Responsible Derivation in Psychology: When to Derive, How to Do It, and Note Model

Deriving is not failure. It is one of the most responsible and ethical clinical decisions you can make as a psychologist. The problem is that many professionals do not know when to do it, how to communicate it to the patient, or what information to include in the referral note.

In this article we explain everything: the criteria to derive, how to handle the situation with the patient, how to write the note and what responsibility you have after referral.

What is responsible referral?

Referral is the act of directing a patient to another professional or service that can provide more appropriate attention to his needs. "Responsible" implies that:

• It is based on a reasoned clinical assessment
• The patient is communicated in a clear and respectful manner
• Facilitating continuity of care through relevant information
• It is done to a professional or service specific and competent
• Documented in medical records

When do you have to drift?

1. Limits of your competence

When the patient presents a problem that exceeds your clinical training or experience.

Examples:

• A patient with a severe eating disorder and you have no TCA training
• A situation of child sexual abuse and you have no experience in complex trauma
• A case requiring neuropsychological evaluation
• A patient who needs partner therapy and only individual work

Ethical framework: Codes of ethics are clear — working outside your area of competence is a lack of ethics. It’s not about knowing everything, but about recognizing what you don’t know.

2 Need for pharmacological treatment

When you evaluate that the patient could benefit from psychoactive medication.

Examples:

• Major depression with severe symptoms that do not respond to psychotherapy alone
• Severe anxiety disorders with frequent panic attacks
• Bipolar disorder, schizophrenia, or other conditions requiring medication
• Severe insomnia affecting daily functioning

Important: This referral is usually a interconsultation, not a transfer. The patient is still in therapy with you and, in parallel, consults the psychiatrist. You need to coordinate with the colleague.

3. Absence of therapeutic progress

When no significant progress is observed after a reasonable period of time.

Alert signs:

• Therapeutic objectives are not met after several months
• Patient expresses sustained dissatisfaction with the process
• You feel that the therapeutic relationship is not consolidated.
• You notice that your approach is not the most appropriate for this problem.

4. Conflict of interest

When a situation exists or arises that compromises your professional objectivity.

Examples:

• You discover that the patient is familiar, friend or close acquaintance of someone in your environment.
• The patient is the ex-partner of another patient of yours.
• Countertransferential feelings arise that you cannot handle
• There is a labor, commercial or social link that interferes

5.

When the patient requires attention that you cannot provide at that time.

Examples:

• Suicide crisis requiring hospitalization
• Acute psychotic decompensation
• Substance poisoning
• Active domestic violence requiring immediate intervention

6. Patient application

When the patient asks to be referred to another professional, it may be due to:

• Preference for another therapeutic approach
• A desire to work with a professional of another gender
• Moving or other logistical changes
• Dissatisfaction with the process (although it does not always say it directly)

Important: You have an ethical obligation to facilitate referral, not to retain the patient.

How to communicate referral to the patient?

This is the most delicate part. A miscommunicated derivation may feel like a rejection or abandonment.

WHAT YOU DO

1. Explain the clinical motive honestly and without technicalities
2. Standardize the decision: "It is part of professional care to seek the most suitable specialist"
3. Give options: offer more than one professional or service where possible
4. To accompany the transition: offer closing sessions and facilitate contact with the new professional
5. Leave the door open: "If you ever need to come back, I'm available"
6. Documenting conversation in medical records

What NOT to do

• Derive by text or email message without an in-person session
• Say "I can't help you" without offering a concrete alternative
• To give the feeling that the patient "is too" or "his case is very serious"
• Derive overnight without closing sessions
• Derive without having a specific professional or service to recommend

Useful phrases

"After evaluating your situation, I think you would benefit from working with a professional who specializes in [area]. It's not that I can't accompany you, but I want to make sure you get the best care possible."

"I think it's important for a psychiatrist to evaluate if the medication could help you right now. That doesn't mean we can stop — therapy we can keep working together."

"I notice that treatment is not progressing as we would expect. I think a change of approach could be positive, and I have a colleague who works very well with these kinds of situations."

Derivation vs. interconsultation

It is important to distinguish between the two:

What to include in a referral note?

The referral note is a clinical document that facilitates continuity of care. It should be concise, relevant and respectful of professional secrecy.

The essential content

What NOT to Include

• Detailed content of meetings
• Unsubstantiated interpretations or assumptions
• Valuable judgments on the patient or his/her environment
• Information that the patient explicitly requested not to be shared
• More information than is strictly necessary

Derivation note template

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DERIVATION NOTE

Date: ___________________

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Direct profession:

Lic. [Name and Surname] — M. P. [Number]

[Speciality / Approach]

[Address of clinical practice]

[Telephone / Email]

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Patient: [Name and Surname] — DNI [Number]

Age: [Age] years

Health insurance/private health plan: [Name] — Affiliate N° [Number]

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Addressed to: [Name of the recipient professional or service]

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1. Reason for derivation

[Simply explain why the derivation is performed. Examples:]

• Psychiatric evaluation is requested to consider complementary psychopharmacological approach
• It is derived for specialized treatment in [area] given the complexity of the table
• Neuropsychological evaluation is suggested to rule out [hypothesis]

2. Clinical synthesis

The patient has been undergoing psychotherapeutic treatment since [date], with a frequency of [quantity] session/is [weekly/in/fifth], under a [theoretical] approach.

Original query reason: [Short description]

Diagnosis / Diagnostic hypothesis: [Diagnosis with criteria used]

Actual state: [Description of clinical status at the time of referral]

3. Treatment performed

• Therapeutic approach: [Guidance]
• Duration of treatment: [Time]
• Key interventions: [Summary of strategies used]
• General evolution: [Improvement, stagnation, aggravation]

4. Relevant information

• Current medicine: [If applicable, or "Does not refer to current medication"]
• Significant background: [Pre-treatment, hospitalization, risk factors]
• Current risk factors: [If there are: suicidal ideation, substance use, violence situation, etc.]
• Support Network: [Family, significant links, available contents]

5. Purpose of derivation

[What is expected of the recipient professional. Examples:]

• Evaluation and possible indication of psychopharmacological treatment
• Continuity of psychotherapeutic treatment with a focus on [area]
• Psychodiagnostic / neuropsychological evaluation

6. Additional comments

[Any additional information that facilitates attention. For example:]

• The patient has knowledge and consents to this referral
• The possibility of coordination between professionals was open
• Attached [consent / report / previous studies]

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Signature: _____________________

Seal: _____________________

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Note: This referral is made with the consent of the patient. The information contained is confidential and is intended exclusively for the receiving professional.

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Interconsultation template

When it is not a referral but a supplementary consultation, the format is shorter:

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Request for interconsultation

Date: ___________________

From: Lic. [Name and Surname] — M. P. [Number]

For: [Professional / Service name]

Patient: [Name and Surname] — [Age] years

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Reason for interconsultation:

[Short description of what is requested to be evaluated]

relevant clinical data:

• Diagnosis / hypothesis: [Description]
• Time in treatment: [Period]
• Current Symptoms: [Those Relevant to Interconsultation]
• Medication: [If applicable]

Specific question:

[What do you need the other professional to evaluate or respond to?]

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Signature: _____________________ Seal: _____________________

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Post-derivation liability

Until the derivation is completed

Your responsibility as a treating professional does not end when you write the derivation note. Continue until:

• The patient effectively begins care with the new professional
• Or the patient decides not to continue any treatment (having been informed of the implications)

This means that if you give a patient and the new professional does not have an appointment for another month, you are still responsible during that period.

Closing meetings

If referral involves finishing your treatment, closing sessions are essential:

1. Review the process: what was worked out, what was achieved, what is pending
2. Develop farewell: give space to the emotions generated by closure
3. Preparing transition: explain what you can expect from the new professional
4. Delivery of documentation: referral note, and copy of medical records if requested by the patient

Coordination with the recipient professional

When possible and the patient consents:

• Direct communication (call or email) between professionals facilitates the transition
• It's not mandatory, but it's good clinical practice.
• Document any communication in medical records

Derivation in emergencies

When derivation is urgent (suicide crisis, psychotic decompensation, active violence), the protocol changes:

Immediate steps

1. Assess risk and the need for immediate intervention
2. Contact the emergency service or accompany the patient to the guard
3. Communicate essential clinical information to emergency team (verbally if necessary)
4. Contact a relative or patient reference person
5. Document everything in the medical records as soon as possible

Minimum information for emergencies

In an emergency referral, the recipient professional needs to know:

• Name and age of the patient
• Reason for the emergency (current risk)
• Diagnosis if there is
• Current medication
• Emergency contact
• If there were previous attempts (in case of suicidal risk)

Frequent errors

Derive without a specific destination

"You should see a psychiatrist" is not a referral. A responsible referral includes a name, telephone and, if possible, a managed appointment.

Do not document

If the derivation is not recorded in the medical records, it is as if it did not exist. Faced with a claim, you have no support.

Derive too late

Waiting for the picture to become worse or for the patient to enter crisis to derive is a common mistake. If you identify the need, actuate.

Unclosed derivatives

Simply stopping taking care of the patient without closing sessions is a discontinuation of treatment, not a referral.

Not asking for consent

Sharing clinical information with another professional without the patient's consent violates professional secrecy, even in a referral.

Derive for comfort

Deriving because a patient "is difficult" or "I don't like him" is unethical. If there are countertransferal difficulties, the first step is supervision, not referral.

How to manage drifts with Brauni

Brauni simplifies the entire bypass flow:

1. Template referral notes: Generates the note with preloaded patient data
2. Recorded interviews: Document communications with other professionals
3. Follow-up alerts: Remember to follow up to verify that the patient is specific to the referral
4. Full History: Referral is recorded in the patient's medical records
5. Secure export: Send the note to the recipient professional encryptedly

And if the recipient needs a formal report, you can generate it with digital verification from the patient's same file.

Summary