DR. LYNN FRIEDMAN'S BLOG, "ALL THINGS PSYCHOANALYTIC"

Developing a Private Practice - Course blog: The Clinician's Countertransference to the Patient who Comes Late - Johns Hopkins -Dr. Lynn Friedman

Yesterday we talked about the two meanings of countertransference and we said that we would apply these concepts to the reader's question about how a clinician, new to private practice, understands and deals with ones feelings about the patient who is late or, "no shows".  The writer was candid enough to admit that he found coming to work, only to be frustrated by the patient's lateness, or "no shows", irritating. He added that he found it particularly frustrating in that he was just starting his practice and he was eager to have patients. 

Let's examine this in light of the two kinds of countertransference that were described, yesterday. Hopefully, the clinician will explore his feelings about the patient's lateness/"no showing" in his own therapy, in supervision or in consultation.  Obviously, knowing neither clinician nor patient, it's impossible to know what's going on between them but let's consider some possibilities. 

For example, in his own treatment, the clinician may lament how frustrating it is --- to be new in private practice and to want patients and how diminished he feels at being stood up.  Further exploration might reveal that the clinician is the youngest of several children and that he spent his entire childhood, tagging along and being taken for granted and easily dismissed by his older siblings who he adored.  The patient's "no shows" may have evoked in him these very powerful feelings of feeling diminished, devalued and excluded. No wonder he feels angry and frustrated. If this is the case, his anger may be disproportionate to the offense. This is, in fact, how the term, "countertransference" was originally used.

As for the way the term, countertransference, has been increasingly used, separate from what the clinician's history may or may not entail nearly anyone would be frustrated at driving to the office for a single session only to find that the patient does not appear. This sort of behavior certainly elicits reactions in many clinicians, particularly those starting out in private practice. The clinician may be frustrated, disappointed, angry, relieved, or still worse, indifferent. There are several important things to consider here.  Three in particular are: the meaning of the patient's behavior, the therapist's feelings about it and the need to establish a, "therapeutic frame" through which these things can be analyzed.  

Since the patient is new to the clinician, we do not know whether the, "no show" expresses a fear, a tendency to be disorganized, a hostile act in response to something that happened during the phone call or something that the patient perceived happened during the phone call or something else. 

Still more frustrating, if the patient does not show there is no opportunity to learn about the meaning of the behavior.  Hopefully, the patient will call to reschedule and there will be an opportunity to learn more. How, though, does the therapist address the situation so that this is not a recurrent pattern? It is this issue that we will explore in tomorrow's post.

Best to all, LVF 

(c) 2010 Lynn Friedman, Ph.D. All rights reserved 

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught April 30/May1. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university. 

P.P.S. A list of all blog posts can be found at: www.drlynnfriedman.com/blogpractice.html and/or on the blog at: http://www.drlynnfriedman.typepad.com

Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation,feel free to call.

///////////////////////////////////////////////////////////////////////////////

Developing a Private Practice - Course blog: Countertransference - 2 meanings - Johns Hopkins -Dr. Lynn Friedman

Dear All, 

In response to the blog posting on the patient who cancels or doesn't show up, one of you was candid enough to write to me and to tell me how frustrating you found that experience to be. You asserted that it made you feel pretty irritated, you weren't sure how to handle your irritation and you were tempted to respond in kind. 

I think this is an excellent question and I appreciated your openness and your capacity to tune into your own reactions. Our reactions to our patients are really an important guide to understanding them and to understanding ourselves. Years ago, psychoanalysts talked about, "countertransference" in a somewhat different vein than many do today. By countertransference they meant those reactions that a patient evokes in us because WE have unresolved issues & conflicts from our own childhood. Back in the day, it was presumed if we were unable to be dispassionate and objective in those situations, then it must reflect that we were not sufficiently analyzed ourselves. 

With experience, the field has evolved so that today, most analysts and psychodynamic therapists recognize that while all analysts and clinicians, even with extensive analysis, have an unresolved residual issues, a reaction to a patient's behavior is NOT necessarily a sign of the analyst's unresolved conflicts. Increasingly, psychoanalysts have begun to use the word, "countertransference" with a second spin. We use it to refer to our reactions to the patient. It is now understood that, of course, patients can and, in fact, will evoke an array of reactions in us and it is very important to tune into these reactions and to try to understand what feelings they evoke in us. 

In fact, our reactions can tell us a great deal not only about ourselves but about our patients. It is through both of these lenses - using both meanings of countertransference that I will address aspects of lateness and the therapeutic frame in subsequent posts. 

Best to all, LVF 

(c) 2010 Lynn Friedman, Ph.D. All rights reserved 

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught April 30/May1. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university. 

P.P.S. A list of all blog posts can be found at: www.drlynnfriedman.com/blogpractice.html and/or on the blog at: http://www.drlynnfriedman.typepad.com

Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.///////////////////////////////////////////////////////////////////////////////

Developing a Private Practice - Course blog: Lateness & No Shows in the Clinical Hour - Johns Hopkins -Dr. Lynn Friedman

After months of planning and laying the groundwork, you've opened your private practice. You've rented an office two evenings a week.  And, at $60.00 a week, you have launched.  A patient calls and you schedule an appointment. After a long day at work, you drive to your office and wait eagerly for your very first patient.  The bewitching hour is 6:00 pm.  6:00 pm arrives and there's no patient.  Around 6:15 you begin to wonder if you've been stood up.  You're tired. And, if you are really honest with yourself, you are steamed because you've just driven all of the way to the office for no reason at all.  The patient doesn't bother to call to cancel. You are left just cooling your heels.

How should you handle this? Do you stay until the end of the hour?  Do you call? Do you wait for the patient to call? How you respond depends on your theoretical orientation. Without any information about the patient, it's hard to understand the meaning of her behavior.  Is she frightened? Angry? Lost?  But, understanding the meaning of the behavior is, of course, the task at hand. And, it is this understanding that will inform your intervention.  

Waiting until the end of the hour --- since, after all, it is the patient's hour, sends a powerful message: that the hour belongs to the patient and that she is responsible for how it will be used. This includes, not using it at all.  In this way, if the patient arrives 20 minutes late, for example, she knows that you are there. Leaving, after 15 minutes, sends a different sort of message.

And if, indeed, she arrives, do you extend the hour? After all you have no subsequent patients.  That, too, sends a powerful message about how you approach the situation.  There's not a right or wrong answer here EXCEPT that it's important to have, in your own mind, a clear cut rationale for how you might handle this and why.  This will provide a springboard for what you might say to the patient.  In any case, it can be very useful to listen to the patient as they explain their lateness.  Do they rush in huffing and puffing very anxious about what you might think of them?  Or, do they act as if nothing has happened?  How does their lateness sync up with their presenting problem? Learning a bit about their experience of lateness in other arenas might be very useful. However, in this early juncture it must be approached with the utmost tact.  And, if it can not be gotten at skillfully, it can be tabled until it reveals itself as a more persistent pattern.  

What if the patient never shows? Do you call? Again there is some theoretical disagreement about this.  Calling maybe experienced as caring. It can also be experienced as intrusive.  Not calling may be experienced as respectful of the patient's autonomy and as letting the patient take responsibility for themselves. It can also be experienced as indifference.  Any option carries with it consequences and implications.

A key point to consider is that at this early juncture you are establishing a framework for how you will handle lateness and absence.  At the very least, it seems important to clarify the meaning of the behavior. Of course, at this stage of the game the meaning can be very difficult to divine. Obviously, there's so much to be said about this topic. I hope that you will write in with more questions.

Best to all, LVF

(c) 2010 Lynn Friedman, Ph.D. All rights reserved

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: www.drlynnfriedman.com/blogpractice.html
Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.///////////////////////////////////////////////////////////////////////////////

Developing a Private Psychotherapy Practice Blog - Psychodynamic psychotherapy - Documented efficacy - Dr. Lynn Friedman - psychologist - Johns Hopkins course

Research Data published by the APA document the enduring efficacy of psychodynamic psychotherapy. Read here: < http://www.sciencedaily.com/releases/2010/01/100125094501.htm>

Best to all, LVF

(c) 2010 Lynn Friedman, Ph.D. All rights reserved
P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: www.drlynnfriedman.com/blogpractice.html
Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

 

Developing a Private Practice - Course blog: The Therapeutic Frame - Johns Hopkins -Dr. Lynn Friedman

The Therapeutic Frame and Practice Considerations by 

I received an email from a clinician asking about how to manage what they referred to as the "business aspects" of the practice. By this they meant, setting up appointments, handling the ending of a therapy session, establishing and collecting fees, handling of cancellations and, "no shows", dealing with insurance companies, consents to share information and related fare.  I'll be addressing these and related issues in this blog in the weeks to come.  

Although I agree with the clinician that there is certainly a business component to these decisions, I believe that decisions regarding the frame have far reaching therapeutic implications. Moreover, in setting policy, I feel that the clinician must consider every aspect of the frame with special care.  Typically, in working with patients, we encourage them to speak openly and without fear of reprisal.  The session is for and about the patient and we do our very best to set aside our personal agenda and to listen in a non-judgemental fashion.  The so called, "business" aspects, or as they are referred to in clinical parlance, "the therapeutic frame" are first and foremost about the clinical needs of the patient. However, they also reflect the clinician's needs. Clinicians are typically earning a living and therefore, expect to be paid, expect others to agree to and adhere to a schedule, etc.  Thus, these aspects of practice are very important because they convey much to the patient about the therapist's method of working.  Deviations and departures from the frame, whether by the patient or the clinician, warrant careful attention both in the clinical setting and in any consultation that the therapist may seek.   

For those beginning a practice, establishing a frame can be especially challenging.  The clinician is eager to have patients. This can make the clinician ripe for patient attempts to tinker with the frame. For example, many patients, though not all, might prefer to come for free or might prefer to drop in any time without scheduling.  Some would prefer to have longer sessions and others might prefer shorter sessions.  Some would like to schedule appointments and to show up only if they, "feel like it".  The new private practitioner, even though he may be an experienced clinician, is vulnerable to patient efforts to tamper with the frame. Unfortunately, failure to be thoughtful about allowing alterations in the frame is likely to compromise the treatment. It is for this reason, that we will consider aspects of the frame.

Best to all, LVF

(c) 2010 Lynn Friedman, Ph.D. All rights reserved

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: www.drlynnfriedman.com/blogpractice.html
Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.///////////////////////////////////////////////////////////////////////////////

Developing a Private Psychotherapy Practice Blog - Making low fee referrals - Dr. Lynn Friedman - psychologist - Johns Hopkins course

Making low fee referrals

Yesterday's post brought a question about what to do when patients/clients call and they can not afford private fees.  

This difficulty is extremely commonplace especially in this economy. And, it's important for clinicians who receive these calls (whether or not they are actually in private practice yet) to do their best to help patients/clients to connect with low fee and sliding scale resources. Fortunately, here is the Greater Baltimore Washington area, there are a plethora of low fee and sliding scale resources. In other locales, this can be more challenging - that is, it is more easily said then done.  

Yesterday's post detailed a situation in which the counselor was doing outreach related to substance abuse prevention in teenagers. Prior to giving the workshop, it's important that she familiarize herself with the resources in her locale. In that case, she could identify both organizations/individuals who treat substance abusing teenagers and their families. Also, she could identify counseling/therapy resources in general. Beyond this, prior to making referrals, I'd encourage her to call these organizations/individuals to make sure that they are accepting new clients/patients. In doing this, they will become familiar with who she is and what sorts of expertise she has to offer. In fact, she might even offer to give her talk to their counseling staffs.

How can she learn about places with sliding scale referrals? She might check out the local Departments of Psychology and Counseling to see if they have low fee clinics. Similarly, she might look into the local Departments of Psychiatry. Here in Washington, the GW PsyD program has a very low fee clinic and the GW Department of Psychiatry also offers a sliding scale for those in their catchment area. Beyond this, the Washington Center for Psychoanalysis offers sliding scale clinics for both psychotherapy and psychoanalysis. Also, the Baltimore Washington Institute has a similar clinic. Both are excellent resources. To find a list of these sorts of clinics, nationally, look here: www.washingtonpsychoanalyst.com/lowfeepsychotherapist.html

When she contacts these settings, it will be important for her to make a special point of learning how their referral process works. Then, she can talk with the client about what to anticipate. This is critical as many patients/clients become so frustrated with the maze of phone calls, holding patterns, etc., that they give up before treatment starts. As we've discussed, being referred to another clinician can be hurtful to the patient. Streamlining the process and functioning as their, "ombudsmen" can go a long way to ameliorating the hurt. Also, it is a way to ensure that patients receive good care. For those of us committed to the profession this is a very important part of our role. In fact, when we fall down on this part of the job we erode the public's trust.

Best to all, LVF

 

(c) 2010 Lynn Friedman, Ph.D. All rights reserved
P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: Dr. Lynn Friedman's, developing a private psychotherapy practice
 
Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.
 
 
//////////////////////////////////////////////////////////////////////////////
Lynn Friedman, Ph.D.
Psychologist, psychoanalyst, work-life consultant
Faculty Associate, Johns Hopkins University
5480 Wisconsin Avenue
Chevy Chase, MD 20815
301.656.9650
Follow the private practice blog
 

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.
 

///////////////////////////////////////////////////////////////////////////////

Developing a Private Psychotherapy Practice Blog - independent school (private school) referrals - Dr. Lynn Friedman - psychologist - Johns Hopkins course

Reaching out to independent (private) schools.

What are examples of some ways in which counselors, psychologists, social workers, psychiatrists and other mental health professionals might reach out to counselors in independent (private) schools?  

A counselor was very knowledgeable about substance abuse. While she was in graduate school, she wrote a number of papers on the topic. And, beyond this, she had, "personal experience". Her brother had been through numerous rehabilitation programs. During the course of his difficulties, the family (including her) received family therapy.  One of her placements was in a rehabilitation center. Also, she had had a significant amount of her own personal therapy.  At this juncture, she felt that her therapy had given her maturity and perspective on this important area and her placement supervisor had been very impressed with her clinical work.

She decided to design talks for teachers, students and parents  on substance abuse with the thought that, "an ounce of prevention is worth a pound of cure".  Her goal was to teach teachers, students and parents to recognize the early indicators of substance abuse AND to teach them how to take early and effective steps to address these concerns.  Because she was new to the field, she decided to tag team with a senior clinician with significant expertise in this area. She approached him with a proposal.  

She suggested that she would design a workshop for independent schools. He would review it, provide input and suggestions.  They both would conduct the workshop together.  She would do all of the legwork. She would reach out to the schools, provide the mailing and schedule the sessions.  

She was not yet licensed.  However, she was doing this spadework so that she could establish herself as having emerging expertise in the field. Collaborating with an expert allowed her to (a) establish a relationship with a senior person in the field (b) have a role model as to how to present a workshop (c) begin to develop visibility.  Beyond this, she and her senior colleague would do the workshops on a fee-for-service basis. In addition to making a bit of money in the process, people began to contact her (and her colleague) for referrals. Since she was not yet ready to accept patients, she began referring to colleagues in the area. Thus, she developed her own network.  By the time she was licensed, she was already well-connected in the field. Within 6 months she had a full practice.  

Best to all, LVF

(c) 2010 Lynn Friedman, Ph.D. All rights reserved

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: Dr. Lynn Friedman's, developing a private psychotherapy practice

 

Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

 

 

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

 

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.

 

///////////////////////////////////////////////////////////////////////////////

Posted via email from Johns Hopkins developing a private practice course blog by Dr. Lynn Friedman

Developing a Private Practice Blog - creating workshops - Dr. Lynn Friedman - psychologist - Johns Hopkins course

Building your referral base when you aren't yet practicing

You have your area of expertise but you are still not in private practice. Perhaps you are working in a clinical setting and pursuing your license or perhaps you are devoted to some other kind of clinical, research or academic endeavor.  How do you prime the pump for referrals?

One method is to begin to offer workshops in your area of expertise.  You've been attending workshops and coursework in your interest area. Now, put on your own workshop for clinicians interested in this specialty area. If you feel you are too new and inexperienced to do this, there are several approaches you might take.  You might partner with a more experienced clinician. You can agree to do a lot of the spadework in exchange for being mentored by a more experienced professional. Another possibility is that you can set up continuous workshops on the topic - and bring in other (more senior) experts to speak. In this way, you can serve in a leadership capacity while connecting with local (or even national) experts in your area. You could even do this on a fee-for-service basis.  Alternatively, you can join a local mental health association and volunteer to serve on the programming committee.  These are all wonderful ways to learn and to establish collegial relationships. If you are interested in more of my thoughts on this topic, you might check out this article that I've written. www.drlynnfriedman.com/passporttonetworking.html

Best to all, LVF

(c) January 24, 2010, Dr. Lynn Friedman, All rights reserved.

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: Dr. Lynn Friedman's, developing a private psychotherapy practice

Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.

///////////////////////////////////////////////////////////////////////////////Posted via email from drlynnfriedman's posterous

Developing a Private Practice Blog - making referrals - Dr. Lynn Friedman - psychologist - Johns Hopkins course

Referring to skilled colleagues

You are networking. You offer workshops or you're on the programming committee of your local organization. And/or you have a website. And, people are starting to call you and they are asking if they can see you. However, you haven't yet established a practice. Maybe you are not yet licensed or perhaps you are committed to other endeavors and you are just laying the groundwork at this point. 

So, you have to tell the prospective patient that you are not taking referrals at this time. You can say something like, "I am not yet taking referrals and I do not anticipate doing so until (the date) or until some time in the next several months". However, if you can tell me a bit about what you are seeking, I will try my best to give you the names of skilled clinicians in the area.  And, if you'd like, I'd be happy to call ahead and streamline the process for you.  Then, call the clinician and ask them if they have any openings.  In this way, you have helped to patient to avoid another rejection. I say, "another" because to the unconscious, the fact that you are unavailable will be experienced as a rejection, albeit it is an inadvertent one. 

As for finding referral sources by now you should know these names because you have done some investigation and you have identified the local talent. They are in your study group, or they have spoken at your workshops, etc.  Also, be sure to create a list of places and people with sliding scale fees for those patients who are seeking that. 

One more thing to consider: Be sure to refer to skilled and qualified people as your reputation is on the line. If you refer to highly trained, competent and HELPFUL people, you will be seen as knowledgeable.  

Worried about how to present yourself to other clinicians?  Check out this article that I wrote for the Washington Post.www.washingtonpost.com/wp-dyn/content/article/2005/11/23/AR2005112301031.html

That's all for today. Tomorrow, we will talk about how giving referrals can lead to establishing reciprocal referral relationships.

Best to all, LVF

(c) January 23, 2010, Dr. Lynn Friedman, All rights reserved.

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: Dr. Lynn Friedman's, developing a private psychotherapy practice

Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.

///////////////////////////////////////////////////////////////////////////////

Developing a Private Practice Blog - getting referrals - Dr. Lynn Friedman - psychologist - Johns Hopkins course

One reader asked, how will referring to others get me referrals?

This is a good question. In order to get referrals by giving referrals you need to take several steps. First, call the person to whom you are referring. Make sure that the person receiving the referral is willing and able to accept the patient.  That is, make sure that they have the time, experience and interest in accepting the patient. If they are unwilling or unable, then the referral call will be a burden and they will have to re-refer the patient. More importantly, the patient will experience it as a rejection, no matter what their actual reason for not accepting the patient may be. It's not so easy after you muster all of your courage to call a therapist to be told that the clinician has no openings.  To the unconscious this will likely be experienced as a rejection. So, for the patient's sake and for the clinician's sake, you want to pave the road to ensure that a successful connection is established.

Second, talk to the clinician and share (after getting permission from the patient) based on the information that you have, how you are thinking about the patient. This gives the clinician a, "heads up" so that they can begin to think about how they might be helpful to the patient.  Also, it allows the clinician to become familiar with your clinical thinking.  This means that down the road when you are accepting patients, they will know something about you and about how you think and how you work. Having learned a bit about the kinds of patients who you might treat effectively,  they will know who to refer to you.  

Third, and this is important, assess whether the person to whom you are referring is receptive to you. Are they responsive and appreciative? Are they collegial?  Are they interested in getting to know you better? And, do you have a sense that they will relate to the people who you refer in a caring, skilled, professional and ethical way?  Your goal is to establish trusting, reciprocal, referral relationships. That is, you want to find colleagues with whom you would like to share cases. For example, once you are in practice, they may see the parent while you see the child, etc. Not everyone is receptive to this. However, by talking with and meeting with your referral sources, over time you will identify a cadre of clinicians with whom you will establish reciprocal relationships. These should be people whose clinical work you trust.

Here are some more thoughts on practice development. www.drlynnfriedman.com/buildingprivatepracticeworklife.html

Best to all, LVF

(c) January 23, 2010, Dr. Lynn Friedman, All rights reserved.

P.S. The waiting list to take this class has grown. Therefore, Johns Hopkins has added a second session to be taught the last weekend in April. Already practicing professionals and graduate students from elsewhere may enroll as special students. The course will run from 9:00 am - 4:00 pm on Friday and Saturday. Information about registration may be obtained through the university.

P.P.S. A list of all blog posts can be found at: Dr. Lynn Friedman's, developing a private psychotherapy practice

Confidentiality Policy: Please note for reasons of confidentiality and copyright all letters to the blogger will be summarized and edited. Also, I will not write about real patients. Instead, I will create fictionalized vignettes. When you pose a clinical question, please ask it in a general way. DO NOT write about real patients. Thank you.

//////////////////////////////////////////////////////////////////////////////

Lynn Friedman, Ph.D.

Psychologist, psychoanalyst, work-life consultant

Faculty Associate, Johns Hopkins University

5480 Wisconsin Avenue

Chevy Chase, MD 20815

301.656.9650

Follow the private practice blog

http://www.drlynnfriedman.com

http://www.corporationsonthecouch.com

Dr. Lynn Friedman welcomes referrals for supervision or consultation, feel free to call her.

///////////////////////////////////////////////////////////////////////////////