Some Psychodynamics in Referring a Patient for Psychotherapy

The psychodynamics involved in referring patients for psychotherapeutic and analytic treatment has received very little attention in the literature. In his book Psychoanalysis in America Murray Sherman1 wrote:

Over a period of time, a particular therapist may develop a particular type of practice built upon his past successes, failures, and sources of referral. The referral process itself would likely be most resistant of all to scientific appraisal, but there is doubtless a subtle social exchange that occurs but receives little attention in terms of the psychological and even unconscious significance involved. A determined researcher would find this a most rewarding field for investigation.

This paper is an attempt to initiate dialogue and further research into some of the dynamics involved in referrals, an area, as Sherman stated, that has been shrouded and neglected. An extensive review of the psychoanalytic literature yields virtually no data on the subject; in social work journals and those on community psychiatry there is some mention and study of sources of patient referral in various communities, but very limited if any attention has been given to why A refers a prospective patient to B and what are some of the dynamics and consequences of this interaction.

We are interested in focusing, in this introduction to the subject, on several types of referral. Specifically, we wish to discuss some of the psychodynamics involved in the following situations:

1. The patient in treatment refers an acquaintance or friend to his own analyst for treatment.

2. The friend or an acquaintance of the

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   analyst who is not an analyst refers a prospective patient.

3. The analyest refers a prospective patient to another analyst.

As we have reviewed instances of referrals made to us and referrals we have made over the past decade, certain hypotheses evolved which still remain to be fully proven. Our major hypothesis, which we will review in this paper, is that all referrals contain an unconscious