*November 5, 2012: If you’re interested in the Alpha launch of my new Getting Better product for getting feedback from your psychotherapy clients, after treatment has ended, read this post.
This article is part of an online course: Digital and Social Media Ethics for Psychotherapists for 8 CE credits
Recently, I attended Mental Health Camp, where I had the opportunity to engage in a rich exchange with a group of smart, articulate folks who blog about mental illness. One piece of that conversation included my asking what clients would like from their therapists online. Something that came up in this discussion was the desire for websites where clients could learn more about therapists and read other clients’ reviews of therapists.
I responded that for me, the thought of client reviews of therapists is a serious concern. I certainly recognize the utility of consumer review sites and I know they can be a great resource when someone is seeking a therapist. However, I would discourage my own clients from posting reviews of my practice on business review sites. I mentioned state licensing boards where clients can check on a the status of a therapist’s license or to see if there have been disciplinary actions against a particular therapist. But I think business reviews of the practice of therapy currently open up a can of worms.
I thought it might be useful to outline some of my concerns here and make note of some important things to consider if you are a client who is thinking of posting a review of a psychotherapy practice online.
The Therapeutic Relationship
When you’re in therapy, it’s important that you discuss your feelings and reactions to the work directly and in person. These reactions, whether they are positive or negative, can be a significant part of the therapy. They provide you and your therapist with useful information about your needs and wishes, and they can also help you learn how to express your desires clearly which can help you get more of what you need from other people in your life. Choosing to bypass this direct exchange by posting a review instead can lead to your missing out on pivotal and transformative moments in the process of therapy.
Even if you decide not to return to a therapist, it is important to let your therapist know directly why you felt it was not a good fit for you. Sure, this can be helpful information for your therapist, but, even more importantly, it may also help you experience satisfaction and closure about choosing to end the relationship.
Testimonials and the Ethics Code
The American Psychological Association’s Ethics Code under which I practice states under Principle 5.05 that it is unethical for a psychologist to solicit testimonials. The full text states: “Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.” Ethics Codes for social workers and marriage and family therapists have similar provisions.
In my own practice, I take this mandate further and also do not ask past clients to provide testimonials of my work. This is partly because a client may wish to return to therapy with me at a later point in time. We may complete one piece of work together but there could be circumstances which bring someone back to my office months or years later. I prefer to think conservatively about these matters and allow for all possible outcomes.
If someone likes my work, and they would like others to know about it, the best thing they could possibly do is refer others to my practice. This would be preferable to me than receiving a positive review or testimonial.
This is the piece that I find myself most concerned with when it comes to client reviews of therapy. If you choose to write something about your experience with a therapist on a business review site, bear in mind that you will be sharing personally revealing information with a wide range of readers in a public forum. If you feel compelled to post a review of a therapist, in the interest of preserving your privacy, I urge you to create a pseudonym that is not linked to your regular email address and established friend networks. You should also not post a photo.
Remember that things you feel okay about sharing with the internet public today may not be things you feel like sharing with the world tomorrow. While you can almost always delete or edit a review, you will never know who has already read it, so it’s wise to be cautious when talking about your sensitive, personal matters on the internet where information can be collected and archived forever.
While small business owners have the ability to respond to Yelp reviews and many review sites offer this option, psychologists must provide confidentiality to our patients. This means that we are ethically unable to respond to reviews of our businesses in any way that acknowledges whether an individual has been a client of ours. This holds true regardless of whether the review is negative or positive. Unlike other business owners, we cannot address specific complaints or reference any remedies we have offered. We can certainly respond non-specifically to complaints by offering general information about our services, but even this can be clinically compromising in multiple ways.
When someone uses a review site to vent, air a grievance, or even to let a therapist know how they feel, they should bear in mind that the therapist may not even see the review. But even if we do see the review, we are limited in our ability to respond compared to other types of businesses. This is another reason why direct communication would be better.
The folks who attended my panel brought up some other excellent points about the limitations of therapist review sites which included:
Reviews, just like relationships, can be very subjective. What works for one person in treatment may not work for another. What makes one client upset may not ruffle the feathers of another. One person even observed that what works for one therapy client at a particular point in time, may not work for that same client years later, when his needs are different.
Another participant acknowledged that if review site were to offer the best data about a therapist, it would be most helpful to know what the person’s diagnosis was, how many therapy sessions the person attended, and other more detailed information about treatment factors. This information would be very helpful in order to ascertain whether the therapist would potentially be able to help with your particular issue. This is certainly another limitation of reviews of a therapy practice.
Good Venues to Air Grievances or Protect Others From Therapist Misconduct
Of course, there are situations in which it may not make sense to bring up feedback in the therapeutic relationship. One such scenario might be if a psychologist engages in sexual or other exploitative relationships with a therapy client, both of which are strictly prohibited by our ethics code. If a therapist has made verbal or physical sexual advances towards you, please download the State of California’s Department of Consumer Affairs pamphlet “Professional Therapy Never Includes Sex,” and consider finding another therapist to help you sort through what has happened.
There may be other scenarios in which it does not feel safe to return to therapy or when you believe something wrong has occurred that you do not wish to address directly with the therapist in question. If this is the case, the best resource would be to file a direct complaint with the Board of Psychology or the licensing board appropriate to your state and your therapist’s discipline. They will investigate the matter, and, if they deem it necessary, they can put restrictions on a therapist’s ability to practice. If you feel that a therapist is a danger to other clients, this is a better way to protect others than posting a review on a website. But you should also be aware that if you file a formal complaint, details of your therapy may come up in the investigation.
Where Do We Go From Here?
As acknowledged at the start of this post, consumer review sites can be a wonderful resource. The internet is making it much easier to access services and find out more about them. It would be wonderful if there were sites that offered better privacy and more detailed information for people seeking mental health services, while also providing a way for therapists to reach out and connect with people seeking help. It is my hope that some of the review sites that currently exist will offer better security in the future for people who want to post reviews of services that are more sensitive or confidential in nature.
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.
California Board of Psychology main website: http://www.psychboard.ca.gov/
Filing a complaint with the California Board of Psychology: http://www.psychboard.ca.gov/consumers/filecomplaint.shtml
License search for psychologist in CA: http://www2.dca.ca.gov/pls/wllpub/wllqryna$lcev2.startup?p_qte_code=PSX&p_qte_pgm_code=7300
Link to pamphlet: Professional therapy never includes sex: http://www.medbd.ca.gov/publications/professional_therapy.html
Mental health camp: Erasing stigma and exploring possibilites with social media: http://www.mentalhealthcamp.org/
© 2009 Keely Kolmes, Psy.D.
To cite this page: Kolmes, K. (2009) The Yelp dilemma: Clients reviewing their therapists on review sites. Retrieved month/day/year from http://siteinsightdraft2.com/2009/05/07/the-yelp-dilemma-clients-reviewing-their-therapists-on-review-sites/.