Modern Day Digital Revenge:

It has become quite common, in recent months, for me to receive a request for consultation with a therapist who has encountered a negative or toxic review on an online web site, such as Yelp.com or Angie’s List, by a current client or ex-client. Therapists often respond with shock, dread, disbelief and an understandable fear for the future of their reputations, practices and economic future.

Just as increasing numbers of consumers find and vet their therapists online, so can they write negative reviews when things go wrong. Whether the client was genuinely harmed due to sub-standard treatment, simply upset and looking to lash out, or the client is vindictively cyberbullying – the Internet is equal opportunity, and there are no fact-checkers.

The digital era brings increased connectivity with previously unknown people around the globe. From Amazon to Facebook to Yelp, people have the opportunity to write reviews, read and rate other’s reviews, and make decisions based on the experience of people they’ve never had contact with before reading the review. In practical terms, most people trust fellow consumers more than self-touting ads by businesses. After all, the businessperson is motivated to acquire and retain customers, while a harmed or discontent consumer is (theoretically or hopefully) motivated by a desire to protect others.

In the case of psychotherapy, counseling, or mental health services, this is a tricky area. Psychotherapists are bound by rules of confidentiality that don’t apply to clients. So if someone is upset about the course of treatment, they can post a negative review online for all to see – and the therapist cannot simply respond publically.

What psychotherapists can do in response to negative online evaluations and negative postings:

• Do NOT impulsively protest! If you respond impulsively the discontent client may use this to quote you or distort your communication. If you post online impulsively it can put you at risk of violating confidentiality, which can have legal and other ramifications. If the client is extremely upset, anything you do to resolve the issue may be made public and used against you. (If you choose to respond directly, after you have thought it through, carefully consider a polite phone call rather than a text trail.)
• Identify the nature, source and merit of the negative posting: Is the poster a current or former client, a client’s family, friend, colleague or enemy? Is the negative comment in response to a post you have made on the Internet, i.e., Facebook, professional blog, discussion group etc.? Is the complaint simply a personal opinion or does it contain incorrect facts, accusations, threats or liable-defamatory statements? Did the person use his/her real name or use a pseudoname? Bear in mind that review sites typically have no process for authenticating the people who sign up with them, and a review that claims to come from your client may, in fact, be written by someone else without the client’s knowledge.
• Consult with an expert: I have been teaching and consulting with many health practitioners on these issues for years Review my consulting page). You may also want to consult with an expert attorney or with an expert (not just anyone) from your professional organization.
• Bury unsavory content with positive views of your practice: The idea is to attempt to have your web site, blogs, LinkedIn profile, Psychology Today professional profile and similar sites appear at the top of a Google search for your name. In order for this approach to be effective you need to have excellent SEO and social networking marketing plans. Asking colleagues and supervisors (not clients!) to post positive evaluations on sites (such as Yelp.com) is a good idea even though evaluative web sites may not give it as much visibility as they do to negative evaluations.
• Respond strategically (and carefully) to liable postings or defamation: Principally, if the facts stated in the negative posting are factual incorrect and the posting may amount to liable or defamation you can contact web master, the web server and ask them to remove the posting. However, such actions may constitute violations of confidentiality laws. Pursing a legal action can make a bad situation worst. Besides being expensive, you may win the battle but loose the war. The potential negative public fall out of such litigation can be more harmful than the original postings.
• Shape your Yelp page. Yelp gives you the option to post info about yourself and create a professional profile with contact info, a mission statement, etc. This is free and easy to do.
• Ask colleagues and supervisors (not clients!) to post positive evaluations on sites, such as Yelp.com. If you have received unjust negative online reviews on web sites, such as Yelp or Angie’s List, ask colleagues, professors from graduate school, and friends to review you. Never ask a past, current, or likely future client to write a review. These professionals can write about your clinical skills, character, publications, contributions to the field, and integrity. Positive reviews help balance out the occasional negative one. Some experts argue that a few negative reviews may increase the credibility of the positive ones. While asking colleagues to post a positive review seems like a good idea, do not be surprised if Yelp takes these positive evaluations off the first page and leave the negative evaluation on. Sometimes Yelp ‘buries’ the positive evaluations on not-very-readily accessible pages. Some have argued that Yelp disqualifies reviews by reviewers who do not review more than 1 time. Along this lines, if you wanted your colleagues’ reviews to count, you would need to have them review other products, restaurants, etc., so that they would be seen by Yelp as regular, reputable, or credible reviewers. Some technical guidelines regarding this issue can be found here: Ethical Practice Marketing and Online Reviews: Getting Reviews From Colleagues.
• Do not Solicit Reviews/Testimonials From Clients; It is Unethical.

  The ACA, APA, and NASW codes of ethics all prohibit the solicitation of testimonials from clients:ACA Code of Ethics, 2014, C.3.b:

  Counselors who use testimonials do not solicit them from current clients, former clients or any other persons who may be vulnerable to undue influence.

  APA: Ethical Principles of Psychologists and Code of Conduct, 2016, 5.05:

  Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.

  NASW Code of Ethics, 2017, 4.07.b

  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.

• Consult with an Attorney. Consider involving legal counsel to advise you on your options. Sometimes a well-drafted letter from an attorney to either the web site or the poster is enough to get them to take down the posting.
• Contact an organization that may help you restore your reputation: Examples are reputationdefender.com or eff.org. These organizations can be very expensive and sometimes focus on the above mention approach of burying unsavory content with positive ones. In recent years, a whole new “reputation management” industry has spawned. Some companies in this emerging industry have been heavily criticized for falsely promising that they can remove bad reviews on business review sites, including Yelp. A review article on the topic by Wall Street Journal
• When appropriate, a sincere apology can resolve the problem. Refunds can also go a long way. Of course, make sure you do not admit to anything that can come back to haunt you. Also take into consideration that clients may use the apology as additional ammo to attack you further online. Consult with colleagues and experts, as necessary, to make sure that the apology or refund cannot be easily translated to liability.
• On some review sites you may be able to delete your existing profile, if it includes negative reviews, and create a brand new one a few days later. This may not possible with some review sites. If possible, it is a way to start fresh without the negative reviews.
• Some experts suggest responding to a negative posting with a statement, such as “Due to concerns of confidentiality and privacy, I cannot respond to postings by clients or even confirm a client’s status. I therefore encourage disappointed or upset clients to contact me directly so we can discuss possible remedies. It is important for me resolve disputes with integrity and fairness. Additionally, I encourage readers of this site to review my services on my website at xxx and my background at xxx.”
• Surrender: Once you have explored your options and slept on it for a few days and consulted with an expert, you may realize that while you can do some things to help your online presence and reputation, negative reviews are not the end-of-the-world and these kinds of things digitally and virtually happen all the time to the best of the best.

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Remember that a negative review is not the end of your career:

Modern day consumers know that not everyone is satisfied with their purchases or the services they receive all of the time. They know that negative online reviews are normal and expected. Modern day consumers may check the credibility of the reviewer and may check other negative reviews of the complainants on different review sites and find out if these reviewers post many (or only) negative reviews online. With enough positive reviews and available information on the web site and social media, a negative one will not give too many people pause. Some have argued that a few negative reviews can increase the credibility of the positive reviews. Yelp.com has posted a blog called The Positive Side of Negative Reviews, which discusses how a few negative posting may create a more realistic view of the business.

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The concerns with Yelp:

The two main concerns with Yelp are:
• Yelp has too much power to effect your reputation and business:
  If therapists do not have a web presence with their own websites or profiles on PsychologyToday and other sites, Yelp will dominate their Google and other search engine listings and has the power to hurt their business. Needless to say, therapists should focus on having a website with excellent SEO and other ways to increase their web presence (See, What you can do today)
• The concern that Yelp removes negative reviews in exchange for advertisements:
  Many websites, web postings, newspapers, and/or individual businesses have raised the concern that Yelp has been placing negative reviews more prominently (in front of positive reviews) and then removing in exchange for the business buying adverstisement on Yelp. For example, East Bay Express article titled “Yelp and the Business of Extortion 2.0” describes how “Local business owners say Yelp offers to hide negative customer reviews of their businesses on its website … for a price.” In 10/2011 a class-action lawsuit against Yelp, claiming that they had been removing negative reviews in exchange for advertising, was dismissed. Yelp denies these accusations and in their FAQs it states: “No. You can’t pay us to remove or reorder your bad reviews.”

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The Yelp Predicament: Confidentiality and related issues of therapists responding to client’ online negative postings:

• Responding to clients’ negative reviews requires serious consideration of issues of HIPAA law, confidentiality and privacy. When a patient posts a public review online, they have publically announced the professional relationship and, in fact, the relationship is no longer private. Such negative postings are a clear and irreversible acknowledgment that a psychotherapeutically-professional relationship exists. The question still arises, does a client’s public acknowledgment of the therapeutic relationship give therapists the right to openly respond, defend themselves, and acknowledge the therapeutic relationship?
• Keely Kolmes, Ph.D., one of the few experts on psychotherapists and social media, states in her blog that “clients have a right to disclose their relationship to us with anyone they choose, without a threat of our disclosing their health data.”
• Jeff Younggren, Ph.D., a consultant for the APA Insurance Trust and a highly respected forensic expert, writes insightfully on the topic in the above-mentioned blog:
  

  I think that there is a concept in the law called “inconsistent conduct” that relates directly to rights of confidentiality. That is, when a client’s conduct is inconsistent with an expectation that information be confidential, like not paying your bill, you have rights to proceed to collect the bill legally, which might be seen as a violation of confidentiality, which it isn’t. It might be unwise to do, but it is not a violation of the law. Perhaps the strongest example of this can be found in the exception to privilege where a client puts their mental health at issue in a legal proceeding. When this occurs, privilege has been waived. Now, whether an attack on the Internet of your reputation would be seen as inconsistent conduct is a legal question that has not been answered yet. While I think that such conduct does increase the right of the therapist to defend him or herself, one should really be careful here. I would think that a psychologist considering this would be wise to consult with an attorney experienced in mental health law before doing so.

• Some have suggested that therapists reply to negative reviews with “Please contact my office to discuss your concerns” or with “As a health care professional I cannot ethically reveal information about my clients, even to the point of neither confirming nor denying whether a person was ever my client. I am always willing to discuss clients’ reactions to our work together with them in person, whether favorable or negative.” These responses neither violate confidentiality nor HIPAA while giving clinicians ways to respond.
• Similarly it has been argued that contacting the site hosting the reviews and asking that a “malicious” or “threatening” review be taken down, for example, also would not violate confidentiality.
• There is also a concern that the posting was falsely attributed to a client, that in fact it was someone else. In this case, therapists acknowledging the confidential therapeutic relationship would be a clear violation of confidentiality.
• In Summary, like many digital ethics concerns, the issue of how to respond to negative postings is not resolved yet. To my knowledge, as of 2012, there are neither court rulings nor licensing board guidelines nor state regulations that help therapists be clear about their ‘rights’ to respond to clients’ negative online postings.

What you can do preemptively, TODAY:

• Sign up for Google Alerts to be notified of new online content about yourself. This will be a way for you to immediately be aware if someone posted any comment about you online. Be sure to create several, under different configurations of your name, specialty, and location. For example: “Dr. Ofer Zur”, “O. Zur, Ph.D.”, “Dr. Zur”, etc.
• Have a simple, well-written professional web site. This is where most people go first to get to know a therapist.
• Be present on social media (such as LinkedIn, FaceBook Fan Page, Google+) and therapist listing sites. Putting enough information about yourself online makes it easy for people to check you out themselves and make their own decisions.
• Shape your Yelp page. As noted above, Yelp gives you the option to post info about yourself and create a professional profile with contact info, a mission statement, etc. This is free and easy to do.
• If you’re on a review site, such as Yelp, ask colleagues, professors from graduate school, and friends to review you. Never ask a past, current, or likely future client to write a review. These professionals can write about your clinical skills, character, publications, contributions to the field, and integrity. Positive reviews help balance out the occasional negative one.
• Distribute a social media policy to clients that describes alternatives to posting online reviews. Keely Kolmes, PsyD’s social media policy includes an example of doing so.

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What you can do to try to prevent negative postings:

Remember the old saying that ‘an ounce of prevention is worth a pound of cure.’ The best way to keep disgruntled patients from posting negative reviews online is, if possible, not to have any disgruntled patients in the first place. Obviously, one cannot fully control whether discontented clients or patients would post negative online reviews. However there are several simple and doable measures that psychotherapists, counselors and mental health professionals can take to help prevent such negative online postings.

• Clients are often upset over issues around fees. Be highly flexible when it comes to dealing with clients’ debts and fee disputes. Whatever your policies, be clear and kind about implementing them. Sending clients to a collection agency can trigger negative online reviews and even board complaints.
• Be very flexible when it comes to cancellation policies. Articulate your cancellation policies in the Office Policies – Informed Consent form (available as part of Zur Institute’s Clinical Forms) and apply them kindly and generously.
• One of the most common areas of clients’ discontent in the 21st century are issues involved with child custody. Be extremely careful not to make custody recommendations unless you are a trained-certified custody evaluator and have followed the relevant protocols and professional guidelines for custody evaluation.
• Needless to say, be very careful with BPD and other personality-disordered clients.
• Review the Zur Institute’s summary of Where Are The Real Risks? and Ethical Risk Management article and summary.
• Consult with an expert on difficult cases so you are not blindsided or surprised when therapeutic ruptures take place and online negative postings follow.

Resources

Following are a few resources aimed to help therapists build up positive online presences:

Articles about Therapists’ Online Transparency and related topics:

• The Google Factor Psychotherapists’ Intentional & Unwitting Self-Disclosures On The Net
• Dr. Keely Kolmes’ article on The Yelp Dilemma: Clients Reviewing Their Therapists on Review Sites
• Therapists’ Transparency
• Cyber -Bullying

Blogs and discussion groups on the Yelp Dilemma

• Highly debatable and controversial topic
• Unfortunately, Reviews on Yelp Cannot Be Relied Upon for Vetting Purposes
• Ethical Practice Marketing and Online Reviews: Getting Reviews From Colleagues
• A Yelp Review is Not an Authorization to Release Client Information

Sample of online reports on lawsuits regarding online negative reviews:

Note: It is important to note that a therapist filing a lawsuit against a client who posted a negative or slanderous online review is not only very expensive but can also be harmful to the reputation of the therapist. It is also complicated regarding the issues of confidentiality, privacy and related matters.

• Court of Appeals Renders Opinion on Yelp Case in Sept/2014
  On September 2, 2014, in Levitt v. Yelp! Inc., the Ninth Circuit Court of Appeals affirmed a district court’s dismissal of a lawsuit brought by business owners against Yelp. Business owners alleged in the lawsuite that Yelp violated the law by extorting or attempting to extort advertisement payments from them by manipulating user-generated reviews and writing adverse reviews of their businesses on Yelp’s online forum. The Court of Appeals determined that the business owners did not adequately plead facts in their particular complaints to show “wrongful” threats to satisfy a claim of extortion for unlawful business practices under the Hobbs Act and California Law. It also found that the business owners did not adequately allege a claim of extortion since the alleged facts did not reveal that the negative reviews were authored by Yelp. Lastly, the Court noted that the alleged facts failed to show that Yelp violated the prohibition of unfair business practices under California Unfair Competition Law.
  Read the case
• A Doctor Sued A Patient For Posting Negative Online Reviews About Her Breast Augmentation
• New Orleans psychologist sues over negative Angie’s List comments
• Doctor sues patient over online review
• Posting Negative Reviews Could Get You Sued
• High court rules online posts didn’t defame doctor

Online articles raising concerns with Yelp practices:

• We hate Yelp
• Outsmarting Yelp – Yelp Sucks
• Class Action Lawsuit agains Yelp
• Businesses accusing Yelp of extortion lose another round in court
• Yelp’s Response to accusations

Yelp’s own response to critiques:

• Audio: Are Online Reviews Bad for Your Health?
• Responding to Reviews

Related Online CE Courses:

• Digital Ethics
• Self-Disclosure

 
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