It sounds like it would be great to get opinions from others when looking for a therapist, but there are a multitude of problems with using reviews and ratings on the internet.

A great many are fake. These could be fake negative reviews, from competitors, random trolls, or disgruntled personal contacts, or fake positive reviews put up by well-meaning but less-informed clients, or black-hat SEO contractors. The public seldom knows anything about the honesty and motivation of the reviewer. I regularly get emails like this one below.

In the mental health field, in addition to helping everyday people with everyday problems, I inevitably deal with all kinds of troubled individuals with all sorts of unfortunate history in very difficult situations. Obviously, I cannot guarantee ideal outcomes for all of them. As you might imagine, it is quite unrealistic to expect all clients to have the perspective to give unbiased reviews. In fact, the more challenging the clientele a therapist willingly takes on, the more likely they will not be satisfied. Thus, reviews will tend to penalize those therapists who work with those in greatest need.

Therapists are responsible for advocating for their clients’ best interests, building up their adaptive behavior, constructive thoughts, and helpful feelings through a secure therapeutic relationship. I ask my clients for private feedback on an ongoing basis. If a client is dissatisfied with a therapist, even if their sense of that seems quite unjustified and distorted, I have a duty to support that client with their feelings and help them work through and learn from them, as part of the private therapy. Simply rebutting a client’s views, especially in public, could be very damaging to the therapeutic relationship and is not ethical, even if the client has betrayed or hurt the therapist.

Clients posting reviews are risking the inadvertent revelation of confidential information about themselves, or even the therapist, so great caution is required. If clients mention specifics of their treatment, a reader may assume that would also be the way the therapist would (or should) work with them, and that may be quite mistaken because of variance between the cases.

On top of all this, clients have a paramount right to confidentiality from their therapists. Responding to the particulars of any public complaint is almost impossible without revealing personal details that the client may feel incredibly sensitive about, even if their identity remains anonymous.

Review sites do not give businesses the choice to remove some reviews and not others, since obviously that could be easily abused by the business. However, review sites also will not take responsibility to adjudicate disputes. Therefore, for a business to challenge a review would only give a sense to the public that there are differing but equally valid points of view, and this would very often be incorrect.

All this severely limits my ability to respond to any reviews, even if unfair or lacking perspective.

The recommended way for a business to combat negative reviews is to seek enough positive reviews to compensate for or overwhelm them. (This advice of course suits the sites publishing reviews, since it works to increase their market power.)

Yet, it is considered unethical for therapists to solicit reviews or testimonials from clients, since clients may feel pressured to provide a good review, feeling it could affect how they are treated by the therapist in future.

In the end, clients of course remain free to post reviews wherever they like. I thank anyone for their positive review, and regret I cannot respond publicly to any negative review, though I would very much like to hear from dissatisfied clients directly. I caution those looking at reviews not to assume that they are reliable indicators of a therapist’s quality of service.