A Mixed Methods Analysis of the Ethics of Behaviors and Attitudes Towards Making Referrals in Psychotherapy

Research Category: Health Sciences
Presenter: Jonathan Entis
PI: William Sanchez

Making referrals to other providers in mental healthcare is a common and necessary practice for psychotherapists.  Yet there exist many reasons for making referrals and not all of them are in the patient’s best interest.  Recent news stories have shed light on discriminatory referrals, in which clinicians have referred out clients whose lifestyle choices or identity factors they find incompatible with their own.  Moreover, current professional ethical guidelines are , at times, contradictory and vague regarding this issue. This study investigates the attitudes and behaviors of psychologists regarding making referrals.  We designed and administered a survey on the ethics of referrals, the Self-Assessment of Referrals Ethics (SARE), to a random sample of psychologists licensed to practice in Massachusetts (N=106). Our findings suggest that psychologists make referrals for many reasons, including but not limited to scope of practice, goodness of fit, remuneration, risk, professional issues, and client welfare.  Many of these themes were also raised as psychologists’ primary concerns when making referrals.  Our results also suggest that many psychologists feel that the APA Ethics Code (APA, 2002) provides insufficient guidance for difficult referral decisions. Possibly due to insufficient power or underreporting, we found that attitudes and behaviors towards making referrals were largely uncorrelated, partly because nearly all respondents denied making referrals for discriminatory reasons.  However, although our results do not indicate that psychologists often make unethical or referrals, the data do suggest that permissive attitudes towards these types of referrals are associated with work environment and time spent with colleagues.