[Transcript] Episode 527: Why Therapists Shouldn’t Use Client Testimonials — Ethics, Risks, and Safer Marketing Strategies

 

Evan Dumas 

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Welcome to Episode 527: Why Therapists Shouldn’t Use Client Testimonials – Ethics, Risks and Safer Marketing Strategies.

 

Liath Dalton 

Yes, this has been a topic that has come up multiple times, understandably so, throughout the years, but over the last few months, this has been coming up more frequently. Because in this sort of current context and environment that practices are operating within, marketing is becoming more and more important, right?

 

Liath Dalton 

So we’re we’re out of the, kind of, bananas season that was occurring during peak COVID times. When practices were managing astronomically long wait lists and having to refer out, but not having people to refer out to, and growing their practices, scrambling to bring on clinicians. Like things have really shifted right? For a whole multitude of factors. And so marketing is now more important in terms of being able to have a full caseload for a practice and its clinicians.

 

Liath Dalton 

And we’ve been seeing more and more practice leaders working with marketing consultants or business coaches who may or may not be specifically from the therapist community or professionals themselves. And so there can be gaps in their understanding of what’s ethical and appropriate for marketing, not just in terms of HIPAA compliance, but specifically with regards to testimonials.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

And then we also know that there are some misconceptions that kind of get propagated within the therapist community itself. So we wanted to address all of that.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

Because the reality is, that in just about every other industry, testimonials are really marketing gold, right? They’re social proof. It’s more effective for someone who has benefited from what you provide to tell other people considering whether or not they want to partake in what you provide, than it is for you to describe it yourself. But, but in mental health specifically, they are an ethical minefield.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

And this isn’t just about a marketing rule. And I really want to center that. Because it is about safeguarding the therapeutic relationship, protecting client trust, and preventing harm.

 

Liath Dalton 

And so I think we want to be centering, what is the outcome, what is the imperative that we are managing? Not just here are the do’s and don’ts, but centering the why. And the why is always going to come back to the client, right?

 

Evan Dumas 

Yeah, yeah.

 

Liath Dalton 

We’re going to give some great examples drawn from the marvelous Dr. Keely Kolmes, who, many years ago now, back in in 2009, wrote an excellent article about the Yelp dilemma. Because that’s when Yelp was really coming, coming on the scene, and everyone understandably had questions about it.

 

Liath Dalton 

So, in 2009 Keely wrote this article and and shared some model language for navigating online reviews on review sites. So we’re going to talk about that, as well as just testimonials in general for your website or social media profile and so on.

 

Liath Dalton 

So, we’ve got to start with the ethics codes, right, Evan?

 

Evan Dumas 

Yeah.

 

Liath Dalton 

So, let’s actually look at the primary ethics codes for each of the main professions that we work with, psychologists, social workers, counselors, MFTs.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

What do they say about it?

 

Evan Dumas 

Yeah, they all pretty much say that psychologists do not solicit testimonials, or counselors do not solicit testimonials, or social workers do not solicit testimonials, or counselors do not solicit testimonials from current clients. Some even say former clients, when solicitation is likely to result in harm or undue influence.

 

Liath Dalton 

Yes, exactly.

 

Liath Dalton 

So the ACA code is actually the most explicit and indefinite of the ethics codes. But I think each profession should draw on that, because it really, I think, gets to the crux of it. Which is their code says, counselors do not solicit testimonials from current clients or former clients.

 

Liath Dalton 

For the NBCC code, they say current clients or former clients within two years of termination. We’re going to talk more about that two year timeline, and what that’s about.

 

Liath Dalton 

And for psychologists, it says current clients or patients, or from other persons who, because of their particular circumstances, are vulnerable to undue influence.

 

Liath Dalton 

So really, the major takeaway from each of them is that it’s focused on protection from undue influence, not just timing, and not just that they are not a current client, but there’s a kind of continuum with regards to former clients, all all going back to this undue influence consideration, right?

 

Liath Dalton 

The, the other piece that we need to talk about is that we keep seeing this come up, particularly in group practices, and particularly as guidance from marketing consultants or business coaches who aren’t therapists themselves, generally, which is: okay so your ethics code prohibits you as a therapist from being the one to solicit testimonials, just have your non-clinical admin staff send it out or make the request if it’s made in person or by email.

 

Liath Dalton 

So that sort of assumption of, if I’m not asking personally or my clinical staff isn’t asking directly, then it’s okay, then it circumvents that prohibition. But it doesn’t remove the ethical responsibility, because the power differential is really originating in the therapeutic role, not in the person making the ask.

 

Liath Dalton 

So if someone you employ and are directing to make the ask is making the ask, and they are connected to you, the client who’s being solicited is not going to experience that as somehow outside of the therapeutic relationship, or removed from the power differential that’s present within the therapeutic relationship, right?

 

Evan Dumas 

Mhm, yeah.

 

Liath Dalton 

And so, basically, if the request is tied to their status as a client, whether former or current, it’s still solicitation. Now, Evan, what about anonymous testimonials?

 

Evan Dumas 

Oh, yeah, so anonymous testimonials means that whoever’s doing it has a full understanding of what de-identification means. And this is almost never the case, because de-identification is incredibly difficult, because of people’s circumstances or other things can give a real false sense of safety while risking still like boundaries on client privacy.

 

Evan Dumas 

And it’s, you know, it’s still like soliciting, it the act of even soliciting it. Saying, hey, don’t worry, we’ll anonymize it, that still kind of feels ethically icky, too. Like it doesn’t take out the risk, it’s just like a workaround. And as we know, like when you think you found a workaround, that’s still not following the rules, that’s just trying to be sneaky.

 

Liath Dalton 

Exactly, and even with explicit consent, the consent process itself is inherently influenced by the therapeutic relationship, whether current or prior, right? So, like Evan, you said, it gives a sense of safety that is really false and is still jeopardizing client privacy and boundaries.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

So, this all takes us to the guidance that that we give and that Eric Strom, the HIPAA and teletherapy attorney and AMHCA Ethics Committee member, as well, gives. Which is with regards to testimonials, you should take the approach of once a client, always a client.

 

Evan Dumas 

Mhm, yeah.

 

Liath Dalton 

And so in that context, the NBCC specification of two year, two years from termination really falls short. Because the therapeutic bond often is enduring beyond that two, two year time period, right? It’s, that’s a just a arbitrary number. But in practice, we really don’t see that the client sense of the therapeutic relationship or therapeutic bond is going to end after that time period, particularly if you’re doing long term or impactful work.

 

Liath Dalton 

So the reality is that so many people, so many clients, will, even if an episode of care has been terminated, have the sense that, well, they’ll come back if a crisis occurs, or if they need a tune up or maintenance therapy, right?

 

Evan Dumas 

Mhm.

 

Liath Dalton 

So even if there isn’t a active episode of care, there is still an ongoing therapeutic relationship.

 

Evan Dumas 

Yeah, totally.

 

Liath Dalton 

So we say best practice is to adopt the once a client, always a client mindset for testimonial purposes. That’s going to remove ambiguity, eliminate potential harm, and then that’s again, just centering client trust and safeguarding client information and the therapeutic relationship.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

And with with regards to this, I have to say, Evan, we have seen over the years some pretty egregious violations of the prohibition on client testimonials.

 

Evan Dumas 

Oh yeah, oh yeah.

 

Liath Dalton 

Ranging, ranging from, you know, less harmful, where it doesn’t include a name, let alone a first name or initials, to, and is just a statement, that doesn’t have too much context of like specific diagnosis or other things that we would think of as more identifying to a practice, that at one point was including client testimonials with names and pictures.

 

Evan Dumas 

Oh, yeah, totally. Yeah, actual profile photos, yeah.

 

Liath Dalton 

Right? And it’s hard, because the sort of pushback that we often hear is well, but doctors offices and like medical practices are using testimonials with identifiers and names and photos all the time, why is that okay? They’re not getting in in trouble or hot water for that.

 

Liath Dalton 

Well, their ethics codes are very different.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

The sensitivity of the information that they’re handling is, is is different. And the disclosure from an individual that they have a health care provider, you know, a medical doctor, versus that they are in a therapeutic relationship with, receiving mental health care, or behavioral health care, is very different. And the potential harm that can arise from revealing that relationship is very different.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

Which segues to the public review platform dilemma.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

Because those platforms let anyone leave a review. You can’t prevent reviews from being being left, positive or negative, and in the event that a negative review is left, you cannot respond or engage in the review. Because even acknowledging a review can confirm that someone was a client, which breaches confidentiality. And clients can also unintentionally post private information that can’t really be erased or easily edited out once they discover, oh, shoot, I didn’t want to make that public, right?

 

Evan Dumas 

Yeah, exactly.

 

Liath Dalton 

So you can’t, you can’t turn these off, but there is still a proactive solution that’s aligned with the ethical mandate. And this is going back to what we referenced in the beginning, Dr. Keely Kolmes’ solution.

 

Liath Dalton 

Keely recommends that you post a public review policy directly on your Yelp and Google profiles.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

And you can actually look at Keely’s Yelp profile, I’ll link to that in the show notes, which have their exact language, which you can, they’ve given permission for that to be sort of copied and modified as as you see fit. But here’s, here’s sort of a distilled version of example language to put on your public review platform profiles:

 

Liath Dalton 

“I do not, or we do not, as the practice name request or solicit reviews from clients. Public reviews can risk your confidentiality and our therapeutic relationship. If you choose to post one, please know I will not respond publicly, as that could compromise your privacy.”

 

Liath Dalton 

So that’s setting boundaries, educating them, and it’s protecting both you and your practice and and the clients.

 

Liath Dalton 

So again, going, going back to, we’ve talked about what we can’t do, solicit for testimonials. Certainly not, there’s, there’s no ambiguity around soliciting from current clients. There are potentially areas like gray areas where arguments could be made for psychologists or for social workers, whose ethics codes don’t specify indefinitely, like the the ACA does.

 

Liath Dalton 

But when we are really centering what the outcome needs to be, and all the different factors that inform and influence that, it’s, best practice is absolutely going to be the once a client, always a client, mindset. So now, what are some ethical alternatives to client testimonials?

 

Evan Dumas 

Yeah.

 

Liath Dalton 

And this is one we talk about a lot, right, Evan?

 

Evan Dumas 

Yeah, do you want me to go over them?

 

Liath Dalton 

Yes.

 

Evan Dumas 

All right, yeah. So you can use testimonials, if they’re from your peers and from your colleagues, if they’re professional endorsements. Say, people you went to school with, or people you’ve done case consultation with, or people that you were in a group with in the past. Like, those endorsements carry a lot of weight too, because they’re fellow professionals. They show that, you know, you can’t exert an undue influence and not form a client, things like that. And it’s also totally safe, because there is no client information related to it or whatnot.

 

Liath Dalton 

Exactly. And it, you can also, of course, be highlighting your qualifications and training, evidence based methods, lean into really sharing your story as a practice, as a therapist, and what what it is like to work with you as a client, or when we’re talking about a group practice, having the profiles of your different therapists really convey what it’s like to work with them as a therapist. Rather than including direct stories or testimonials that speak to that. We still want to be giving prospective clients a sense of what it is like to work with the provider, but that should be coming from them directly, rather than through through testimonials.

 

Liath Dalton 

And then, of course, you know, sharing educational content and supportive resources that can drive engagement and also speak further to what it’s like to work with a particular therapist or with the practice is really beneficial.

 

Liath Dalton 

So takeaways: don’t use client testimonials! They just are not something that is congruent with the needs of the mental health profession and the ethical risks and the potential impact to trust and privacy and the therapeutic relationship really outweigh any marketing benefit. And sort of food for thought, and this isn’t just trying to put a positive spin on something that is limiting, but protecting client welfare and boundaries is part of your practice’s brand, right?

 

Evan Dumas 

Mhm, yeah.

 

Liath Dalton 

And it’s something that builds trust.

 

Liath Dalton 

So if every experience that a prospective client, and an existing client, has with your practice is sort of contained within a sense that their information, their confidentiality and privacy, is going to be safeguarded at every turn and not monetized or not exploited, is is going to help create that container for trust, which is really important.

 

Evan Dumas 

Mhm, yeah.

 

Liath Dalton 

So that’s, that’s the big, big takeaway, is that if you’re naming that in, in where clients and prospective clients are connecting with you that is going to be supportive of effective and sustainable marketing, that that translates to to the ROI that you want, which is that reputation and client trust.

 

Liath Dalton 

So hopefully this, this helped clear up some some misconceptions and dispel some of the myths, particularly around anonymity of testimonials, or if a clinician themselves is not directly soliciting them, what that, what that means, and what some viable alternatives are to using client testimonials.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Thanks for joining us, and we’ll chat with you good folks next week.

 

Evan Dumas 

Yeah, talk to you next week, everybody.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast, or click podcast on the menu bar.