Most therapists approach the question of referrals with a mixture of magical thinking and professional anxiety. They speak of “building a practice” as if referrals materialize through some combination of clinical excellence and cosmic alignment. This perspective, while understandable, obscures the practical realities of how referrals actually work.
When I think about getting referrals, I think of three distinct mechanisms: prospective patients finding me (through clinicians, online platforms, or other professionals), fellow clinicians seeking referrals for people in their networks, and my successfully establishing connections with people actively seeking therapeutic services. Each represents a different pathway, requiring different strategies and involving different degrees of chance and intentionality.
The spaghetti strategy
The fundamental challenge in therapist referrals lies in their inherently indirect nature. We cannot ethically or practically market ourselves directly to patients except through highly mediated channels – Psychology Today profiles, specialized websites, our own professional sites. This creates an ecosystem defined by opacity and uncertainty.
The only way to make spaghetti stick to the wall is to throw spaghetti at the wall. Most of it will fall. You cannot know in advance which strands will stick. But if you don’t throw the spaghetti, none will stick.
My role as an active agent centers on maximizing the possibility that chance and external factors will work in my favor. This means identifying multiple pathways through which people might learn of me: online marketing platforms (ZenCare, my website, Manhattan Alternative), participation in communities of therapists (my analytic institute, clinician groups), and service provision to colleagues (a monthly newsletter listing clinical events in New York and online). Each represents a deliberate marketing strategy.
Wholesale versus retail
Professional referral sources operate as wholesale channels; individual patients represent retail. A colleague who refers to me might do so repeatedly over years; a patient can only ever be one patient. This economic reality should fundamentally shape how therapists allocate their marketing energy.
Professional referrals also tend toward higher quality. They arrive as people more serious about seeking treatment, carrying an initial positive transference derived from the trusted relationship that generated the referral. This differs markedly from the dynamic when someone cold-calls after finding five therapists online.
The goal becomes positioning yourself to be the first person colleagues think of when considering referrals. This requires sustained visibility over time – staying fresh in people’s minds rather than hoping they’ll remember you when a need eventually arises.
Marketing as self-representation
I distinguish between networking (relationship-based approaches) and advertising/marketing (discrete promotional activities engaged in primarily for business generation). Both matter, but they operate through different mechanisms.
In formal marketing contexts – websites, directory profiles, promotional materials – I strive to represent myself authentically rather than crafting strategic personas designed to appeal broadly. My marketing materials serve dual purposes: attracting people for whom I might be effective, and communicating to others that I would not be suitable, saving everyone time and effort.
This means including specific details about how I think and practice. I state my preference for multiple weekly sessions. I discuss fees without mentioning numbers, focusing instead on questions of meaning and feeling. Such specificity inevitably may well repel some potential patients, but epistemology rears its ugly head: how could I ever know? (And isn’t the anxiety about unknown losses precisely what keeps most therapists trapped in generic self-presentation?) ¯_(ツ)_/¯
The integration question
Marketing represents neither something separate from my practice nor separate from my life. It extends naturally from how I represent myself professionally and personally. This integration eliminates the exhausting work of maintaining different personas across different contexts.
The ethical question that emerges – whether conscious efforts to stay “top of mind” with referral sources constitutes manipulation – dissolves when marketing becomes an authentic extension of professional identity rather than calculated performance. Colleagues sense the difference between genuine engagement and agenda-driven networking.
My marketing choices reflect my clinical philosophy. When I discuss fees in terms of meaning rather than mechanics, or specify my preference for intensive treatment, I filter not merely for practical compatibility but for people who share certain assumptions about what therapy is and how it works. In this sense, marketing begins the therapeutic process before first contact, shaping potential patients’ understanding of therapy itself.
The most effective approach to referrals combines systematic thinking with authentic self-representation. Throw lots of spaghetti at the wall, but make sure it’s actually your spaghetti.
