The Yelp Dilemma: Clients Reviewing Their Therapists on Review Sites
*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.
Your Privacy
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.
Your Confidentiality
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.
Other Limitations
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.
References
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 https://drkkolmes.com/2009/05/07/the-yelp-dilemma-clients-reviewing-their-therapists-on-review-sites/.
December 10, 2014 @ 11:02 pm
Very informative and educative piece. I enjoy this article for my research at Capella University. Good work!
June 27, 2015 @ 9:28 pm
I’m thinking about putting a testimonials section on my website because I see great value in it helping prospective clients better understand whether I’d be a good fit for them or not. With that said, I agree it should not be an open forum for clients to criticize my work. What requirements do you believe need to be met to make sure there is enough privacy and constructive/helpful testimonials FOR prospective clients.
August 23, 2015 @ 8:26 pm
I suggest you review the ethics code of your discipline to see what it says about testimonials from clients. I also think that if we want to give a balanced view of our work, we cannot only show the positive things people say about it. Best wishes.
July 18, 2015 @ 9:39 pm
As a client who has posted a review of their T online, I appreciate the points you bring up. A lof of these I never thought of and they are very valid concerns.
My review was positive and I felt compelled to write it since the only other reviews I’ve read for my T weren’t so nice. Since you’re right, every ones experience is different I thought a positive, though honest, review might be useful to other prospective clients. Plus, sometimes when you like a service you want to tell people about it. Referrals are a preferred alternative, but I have yet to have anyone directly ask for one. The search for a psychiatrist or therapist can be overwhelming and going into a meeting with at least a little information about their general approach or personality type can be a big asset. Generic reviews of practices with many therapists to choose from are essentially useless and clients often avoid the search for a therapist because they don’t want to have go into meeting after meeting not knowing what to expect. It’s like going on a blind date – you want to have at least a little info so you can back out if you know it will be a dud. I understand that one person’s favorite therapist may be someone else’s worst nightmare. Aside from that, if the client wants to give their therapist a plug its unsolicited, I think it’s pretty harmless.
July 21, 2015 @ 5:35 pm
Dear Sadie, thank you for your comment. I agree that an unsolicited comment from a client is harmless and probably speaks well of the therapy relationship. What I find to be a sticky new cultural phenomenon is that clients (like you) are now in the position of wanting to publicly defend their therapists against the negative reviews that they find. As you note, you saw some not so nice reviews of someone you had good experiences with. I think this is an interesting time when clients are defending their providers against statements made by strangers. This is not something I think we would have imagined 10 or 15 years ago.
Best wishes.
September 12, 2015 @ 5:40 am
I was very relieved to find your article (validating my uncomfortable feelings.) My therapist recently started his own practice & became laser focused on social media ratings. We’ve had a multi year positive treatment history, but his asking, then reminding me to post reviews, on more than one site, felt…like he was better than that.
And now I don’t know what to think.
December 22, 2015 @ 11:30 pm
As a therapy client who has suffered through harmful and nightmarish therapy, this article strikes me as mostly about protecting therapists from liability and from client honesty. My experience was not of the sort that is easily understood or ratified through some formal grievance process. Lot of subtlety and detail. So to suggest that my only recourse is to suffer through the bureaucracy and stress of a formal grievance process, with the possibility that it will be dismissed by a group of people with a bias in favor of the profession, seems self serving and dishonest. Why not use a tool that offers direct and immediate and public feedback (Yelp), as long as it used carefully and respectfully?
February 18, 2016 @ 12:37 am
I recently had a very traumatic experience in counseling. The counselor is a Christian Counselor and used some very unorthodox tools in her therapy leaving me very confused and injured. I would like a place to review her and have considered a State grievance but I live in a small town and do not wish my reason for therapy to be discussed.
July 15, 2016 @ 5:23 am
I don’t think it’s an accident that there doesn’t seem to be any response to this question.
As much as therapists harp and harp and HARP on the importance of the therapeutic relationship between themselves and their clients, when it’s the therapist who behaves unethically and irresponsibly and the only “official” measures a client can take are to attempt the arduous process of filing a complaint – not that we’re not under enough stress already to begin with – only to watch the review board (who is, we notice, organized entirely of therapists!) close ranks around the perpetrator …
let’s just say it doesn’t engender an awful lot of faith in the “system” of therapy, as it’s publicly touted to the rest of us.
September 2, 2021 @ 5:19 pm
Hey. I don’t know if any of you will see this or not, but I wanted to just respond to let you know that what you’re saying about unethical practices is important. I am a therapist myself, who has my own history of mental health issues, so I’ve had my own experiences with this type of thing on both sides of the issue. One thing that I think is an issue is that clients are given documents about their client rights and such, but I don’t think that does enough to provide FULLY informed consent. That’s why when I meet with a client for the first time, I let them know that:
I am here to help you and to serve as a model of a healthy relationship that you can use to guide future relationships. Because of that, I want you to know that I am passionate about maintaining your rights as a client, and I consider it my ethical obligation to always do what’s best for you, which means that I value your input during this process, whether it be positive or negative. If I ever do anything that makes you feel judged, misunderstood, or that makes you feel that I minimized or was dismissive of you, I want you to let me know. I think that lets clients know right off the bat that I value them. I’ve found myself using the example of a client I had who seemed like he needed to develop some mindfulness skills, so I gave him an exercise to practice at home. For the next 5 sessions he kept coming in saying that he meant to do it but had forgotten for whatever reason or another, so each time we developed some new way to help him remember, which never actually resulted in him remembering. LOL. Eventually, after so many sessions, he said to me “Alan, I’m not doing it because I don’t want to. It doesn’t sound like something I would enjoy”. Had that client said that to me at the beginning, we could have used those next several weeks helping him develop what he needed in a way that he would have been interested in. I do know, though, that there are a LOT of therapists and doctors who don’t listen, and who will tell clients “You’ll do as I say or else”, or who (like one person mentioned) will inject their own values and beliefs into their work and don’t seem concerned at all about how it impacts their client. And you’re right…it seems like a lot of times when clients complain, they encounter a culture of people who will then turn it around on the client and tell them they’re wrong, that they’re being irrational, or their concerns are dismissed because “they’re confrontational and angry…it’s part of their mental health problem”. I guess my best advice would be to discuss this with your provider at your first visit, unless your provider brings it up on their own like I do. Of course, remember to use your most “appropriate” language. My suggestion for clients would be to say something like “I’ve had bad experiences in therapy in the past, where I felt unheard or where I felt that my therapist had an approach that didn’t serve me well. However, I understand that all therapists are different, so I wanted to ask you how you feel about these issues. I want to find a therapist I can truly connect with and trust.” Also, remember that research has shown that therapy is relatively ineffective on it’s own, but that it only really becomes effective when clients have a strong, trusting, and meaningful connection with their therapist. I don’t have sources to cite for that, but there is actual research about it, and that is widely assumed to be true in the mental health community. Therefore, in my opinion, for any therapist to engage in therapy with a client where they are disregarding the client’s right to have a voice in their treatment and to have a choice about who and what they do is highly unethical, as we know that a client in those situations will not do well. You, as the client, just have to remember to respond to these things in a calm, assertive manner that is respectful and avoids “blaming”. That will minimize the chance that they will respond with defensiveness.
February 7, 2016 @ 3:57 pm
The medical field in general is required to keep patient information private. Imagine not being able to review your medical doctor on line. I feel this keeps the doctor honest. It warns others of either biases or poor bedside manners. One person may not care about their doctor’s personality while another requires a “gentle touch”. Therapists and psychologists are still human and act out as any patient might, often more so. Any businesses whether medical or other is still a business. The patient/client should come first. The doctor, therapist or healthcare professional should not be above review.
September 2, 2021 @ 5:29 pm
Hey Neil. I agree. Therapists do need to be held to account. I’m sure that there are clients out there who have had some negative thoughts about me, but at the same time, I feel that most of my clients would give me a positive review if I asked. Personally, I would welcome reviews both good and bad. I can also understand why negative reviews would be tricky. There are a lot of times when clients get upset at therapists for something and don’t confront it in session. I had a client once who was very upset because a therapist had made a hand gesture that she interpreted as the therapist being dismissive or flippant about something that was important to the client. In reality the other therapist had no idea that she had done anything that had upset the client so greatly and hadn’t at all meant to minimize the client but hadn’t been given any chance to fix it. If that client were to have gone online to write a review, she would have been doing it based on an assumption that was incorrect and could cause others to be hesitant to see that therapist. However, in a system that seems set up to protect bad behavior sometimes, I can see the utility of being able to post negative reviews.
May 25, 2016 @ 7:39 pm
Hello, I would interested in hearing your current 2016 views. I am confused on some of your points as creating a yelp profile for your business in no way implies that you are soliciting testimonials. Yes, if you encourage your clients to post or even reward them to post them that is definitely a breach of 5.05. What I find discerning is that the APA and this industry is attempting to hold on tightly to the in room rules regard less that in less then 10 years 75%, or more, of therapy will be completed remotely. We are looking towards the future to give our clients all the benefits of technology. From this article I am hearing that you do not trust your clients or reviews to give the information you want them to give. They have every right to review any goods or services they receive including therapy. To say that a client should not review or post their thoughts on therapy or even a specific therapists is like saying ‘we know what is best for you, do not talk back.’ Old, old, old school.
June 6, 2016 @ 4:08 am
At the time that I wrote my post, Yelp would not remove public listing that they created and I and others shared the concerns that people or licensing boards might view these listings as a request for reviews, since that was the sole purpose of Yelp. I absolutely have always supported clients’ rights to review or talk about therapists in any venue of their choosing, but I did not like hearing from psychotherapy clients that they felt pressured to leave Yelp reviews at the end of treatment. In fact, I have gone on to develop a post treatment satisfaction survey based upon client’s description of the data they would find most useful and that goes missing on sites like Yelp because I believe there can be a better system than simply a rant vs. rave system. Thanks for your thoughts!
August 25, 2016 @ 7:18 pm
I wonder if you would comment someplace on your website or at PsychCentral about the advisability of clinical psychologists commenting often and publicly, often vehemently, via Facebook or Twitter on the political issues of the day. I can think of at least one Australian Muslim psychologist who does this a lot. I fear that it is a route to creating unnecessary subtext in the therapy room; a psychologist publicising her or his political positions will make patients want, potentially, to curry favour with the therapist by ascribing to that position or positions.
April 28, 2017 @ 7:10 am
Dear TPG, I think this is a fascinating issue, and it’s been especially resonant for me this year. I think it’s a challenge since the days of the blank slate are over for many. Clients can easily access information such as political donations, whether or not a clinician is open about their political views. On the other hand, many clients may choose a therapist precisely because they assume the therapist agrees with their political views. I am also hearing more about clinical scenarios in which political differences are openly discussed in the therapeutic relationship (if the therapist’s views are already known to the client) and I am aware of some situations in which that increased the feelings of safety and respect. Not all clients want to curry favor–some want to be seen and heard just as they are. But perhaps I will consider an essay on this in the future. Thanks for asking.
January 24, 2017 @ 12:14 am
I would like to understand and flush out your comments above about Yelp. I think it is IMPORTANT for therapists, who are running a business to at least create and therefore “control” their brand by creating a Yelp profile and not leave this up to a possible upset client to do for them. I agree it is unethical to solicit reviews of either past or present patients, but it certainly is NOT unethical to create social media sites for your Brand so that someone else doesn’t. Please can you speak to this as there is so much GREY area still out there about this, especially amongst therapists and the ethics board. What is the Boards position on this?
April 28, 2017 @ 7:00 am
I am a strong believer in claiming one’s business page on Yelp. I can’t speak for any Board of Psychology, but I don’t think any Board would have a problem with ethical marketing. I have actually used my own Yelp page to explain why I do not solicit testimonials from clients and to explain why I will not be responding to any reviews. Take a peek.
April 10, 2018 @ 12:12 pm
I looked at your Yelp page but I couldn’t find your explanation of why you do not solicit testimonials and why you won’t be responding to any reviews. Did you take this down or am I looking in the wrong place. Also, thanks for posting about this topic, it’s interesting.
April 18, 2018 @ 7:06 pm
In November of 2017, Yelp removed my text and claimed it violated their Terms of Service. I will soon be posting a blog update on this as they have not been responsive to my emails explaining that I had posted this information about my business because they directed me to do so in 2010. As of April 18, 2018, I have reposted the text on my Yelp profile, but I moved a link to my client satisfaction data since they request no url’s in this section. Hopefully, they will leave it up!
August 4, 2017 @ 12:17 am
I came across this as I was looking for options to review a therapist that I saw. I think your points are very valid, however they leave out some important perspective on the part of some clients. In my case, as in the case of other commentators, I saw a therapist whose behavior was damaging to me, however not in any way that I can imagine would be grounds for a formal grievance. I did try to directly address the issues with him during, at the conclusion of, and following the end of the relationship, but he was defensive and dismissive. I have continued to suffer from the effects of my therapy with this person, and see leaving a review as a way to give a “head’s up” to potential clients, to get some degree of closure, and to some extent to minimize my feeling of being victimized by this person who played fast and loose with my emotional well being. Social media sites are communities of sorts, and anyone reading reviews can evaluate the content to determine its credibility and relevance to them. While I am pretty forthcoming with both positive and negative referrals, they aren’t common on the mental health counseling space and a more public option is probably the better option in this respect.
January 26, 2018 @ 7:46 pm
just an FYI that in Ontario Canada when you are a registered psychotherapist with CRPO they make it clear that it is considered misconduct when you post testimonials from clients on your website. It is not permitted.
April 22, 2020 @ 4:50 am
Thanks for the post.Another websites for local business I can recommend are Google My business and Websst.
Regards:Teresa
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