Practitioners, How Good is Your Referral Tracking?

Photo by rawpixel -

Almost every mental health practitioner tries in some way to keep track of referrals. But do you know how your referrals compare to your conversions? How about the impact of primacy and recency effects? And would you be surprised to learn that nobody finds you via your own website — even if you think they do?

It all seems so simple… In theory, you test your practice marketing and advertising strategy by asking clients how they found you, and you adjust your strategy in response to what is working or not working.

The unfortunate reality is that many practitioners inadvertently wind up chasing their own tails with this approach, because they don’t realise just how much is missing from the picture. Sometimes, working with such incomplete data can actually be worse — as in deeply misleading — than working with no data at all.

Understanding the Territory and the Pitfalls of ‘Obvious’ Ways of Tracking Referrals

First, let’s distinguish two very different terms:

This is the number of encounters with any of your channels — your email address, your phone number, your website, the front door of your practice — which are prompted by a prospective client’s interaction with some other person or resource. Notably, not all of these encounters will necessarily result in any direct contact with you. For example, someone visiting your own website as a result of clicking on a link on a different website may never decide to get in touch with you, and someone given your name and address by a colleague may drive past your office without ever stopping. Referrals are usually expressed as a whole number, such as three referrals from other practitioners or nine referrals from a website. Importantly, most of the factors which figure into raw referral numbers are outside your direct control.
This is the set of people who have converted from being qualified prospects (someone aware of and actively interested in and able to pay for your services) into being paying clients. Conversions are usually expressed as a percentage, and typically marketers talk about conversions relative to a given channel — so that, for example, personal referrals might be said to convert better than referrals via pay-per-click advertising campaigns. A pay-per-click advertising campaign might be doing exceptionally well with 1% conversions, while personal referrals might be disappointing if they convert at less than 15%. Importantly, many of the factors which influence conversions are under your direct control.

Try Online Counseling: Get Personally Matched

By distinguishing these two terms, you can immediately see the first problem with ‘obvious’ ways of tracking referrals, such as simply asking clients how they found you: with that method, you are not measuring referrals at all, you are measuring referrals multiplied by conversions. For example, over a given period of time, you might receive 20 referrals from colleagues who hand out your name, address and telephone number. But because your telephone always goes to voice mail and your physical office needs a coat of paint on the front door, none of these 20 referrals ever winds up converting into a paying client. The problem here is not your referrals — your referrals are great, you just don’t know it! Instead, you are doing a poor job with your conversions. You would be entirely wrong to conclude that you should stop putting effort into raising awareness of your practice with colleagues, because actually they are doing a great job for you! It’s your phone arrangement and your front door which need attention.

If you really want to measure referrals in a way that will enable you to take responsibility for identifying and remedying problems in your conversions, then you need to measure encounters earlier in the sequence of events so as to include non-converting prospects. You might want to know, for example, not just how many people leave messages on your voice mail, but how many people call your number in the first place. You might also really want to know how those people even came to have your number.

Obviously, that is tricky: not only do you never speak with the people who don’t leave messages, but even if you do, it’s unlikely in the extreme that you’re actually going to start hitting people with a marketing questionnaire right at that first contact. Yet if you do not do that, then you don’t know a thing about the referrals that led them to you.

Let me say that again: unless you are introducing marketing questionnaires right into very first contacts with prospective clients (which I would never advocate), then you don’t know a thing about your own referrals.

It gets worse — quite a bit worse.

How ‘Simple’ Questions Can Get it Wrong

Even for practitioners who are aware of the interplay between referrals and conversions and the importance of distinguishing one from the other when measuring marketing effectiveness, it can be easy to wind up with misleading data due to two basic factors:

  • human beings rarely make complex decisions on the basis of just one source of information, and
  • primary and recency effects.

Taken together, these two factors make it very challenging indeed to figure out referral effectiveness — especially for web-based referrals.

The first factor means that your potential clients probably consult more than one source of information about you before ever getting in touch: they might type your name into Google, they might ask friends or colleagues about you, they might visit your website, and so on. But the second factor also means that when you ask a simple question like “how did you find me?”, your client or prospective client is more likely to remember and to reply with a source which they consulted either right at the start or right at the end of the process.

So, for example, you might find that quite a few people respond to such a simple question with the answer “with Google” — but you might not realise that even though they used Google, what really happened is that they then consulted 5 or more different results they found on Google. Maybe they consulted two or three directories, your own website, a professional association’s website, perhaps an article you wrote several years ago and had forgotten about… The point is that being found “with Google” tells you almost nothing except that one or more websites had something to do with it, and it’s entirely possible that they all figured into their decision to contact you. (Remember, you’re not selling commodity items like bags of flour or oil changes: people want to know more about you, they want to know whether they can trust you, and they want to be reassured about you by more than one source.) The misleading answer you receive is due to the primacy effect — the tendency of memory to be biased toward the first in a series of events.

Likewise, you might be very flattered to discover that many of your clients respond to the question “how did you find me?” with “via your website”. Except that um, no, they didn’t. Almost nobody will find you via your own website unless some other website comes earlier in a chain — it might be Google, it might be a directory like our own, or it might be some other website — but it is unlikely in the extreme that your clients find you by visiting your website directly, as the first step in the process. (Maybe a few just come up with your domain name out of thin air, but precious few.) You wrongly hear that that’s how they found you because of the recency effect — the tendency of memory to be biased toward the last in a series of events. Let me say it again: the reality is that nobody finds you via your own website.

While it’s easy to wind up with a misleading picture as a result of asking questions of these complex creatures we call human beings, you might think it’s straightforward to get a clear picture when it comes to referrals to the specific marketing channel that is your own website. After all, these are just machines — surely the answers are all there in bits and bytes in server logs? It turns out to be quite a bit more complicated than that, but that’s a topic for a longer article than this one.

The Bottom Line

As I suggested at the outset, referral tracking is quite a bit more complicated than it might seem at first glance — and in some scenarios, incomplete data could lead you to make worse decisions than you wuld make with no data at all. If you really want to understand the flow from referral through conversion — and to understand it in enough detail to support informed decision-making about your marketing strategy — you’ll need something significantly more sophisticated than merely asking clients how they found you via an exit questionnaire.

Perhaps the most important thing to remember is the old truism about the scientific method: an absence of evidence is not evidence of absence. If you can’t find evidence of something — a referral from a specific site, for example, or referrals from colleagues — that is not the same as evidence of the absence of such a thing. Unless or until you have positive evidence about the effectiveness of a given marketing channel for generating referrals, persuading yourself that you know what’s going on anyway and chopping and changing your marketing approach accordingly is not being a hard-headed businessperson — it’s just trading healthy scientific skepticism for wishful thinking.

NOTE: This article is adapted from the first half of ‘How Good is Your Referral Tracking?’, which was originally published several years ago and made available exclusively for members of our practitioner directories — including and in the UK, and in Australia. The original article goes on to explore techniques for tracking website referrals and addresses issues specific to evaluating directory listings. I’ve decided to make this first part available more widely because the message that has come through to me clearly, through countless conversations with practitioners about their marketing efforts, is that many could have benefited tremendously if more information about referral tracking had been available to them at an earlier stage of building their businesses.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

One Comment on “Practitioners, How Good is Your Referral Tracking?”

Would you like to join the discussion on “Practitioners, How Good is Your Referral Tracking?”?

Overseen by an international advisory board of distinguished academic faculty and mental health professionals with decades of clinical and research experience in the US, UK and Europe, provides peer-reviewed mental health information you can trust. Our material is not intended as a substitute for direct consultation with a qualified mental health professional. is accredited by the Health on the Net Foundation.

Copyright © 2002-2023. All Rights Reserved.