Sites like Yelp, HealthGrades, and Angie’s List present problems for mental health professionals. We typically cannot solicit testimonials from clients, so most clients do not write reviews. When someone does, though, any response risks breaching confidentiality. So therapists usually stay away from review sites. But that leaves us with little recourse in the event that an online review is harsh, incorrect, or even fake.
These concerns are not merely theoretical. In a 2015 disciplinary case out of California, a therapist attempted to defend himself against what he considered false accusations in a Yelp review from an angry client. The therapist responded to the review, but then changed his mind, and took the response down. By the therapist’s report — and there is no evidence that either the client or the licensing board disputes this — his response to the client was online for no more than three to five minutes.
When you post a review on Yelp, the site offers to automatically email you if anyone posts a response. While this is not clarified in the public documents available about the case, the client may have selected that option. However it happened, the client obtained the therapist’s response, and it became the basis of a licensing board complaint. The therapist was ultimately ordered to pay a $750 fine for violating confidentiality (and for briefly practicing on a delinquent license).
There are two notable conclusions to draw from this case:
1. Responding to an online review can violate client confidentiality.
This is true even when the client says in their review that they are a client. In doing so, they do not give you permission or legal authority to publicly discuss their case. Therapists struggle with how to handle review sites for precisely this reason. Even if you responded only to reviews posted by non-clients, that arguably would imply that those reviews to which you did not respond were clients. Having any kind of presence on these sites without risking confidentiality violations is challenging.
2. Even after a violation, mitigating the damage can lessen the punishment.
It clearly mattered to the Board of Behavioral Sciences that the therapist involved took steps to minimize the damage done, even after having committed violations. He thought better of responding to the review and took it down immediately. Few if any outsiders likely ever saw it. He also immediately paid his renewal fee and contacted clients to arrange for continuity of care upon recognizing that his license was delinquent. The penalties in this case could have been much more severe, and the fact that they were not indicates that the Board valued the steps the therapist took even after the violations took place.
That first conclusion is, to me, the most important. This will surely not be the last case where an online review of a therapist leads to a confidentiality violation. Staying away from Yelp and other review sites is problematic, but being on them is dangerous too. I continue to believe that the best solution, for therapists and our clients, is to lift the ban on soliciting testimonials. It would not have changed the outcome of this particular case. But it would dramatically change the landscape for therapists wrestling with how to handle their online reputations.