Dean Levitt
Mental health professionals face unique ethical concerns when soliciting reviews or testimonials from clients. Balancing the need to promote their practice with maintaining confidentiality and professionalism is crucial.
Ethical concerns around soliciting reviews
Soliciting reviews from current clients can create a power imbalance in the therapeutic relationship. Clients may feel pressured to provide positive feedback, or they might even feel like their continued treatment depends on it. This can be particularly challenging for vulnerable clients who might feel compelled to give testimonials, even if they don’t feel comfortable doing so.
Furthermore, soliciting reviews may create an appearance of bias. Therapists could be seen as prioritizing self-promotion over client welfare, potentially undermining the trust that is so essential in a therapeutic relationship. When the focus shifts from helping clients to boosting one’s online reputation, it can harm both the client and the professional standing of the therapist.
HIPAA regulations and online reviews
The Health Insurance Portability and Accountability Act (HIPAA) establishes strict privacy and security standards for protecting sensitive health information. Soliciting reviews could lead to HIPAA breaches if clients’ protected health information (PHI) is inadvertently disclosed.
Public reviews may expose a client’s identity or relationship with the therapist. Even seemingly harmless details can sometimes be enough to identify a client, leading to unintended consequences. Responding to reviews could also inadvertently reveal PHI, as therapists might unintentionally share information that can be traced back to a specific client.
Related: HIPAA Compliant Email: The Definitive Guide
Here are a few examples of how PHI might be revealed in client reviews:
- Describing specific treatment details: A client may inadvertently disclose their diagnosis or therapy type, which could be considered PHI.
- Mentioning appointment dates or times: Sharing information about appointment schedules may provide enough context for others to determine the client’s identity, especially in smaller communities or specialized treatment programs.
- Revealing personal experiences: Clients might share personal stories or discuss their symptoms, which could inadvertently reveal their identity or disclose sensitive information about their mental health.
- Using their real name or recognizable username: Clients may use their actual name or a username that could be traced back to them, making it easier for others to identify them as a client of a specific therapist.
Soliciting reviews that lead to the disclosure of PHI is a violation of HIPAA for several reasons:
- Confidentiality: HIPAA mandates maintaining the confidentiality of PHI. Publicly available reviews can compromise a client’s privacy, as anyone can access the information.
- Unauthorized disclosure: HIPAA requires healthcare providers to obtain written authorization from clients before using or disclosing their PHI, except for specific purposes like treatment, payment, or healthcare operations. Soliciting reviews may not fall under these exceptions; thus, obtaining proper authorization is necessary.
- Minimum necessary standard: HIPAA also requires healthcare providers to disclose only the minimum necessary information when using or sharing PHI. Soliciting reviews that reveal more information than necessary, even with client consent, could violate this standard.
Privacy concerns
Confidentiality is a cornerstone of the therapeutic relationship, and breaching this trust can have serious consequences. Reviews, especially on public platforms, can compromise client privacy in various ways.
Clients may not fully understand the implications of posting reviews or the risks to their privacy. They might not realize that their comments can be traced to them or that their feedback can inadvertently reveal personal details. The potential for exposure can deter some clients from seeking therapy or fully engaging in the process, ultimately undermining the benefits of treatment.
Issues responding to existing reviews
Therapists may be tempted to respond to reviews, but doing so can be fraught with ethical and legal challenges. Responding to positive reviews may create the appearance of favoritism or even encourage other clients to leave similar reviews, further blurring the lines between professionalism and self-promotion.
Addressing negative reviews can lead to revealing confidential information. It’s easy to get caught up in the emotions of a negative review, but responding defensively can ultimately harm the therapist’s reputation and their clients’ trust. Staying silent on reviews can be frustrating but may be the most prudent course of action.
Professional organizations and their stances on reviews
Most professional organizations discourage soliciting testimonials from current clients due to potential conflicts of interest and power imbalances.
American Psychological Association (APA)
The APA prohibits soliciting testimonials in standard 5.05. They emphasize the importance of maintaining confidentiality and avoiding actions that could harm clients or exploit their trust “because their particular circumstances are vulnerable to undue influence.“
National Association of Social Workers (NASW)
The NASW cautions against soliciting testimonials in standard 1.07, saying, “Social workers should avoid posting any identifying or confidential information about clients on professional Web sites or other forms of social media.”
American Counseling Association (ACA)
The ACA advises against soliciting testimonials from current clients and those who may be vulnerable. However, they say, “if a client wants to give a testimonial, counselors should do their best to educate the client on the risks and benefits of doing so.”
American Psychiatric Association (different from the American Psychological Association)
While the American Psychiatric Association does not explicitly address soliciting reviews or testimonials, they do emphasize the importance of maintaining professional boundaries and ensuring confidentiality. They allow for indirectly asking clients for reviews, saying, “The Ethics Committee has opined that these solicitation practices are ethical so long as the same information and opportunity to comment is given to all patients without coercion, and no patient is directly asked to provide a review.”
Suggestions for ethically navigating reviews
Navigating the complex world of online reviews can be challenging for mental health professionals. Still, there are ways to approach this issue ethically and responsibly:
- Consult your professional organization’s ethical guidelines and relevant laws to understand the rules surrounding soliciting reviews.
- Prioritize client privacy and confidentiality when considering seeking or responding to reviews. Remember that even well-intended responses can have unintended consequences.
- Consider alternative ways to promote your practice, such as networking with other professionals, obtaining referrals from colleagues, or creating informative content for your website or social media platforms.
- If seeking testimonials, focus on former clients or those who have completed therapy and fully understand the implications of sharing their experiences. Ensure they are comfortable and willing to share their stories without pressure.
- Develop a strategy for managing online reviews and establish clear boundaries for engagement. This may include setting guidelines for when and how to respond to reviews or seeking professional guidance on handling specific situations.
Related: Six PHI pitfalls for therapy practices that put HIPAA compliance at risk
Soliciting reviews for mental health professionals can be a complex ethical issue, with concerns around client confidentiality, HIPAA regulations, and privacy. By understanding the guidelines set forth by professional organizations and adhering to ethical practices, therapists and counselors can navigate this issue while maintaining trust and professionalism in their approach.
