attract specific client populations.
- Participate Online: Engage in Google Groups, listservs, and discussion forums.
- Join Groups: Participate in reading, discussion, and supervision groups.
- Be a Resource: Offer valuable resources, like memos or newsletters, to colleagues.
- Network: Regularly meet with other clinicians informally.
- Use Marketing Platforms: Experiment with various platforms for online presence.
- Respond Quickly: Promptly respond to referral inquiries to increase success.
My own history and approach to getting referrals
I have a full practice – about fifteen patients (most of whom come more than once a week), something like twenty-five to thirty sessions. Over the nearly ten years I’ve been practicing, I’ve had something like 150 first sessions.
Prior to being a therapist, I worked in private equity, buying (and managing, and selling) companies. I learned to spend lots of time developing “deal flow” – the steady flow of possible acquisitions. The more robust our “flow,” the more transactions we completed. And/but… nine out of ten initial “opportunities” sucked – we would never invest in those companies. And of those remaining one out of ten? Something like nine out of ten of them never resulted in a transaction. In other words, we had to look at a hundred companies or more to buy just one. Our whole business depended on our buying companies. So we spent a lot of time generating those leads. (One might say that our whole business, actually, consisted of generating and evaluating leads.)
Most therapists don’t think like this. We tend to think our job is seeing patients, and to think of getting patients as a thing that stands between us and doing our job.
Many of us list ourselves on Psychology Today, create a web site, or both. Some of us pick a premium marketing web site, like ZenCare, or Alma. And then, by and large, we sit back, and wait for our phone to ring. I don’t have a Psychology Today profile. (I did, for four years, but never got a referral that stuck. I do a profile, currently, on ZenCare. As well as a few others.)
And we wait.
And we wait.
I said above that I’ve had something like 150 first sessions. To generate those 150 first sessions, I would estimate something like 1,500 people had to be given, or to find, my name and contact information. I certainly heard of a lot more referrals I might expect from colleagues than ever materialized. A lot of first scheduled sessions didn’t show up. Not to mention the number of first sessions I had that didn’t lead to second sessions, or second sessions that didn’t lead to third sessions.
When I began, my “yield” – the proportion of referrals that led to ongoing treatments – was low. Over the years, it has increased steadily. I understand this to be due to a combination of factors: most important, as I’ve gained experience, colleagues have provided a steadily growing proportion of referrals, and these have been referrals of partners or friends or family members, or of those of their own patients. These referrals arrive, typically, with a strong, positive, idealizing even, initial transference – helpful in establishing a treatment. In addition, I’ve relied less on sources of what I think of as “lower-quality” referrals – generic platforms like Psychology Today, Google Groups and listservs on which clinicians I generally don’t know are seeking referrals for patients they generally don’t know. (Note: on this page, please find a list of Google Groups and listservs with which I’m familiar. I’d love to add more. If you have one to add, please let me know, in the comments!)
Building a full practice, with a steady stream of high-quality referrals, requires work. Most therapists with full practices have a variety of referral sources, each of which requires some combination of work and luck. We throw lots of spaghetti at the wall, and very little of it sticks.
What follows are the ways I know to generate referrals, and some comments on the relative quality of the referrals you might expect each to produce.
Making referrals
People who make referrals get referrals. Making a steady flow of high-quality referrals inexorably leads to receiving a steady flow of high-quality referrals. Clinicians appreciate referrals, and making a quality referral brings yourself to the top of your colleagues’ minds – guaranteed. I have found a number of ways to make referrals, as a result of which a small army of clinicians are grateful to me. That gratitude? It produces referrals.
Below, I describe how I’ve done this, but I want to be clear: I don’t recommend my strategies to you, unless, and except, to the extent that, they resonate with you, feel natural to you, appeal to you. Rather, I recommend that you think conceptually as I have done, about the ways you might most authentically, enjoyably, and effectively put yourself in a position to make referrals.
Free brief initial consultations
My web site has a widget that allows visitors to schedule a free 15-minute consultation with me. The widget interacts with my schedule, so people can see when I’m available at all times, in real time. This allows me to make – and to get – lots of referrals. When I meet with people who come to me this way, I often begin by saying something like, “We’re going to meet briefly, just so I can get a sense of whether I might be the right person for you, or if you might be better served by my introducing you to someone else,” or, sometimes, I respond to the booking e-mail by saying, “My practice is full at the moment, so I’m afraid I can’t work with you, but I’d be glad to meet with you and see if I can’t connect you with someone good for you.” I treat each person who schedules an intake like this as a valuable resource (because they are!), and I invest considerable time and energy in thinking about to whom I should refer such people – and, work to establish that strong initial idealizing transference, so that the person to whom I refer the patient can benefit from it, and be receiving a high-quality referral, and not just another generic one.
Listing myself as a provider in areas of niche specialization
This functions similarly to the “free initial consultation” in that it produces a fairly steady flow of people with whom I’m not able to work, or for whom I’m not necessarily the best therapist. This might be because I’m a cis man. It might be because of how I work. It might be because of where I’m located. It might be because of fee, or style, or anything else. The point is, while I don’t, for the most part, put much stock in the idea of “specialization,” many people enter therapy with a specific complaint, so, to the extent one can claim something like an area of specialization, that can create a pipeline of potential patients.
In my case, I’ve done this in two related spheres: first, to people with ego-syntonic non-normative sex and sexuality (so, pitching myself to people in the kink and poly communities). I’m listed on a web site called “Manhattan Alternative,” for example – a resource for people in the kink and poly communities, who seek treatment with someone who is, at a minimum, familiar with the terms and concepts they might use, and who liberates them at the outset from at least some of the fears of judgment or shaming – or simply incomprehension – they might otherwise fear.
And second, I pitch myself to people with ego-dystonic non-normative sex and sexuality (so, people afflicted by shame in their sexual lives, up to and including those who have been charged with or are at risk of committing sexual offenses relating to attraction to minors). Many therapists avoid this population, for lots of reasons. My ability to provide such people with empathy and reassurance at the outset allows many such people to overcome anxiety and to reach out to me.
Actively participating in online discussions
I participate in a dozen or so Google Groups and listservs. From the day I graduated from social work school – and maybe even before – I sought opportunities to participate in discussions in these groups. (Many of the posts in the “practice notes” section of this web site began as responses to, or participation in, such discussions.) Doing this gave a broad audience a sense of who I am, of how I practice. Inevitably, this turned some people off. I’m not the right therapist for everyone; not every therapist thinks, or works, like I do. But. I am the right therapist for some, and many therapists like how I work, like how I think. And Google Groups and listservs allowed me to introduce myself effectively, efficiently, to wholesale volumes of clinicians. And, it has led to a number of successful (by which I mean, “treatments that ‘took,’ and persisted for some time) referrals over the years.
Participating in reading, discussion, and supervision groups
Ditto with reading and discussion groups. I have found such groups terrific ways to extend my network exponentially. I joined a group at another analytic institute, focused on a theorist I never had studied, and learned a ton about a different theoretical approach – and met half a dozen thoughtful, experienced clinicians I never would have known. I joined a thematically organized group (on sex and sexuality), and met a number of sophisticated, thoughtful clinicians whose training couldn’t have been more different from mine. I’ve participated in, and led, a number of supervision groups over the years. Each of these has provided an opportunity to become intimate with the work of others, and for them to do the same with mine. Which, inevitably, leads to referrals!
Making myself a resource to the community (Josh’s list, etc.)
A couple of times over the years, I’ve seen ways in which my previous experience and perspective might help my colleagues in this new field. The first time, I became curious about the pros and cons of establishing a PLLC (the New York State version of an LLC for licensed professionals). I did some research, talking to a number of clinicians, as well as to accountants, and lawyers. Instead of just reaching my own personal conclusions, I put in an extra hour or three of work and wrote up what I had learned in more generally applicable terms, and I shared that memo freely with anyone who asked. For two or three years, every time the question came up on a Google Group or listserv, I’d offer up my memo. I don’t know how many people read it over the years (I sent it out over 200 times).
The second time – and this one continues to this day – I identified a need in the community. We clinicians receive hundreds of event announcements a month. Every institute, many group practicies, lots of vendors, universities, interest groups, etc., all sponsor events. Keeping track of them all can overwhelm even the most e-mail savvy among us. I had the insight that all this data could be presented usefully in a periodically updated newsletter, one that standardized the format in which events were presented, and included only the barest minimum of information (title, date/time, presenter/s, sponsor, URL). It took a few hours each month to trawl through my e-mail and present the information in this way, and, quietly, I began sharing my list with people. I never really promoted it, just offered it up when it came up. And over time, more and more people started asking for it. And sharing events to be listed in it. It’s grown, and grown, and continues to grow, to the point that now, over 1,200 people receive it each month. Now, I pay a colleague to do the work of compiling all the data, and I collect voluntary donations from those who receive the list. The donations don’t cover the cash costs, but that’s fine!
Between the PLLC memo and my list of events, a lot of people out there think appreciative thoughts about me. And, though I don’t generally recommend Don Corleone as a role model, he was right that having people out there owe you favors can lead to good things.
Networking compulsively
I hate the word “networking.” My experience? Generally speaking, people who actively conceive of what they’re doing as networking aren’t very good at it, don’t do a very good job of selecting “networking” events, and don’t do a very good job of marketing themselves at such events.
What I mean by “networking” is simple: doing something I love with other people. I love to talk with other clinicians, and I make a point of having coffee, a drink, or a meal, with another clinician at least once a week. More often than not, this is someone I don’t know very well, or haven’t seen in a long time. I enjoy such meetings, and they put me at the top of people’s minds – and expand the network of people to whom I can refer (and from whom, natch, I can receive referrals).
Marketing/advertising
I wrote at the beginning of this post that many of us set up our profiles, sit back, and wait for the phone to ring. I don’t advise that as a strategy. At the same time, marketing platforms can help. I know more than a few clinicians who’ve built successful, full practices using only Psychology Today. (I don’t know how! Ask them!) Money spent on such platforms is small potatoes, generally. Even the most expensive platforms pay for themselves quickly with just one or two full-fee referrals, so I recommend experimenting. Give yourself a budget, and spend it, on marketing. Whether at Psychology Today or one of the higher-end, higher-touch platforms, like MyWellbeing, Zencare, or Alma. And, of course, there are lots of free or very low-cost networks that organize themselves around geography, or identity, or diagnosis. These all can be very useful!
Finally, your web site: clinicians are among the least technically savvy of white-collar professionals, but I think it’s verging on business malpractice not to have a web site. I had one colleague who had a beautiful web site for years that consisted of a simple line drawing and her contact information. Others have robust, deep web sites with lots of written and spoken and video material available for prospective patients and clinicians to get to know them. I’m agnostic as to which approach, or where between them, is right for you. But patients and clinicians need to be able to find you on the web, if they want to, and to form an opinion about what they find there.
My web site includes a few small written pieces that give people a sense of how I think, how I work. I suspect it scares off at least as many people as it attracts. That’s fine by me. If people with whom I wouldn’t click can determine that without wasting their time meeting me, I’ve done them, and me, a favor.
Handling referrals when they come
Early in my career in finance, before the days of e-mail (but in the short period when voicemail was sovereign), I arrived at my desk one morning to a voicemail from one of my (too-many) bosses. “Come see me when you get in, please,” she said. She didn’t mention urgency. Other than, I suppose, in retrospect “when you get in.” Well, I arrived at my desk, heard the voicemail, sat down, opened The Wall Street Journal, and started (as I did every morning) to read it – delighting in the knowledge that, in fact, reading the paper was an acceptable activity in this job. Five minutes into my reading, F (she who had left the voicemail) turned up at my desk. “What are you working on that’s more important than coming to see me?” she asked.
F taught me a good lesson that day. People don’t like being kept waiting.
When someone calls, texts, or e-mails with a referral – whether they’re a prospective patient or a friend or another clinician – I like to respond as quickly as humanly possible. I do this for several reasons:
- People don’t like being kept waiting.
- People do appreciate being attended to quickly.
- Often, people reach out to two, three, or more clinicians at a time when making/seeking referrals. My chances of being the “winner” often depends at least partly on the speed of my response.
Conversely: more than a few of my colleagues have fallen off my list of those to whom I refer by taking too long to get back to me when I’ve tried to refer to them. I tend to tolerate a 48-hour response time for a little bit before giving up. More than that? I’m unlikely to refer a second time, unless there’s some compelling specific reason why I believe the clinician is the “right” answer to the question. And if a person doesn’t bother to respond at all? (That does happen, believe it or not – people fail to respond to e-mails or voicemails, whether intentionally or otherwise.) Well, that just gets you stricken instantly from my list. This isn’t punitive. I’m not angry. I just value being able to offer to my friends, colleagues, and prospective patients a quick response, and if someone doesn’t see things the same way I do in this regard, it’s not good for me, or for those for whom I seek referrals.
Bottom line: answer your phone. Respond to your e-mails and voicemails. I promise: you’ll never lose a referral by responding quickly. And every minute you wait increases the chance you’ll miss out on a great patient.
