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Yelp and Angie's List LogosAs I’ve said before, garnering online reviews of your private practice is one of the most effective marketing moves a business owner can make, and so it’s too bad that soliciting reviews or other testimonials from clients is explicitly unethical for American mental health clinicians. There is no prohibition on asking for them from colleagues, mentors, and others who know your work in a professional capacity, however, so long as you keep certain caveats in mind and properly weigh the risks and benefits of doing so.

Online reviews — such as those found on Yelp, Google Places, Angie’s List, Health Grades, and others — are well known to improve your website’s position on search results and also increase your likelihood of appearing in coveted local search results. Additionally, Americans are looking for “social proof” of the effectiveness of a service provider before making a move to hire them.

One can see social media marketing experts frequently touting slightly varying stats that go along the lines of, “90% of Americans trust online reviews, only 15% trust advertising.” What’s more, colleagues in your area may solicit reviews from clients, despite the ethical prohibition on doing so, and gain greater marketing position as a result. Other professions such as coaching and non-licensed practitioners of therapies used by licensed mental professionals, such as hypnotherapy, also generally are not limited by this particular ethical prohibition. Many of my consulting clients have expressed deep frustration with this state of affairs.

Besides the issue of marketing, there’s also the concern of dealing with negative reviews. Some such reviews may be left by angry past clients or even people who never were your client. Our mandate to protect client confidentiality can significantly tie our hands in dealing with these negative reviews. As Ofer Zur has written before, one of the best ways to handle them is to bury them in positive reviews, generally solicited from colleagues and others who know your work and are highly unlikely to be clients.

Solicitation of Reviews/Testimonials From Clients is Unethical

The ACA, APA, and NASW codes of ethics all prohibit the solicitation of testimonials from clients:

Counselors who use testimonials do not solicit them from current clients nor former clients nor any other persons who may be vulnerable to undue influence.
ACA Code of Ethics, 2014, C.3.b

Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.
Ethical Principles of Psychologists and Code of Conduct, 2010, 5.05

Social workers should not engage in solicitation of testimonial endorsements (including solicitation of consent to use a client’s prior statement as a testimonial endorsement) from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence.
NASW Code of Ethics, 2017, 4.07.b

 There is a lively and relevant debate about whether or not this is appropriate in the modern social climate, given the impractical consequences of the blanket prohibition. That debate is better left to a different article, however.

There are other clinical and ethical concerns around clients leaving testimonials for therapists regardless of the ethical mandates. I highly recommend exploring those issues before embarking on any marketing campaign that includes online reviews. Here are some relevant articles:

Solicitation of Reviews/Testimonials From Colleagues and Mentors is Not Unethical

There is no ethical restriction on asking non-clients to review your work online. The ethical problems involved come more tangentially. These are the dilemmas I see:

  • Administrators of online review websites generally expect that reviewers are those who have received our services. Additionally, we are required by ethics codes to thoroughly and accurately represent ourselves. As such, I would posit that those who review you should have had some opportunity to know your work in some way. Supervisors, professors, colleagues in consultation who watch video of your work, and those in similar positions seem to be good choices.
  • Clients and others who see that you have reviews may take them as a sign that reviewing your practice is a good idea. If you haven’t prepared clients for this situation, such as through a social media policy, they may also leave reviews before weighing the risks and benefits of doing so.

Given the above concerns, I recommend you ask that colleague reviewers include these things in their review, where possible:

  • Their relationship to you, with emphasis that they are not a past or current client.
  • How the reviewer is able to directly know your work, and/or the limitations on the reviewer’s knowledge of your work.
  • A reminder to clients that leaving a review can put their confidentiality and relationship with the therapist at risk.

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Along with those items to include in the reviews themselves, I also recommend that where possible you craft your review site profile to help ensure that clients and potential clients are informed of the risks and benefits of leaving reviews. See these Yelp profiles for examples:

Review Websites Are Not Fans of Solicited Testimonials, Either

Review sites like Yelp and Google Places both state that businesses should not ask customers for reviews – they should come spontaneously. This official statement of policy is made suspect, however, by such practices as giving business owners window stickers that say “People like us on Yelp” and other encouragement to indirectly solicit reviews from customers. Additionally, we have the special consideration that we cannot use the accepted indirect solicitation methods such as putting Yelp or Google stickers on our windows. We certainly cannot do what many medical and dental providers do and offer rewards in exchange for reviews.

With this in mind, I recommend that you follow these guidelines in asking for colleague reviews in order to be a “well behaved” user of review sites:

  • Make sure reviewers only review you on one site. Do not write a review for the same private practice on multiple sites.
  • Ask colleagues to only review you on a site for which they already possess an account. Ask them not to make an account specifically so they can review you. Keep in mind that if someone has a Gmail account, they should be able to write reviews on Google Places with it.
  • Do not ask for reviews on sites whose policies require that reviewers be past customers. For example, Health Grades requires that reviewers be past patients of the clinicians reviewed.

This article is offered in hopes of removing any unnecessary sense of restriction from the idea of online reviews. Social proof is emerging as a huge part of how modern people make decisions on what to buy and who to go to for services. This is unlikely to change in the future, and it is likely that professional ethics will need to adjust to keep up while still addressing what clients need for safety and continued clinical effectiveness. In the meantime, we are still quite restricted, so we must do what we can to deliver what potential clients need to make their decisions about who to call for therapy while remaining compliant with professional ethics.

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