Referral to psychoanalytic candidates: a special problem in technique

The technique of referral has been given scant attention in the analytic literature. Yet the method of referral, particularly to analytic candidates, can have a significant impact on the subsequent treatment. Listening to detailed case presentations by candidates over a four-year period in a course on selection of patients, it became apparent to me that when analysts referred patients to candidates they almost always avoided telling the patient that the analyst was in training. The reasons for the evasion and the consequences of it are explored in all three parties: the referring analyst, the patient, and the candidate. Clinical material from typical situations is presented to illustrate how evasions and distortions by the referring analyst can have a negative impact on the patient, the candidate, and the analysis. The suggestion is made that the referring analyst be open about the candidate's status, particularly when the patient is being seen at a reduced fee. As with any other situation, candor enhances the chances of success of the referral and subsequent analysis.