The Reciprocity Principle in the Referral Process

The Reciprocity Principle in the Referral Process

© Linda Graham, MFT

One of the best ways to get new clinical referrals is to make them.

Referrals are made first for clinical reasons, for the client’s best interest, to create a resource base that will be the most therapeutic, supportive, and effective for the client. This isn’t just the dictum of the BBS. It’s the experience of all of us over enough time in this field. It pays off clinically to create synergy for the healing of our clients.

But making referrals also helps us, the clinicians, in several ways. And in an increasingly competitive market with growing concern about getting referrals, I want to highlight some of the benefits of making them. I’ve experienced these benefits below; you’ve probably experienced many others.

1) preparing to discuss a client with another clinician focuses my clinical thinking. I often perceive the client afresh in the moment just before making the phone call.

2) discussing a potential client, or later a mutual client, with another clinician broadens my understanding of the case and often deepens it as well. Certainly this does benefit the client but contributes to my clinical development as well.

3) referring a client to another clinician because of their expertise allows me to share some of my expertise with them. This works even when I’m referring to someone I have not yet met in person. A sound, stimulating consultation can open the door to further networking, can be networking.

4) referring a client to someone, even when I’m not in their normal referral pool and they have never yet made a referral to me, creates a common ground of awareness – of me, my services, that may result – has resulted – in reciprocity later.

It’s this reciprocity that is well worth cultivating over the long haul. I’ve seen a couple now for more than a year that was originally referred to me by another couple I had seen for six months. They were referred to me by his individual therapist when she moved out of state. She – the therapist – was someone I had referred to more than three years before. One of my individual clients (when I had precious few of them) joined her woman’s group. The connection could have been casual or forgotten, but just a few phone calls back and forth over time – we never did meet – created enough awareness and respect to result later in a long-term referral that resulted in yet another.

Working with clients in several modalities – individual, couples, and group therapy – as many of us do, makes it relatively easy – when appropriate – to refer an individual client for concurrent couples or group therapy, or the reverse, someone in a group or couple to individual therapy. When such a referral clearly stands to benefit the client clinically, it has the potential to benefit us in reciprocity as well.

Nor is the principle of reciprocity, thus the benefit of making referrals, confined to our own individual circles of favorite colleagues, or even with our chapter, or even within our profession. I’ve had occasion to refer clients to credit counselors or yoga classes or acupuncturists, and found the reciprocity principle can extend even beyond therapy and MFCC’s. The clients are the catalysts here, and many of them of course will never choose to discuss their therapy outside of the therapy. But some will. I’ve had referrals come back from the unlikeliest of places – one from a chiropractor, one from a realtor. (!!! Who knows how this stuff works?)

Again the key seems to be the synergy. If a referral truly helps the client’s healing process, they just may credit the source in a way that eventually comes back to us.

One tricky point about making referrals deserves addressing. As clients become accustomed to receiving referrals, and they value both the referrals and the work they are doing with us, they may extend the reciprocity principle to making their own referrals directly back to us. A neighbor, a cousin, a roommate, a best friend. Transference can be rampant here and, while these client referrals can work out well for all concerned, the referrals must be explored thoroughly for meanings, expectations, set-ups, etc., for the current referring client, for the potentially referred client, and for ourselves: how well can we contain (or not) the cross-currents sure to arise then clients know each other and may know they are seeing the same therapist? Clients can be pretty blithe about all the potential ramifications, but we as clincians can never be. Unfortunately, some referrals are just not possible to accept because of material too unconscious to the clients but visible to us. But then, there is always the possibility that referring that potential client on to someone else will start the cycle of reciprocity anew.


Linda Graham, MFT, is in full-time private practice in San Francisco and Corte Madera, CA, specializing in relationship counseling for individuals and couples. She offers consultation and trainings nationwide on the integration of relational psychology, mindfulness, and neuroscience. She publishes a monthly e- newsletter on Healing and Awakening into Aliveness and Wholeness, archived on www.lindagraham-mft.com, and is writing a book: Growing Up and Waking Up: The Dance of the Whole Self. Contact Linda through this website

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