Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I just keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.
This episode is brought to you in part by PAR.
The Personality Assessment Inventory Bariatric compiles the results of the PAI into a useful report for bariatric surgery candidates available on PARiConnect, PAR’s online assessment platform. You can visit parinc.com/products/pai-bariatric.
Hey everyone. Welcome back [00:01:00] to the podcast. Today, we are tackling one of the trickiest aspects of running a practice in the digital age—Google Reviews. Whether you love them or hate them, online reviews are a major factor in how clients perceive your practice, but as psychologists, we don’t have the same freedom as other businesses when it comes to managing them.
We’ll dive deep into the ethical and legal concerns of online reviews, including the APA guidelines that prevent us from soliciting them, we’ll also discuss how to handle negative reviews without violating confidentiality, strategies for getting them removed when possible and how to build a strong online presence that makes reviews less relevant in the first place.
Here are some other topics that we’ll cover: We’ll talk about why online reviews matter and how they impact potential clients’ decisions, whether you can or should ever ask for a review, best ways to respond to negative reviews and staying ethical and professional, how to optimize your Google business profile so that search results work in your favor, what to do when you get a false or [00:02:00] misleading review and how to fight it, which happens sometimes, and why focusing on referrals and SEO strategy may be your best long term solution.
So if you have dealt with negative reviews, we certainly have, this is the episode for you.
If you want some support with your practice, I would be happy to help you. My mastermind groups are full at this point, but I am doing one-off strategy sessions for folks who want to dive in for an hour and work through as many questions as we can or dive deep on a specific topic. It’s relatively solution focused. I’ll send you away with some pretty, hopefully, helpful tips and ideas to move forward. So if that sounds good to you, you can check out thetestingpsychologist.com/consulting and book a strategy session right from the website.
Alright y’all, let’s talk about Google Reviews.
Okay, [00:03:00] everyone. We are back and we are talking about Google reviews. I have a story and a half to start off this conversation. The half story is that first of all, our Google reviews are generally terrible. I think the average is about 3.8 stars, something like that. Our reviews are pretty much universally divided into either 1 star or 5 stars. So if any of you run larger practices or somehow get a lot of Google reviews, you maybe experience the same thing.
Just to set that out at the beginning to maybe normalize any experience, we have probably 25 or 30 reviews at this point. And like I said, they’re pretty evenly split between 1 star, which is largely folks who disagree with the [00:04:00] billing aspect of their evaluation and primarily, that’s insurance. They don’t understand what insurance means or how much they’re responsible for in spite of tons of communication from our practice, or 5 stars, and those are folks who love their evaluation and decided to let us know. So that’s the half story.
The full story that I’ll tell you is I had a coach, probably 5 or 6 years ago, Ken Clark, who some of you may know. He had a great response when someone asked, “What do you do when you get a bad Google review?” The first thing he said was, “Roll my eyes.” Since then, I’ve taken a little softer approach, but if that gives you any indication of how much we should truly care about Google reviews, then that provides a little context.
I am going to start this podcast talking about why Google Reviews [00:05:00] matter, but as an overarching theme for this discussion, just know, like I said, we have 25 or 30 reviews. It’s about 3.5 or 3.8 stars. We have plenty of business, that hasn’t affected us at all, but I would love for you to have a better experience with Google reviews and maybe learn to manage and respond to them appropriately.
So let’s start with why do Google reviews even matter? Well, because people use them. So here’s the reality. Online reviews are a powerful tool these days. I’m sure that y’all have used online reviews to look at restaurants, movies, experiences and any number of other things.
So that matches the research. Studies show that 84% of people trust online reviews as much as personal recommendations, and 90% of consumers read reviews before making a decision. This is 100% true for me. I will [00:06:00] research every decision to death, and reviews are a big part of that.
However, as psychologists, we cannot operate like restaurants or retail businesses when it comes to reviews. The dilemma is that if you’re a private practice clinician, you know that word of mouth referrals are your bread and butter, but what happens when a potential client googles you and sees a low star rating or a single bad review?
Even if you have years of experience and stellar credentials, that one review might be the only thing that they see, which just does not feel fair. But the challenge is that we’re ethically restricted from soliciting reviews and confidentiality prevents us from responding directly. So we’re going to dive into the nuances here and see if there is a little bit of room to navigate this tricky space.
First topic, can you ask for reviews? Well, [00:07:00] no, you can’t. Here’s why. If we look at the APA code of ethics, there are several principles that apply here. One is confidentiality, which is section 4: we must protect client information at all costs. Even acknowledging someone as a client via a thank you reply or a response to a review is a breach of confidentiality.
Section 3 talks about avoiding exploitation. So, asking for reviews, even from past clients might create undue influence. They might feel pressure to leave a review out of obligation, especially if there was a positive relationship.
This is where I got hung up. I went down this path of thinking, oh, with an evaluation, we don’t have an ongoing relationship. What if I just reached out to people who haven’t been seen at our practice in a year?
And as I dug into the [00:08:00] research, I’m sure you’ll get other answers. I’ve seen it in Facebook groups and whatnot. Some people are talking to their attorneys and their attorneys are saying, “Hey, it’s okay to do that. You can go ask for reviews from past clients in our situation.” But after doing a bunch of research for this episode, I landed in the opposite place. I think asking for reviews, even from past clients, is dicey.
The other part of the code that is relevant is Section 5, where we talk about advertising and public statements. So ethical advertising has to be factual and not misleading. So encouraging reviews or soliciting reviews from clients could theoretically create a biased representation of services. Interesting. So that’s the dark horse here. I would not have thought about that necessarily. Confidentiality, avoiding exploitation, makes sense, but the last one provides a little extra context.
So think about it, if you ask for reviews only from happy clients, [00:09:00] you are essentially creating a skewed portrayal of your services, which could be seen as misleading. What do you do instead? You could encourage professional colleagues to endorse your work, build credibility through community involvement and focus on SEO strategies to outrank third-party review sites.
So as we transition here, just to wrap up, soliciting reviews from past clients still presents ethical risks under the APA ethics code, and should be avoided, but there are some alternative strategies that could be ethically and legally sound. So let’s dive in here. Are there any ethical ways to request reviews?
Direct solicitation of clients is ethically risky, like we said, so here are some workarounds. One, you can solicit reviews from non-clients. So if you are out in the community and you [00:10:00] provide workshops, training or consultations to professionals, even parents or others in the community that are non-therapeutic, that do not run through the therapeutic or assessment aspect of your practice, you could ask for reviews about those services.
An example might be, you’re out in the community and you provide a talk for teachers on classroom management of ADHD. You could certainly solicit reviews from them after the talk and invite them to write a review on your Google My Business profile.
We’re going to talk a lot about your Google Business Profile, but that’s going to be a cornerstone of this approach. You want to make sure and have a Google Business Profile, and you can direct non-clients there to leave feedback on these educational or consultation services.
Another way that you can get feedback is to [00:11:00] create an anonymous feedback system. So instead of public Google reviews, you could do a private feedback form. This is essentially the approach that we have taken recently. So we have a Google Form that we send out automatically to clients after they complete their evaluation. This allows you to collect testimonials while protecting client confidentiality.
With explicit permission, you can display anonymous feedback. For example, “Parent of a 10-year-old child with ADHD,” rather than someone’s full name. And you can put that information on your website in a testimonial section. I have no problem whatsoever with an anonymous testimonial section on your website. I think it’s actually pretty helpful.
3rd strategy is that you could encourage referrals, but not reviews. So instead of asking clients for reviews, you could put a statement in your informed consent or even the evaluation or final [00:12:00] paperwork that you send people. Something like, if you were satisfied with our services, we’d appreciate you referring others who might benefit from an evaluation.
Keep it simple, keep it direct. It might feel a little salesy, but I’m a big fan of transparency the older I get. So I think you can say directly, hey, this is how our business runs. Word of mouth is really important. If you had a good experience, we’d love to help any of your friends and family that you think might be a good fit. So this avoids the public testimonials while still fostering that word of mouth growth.
The 4th strategy is what I would call passive encouragement. So what you can do is create a general review page on your website where clients voluntarily leave feedback without being asked. An example, follow-up email after you finish the evaluation. You can include something like, we’re always looking to improve. If you’d like to share your experience, feel free to provide [00:13:00] feedback here, and then you link to that site.
The key here is that it should be completely voluntary and non-directed. So you can’t say, would you leave us a Google review? It’s more like, help us get better. If you’d like to share your experience, go here. Again, this goes to your website. It does not go to Google Business Profile.
There is this question about third-party review sites. Google Business Profile is the main one that people are going to be looking at, but there are these third-party sites that aggregate reviews and will show up in search results. So I’m talking about Healthgrades, Vitals or RateMDs, not really talking about Yelp. That’s in there, but I feel like it’s declining in popularity, but they will automatically create profiles for providers and then allow clients to leave unsolicited reviews.
I [00:14:00] have reviews out there on a number of these sites. It’s frustrating because they automatically create profiles for you but here’s the ethical approach to handling these. Just make sure that your profile has accurate neutral information on it. Avoid soliciting reviews. If people leave them organically, that’s fine. And then do not respond publicly on these third-party sites because this can confirm their client status.
So all that said, what do we do with negative reviews in order to handle negative reviews? In order to handle negative reviews ethically, there are two components: One is a no response rule. I think engaging with negative reviews is usually a [00:15:00] bad idea.
And when I say engaging, I mean actually responding. We’ve already determined you can’t respond in any way that confirms that that individual is a client. There is always a confidentiality risk, even a neutral response can confirm that someone was a client if you give any indication whatsoever that you know them, you worked with them or anything like that.
So no response in my mind is always the best response, but if you do respond, you keep it very general. You do not confirm or deny the client status, obviously. You offer a direct contact option to discuss concerns.
An example, “Our practice values feedback, but due to confidentiality laws, we cannot confirm or discuss any client relationships. If you have concerns, we encourage you to reach out to us directly at the number or the email address.” [00:16:00] So if you have to respond, that’s an okay way to do it.
My attorney advised me to do something slightly different and I’ll talk about this in the section on optimizing your Google Business Profile to minimize the impact of reviews. What she advised us to do is to put a statement in the Google Business Profile that just generally states, hey, due to confidentiality laws, we cannot respond to reviews or solicit reviews. If you would like to get a sense of our services, please talk to our practice or look on our website for testimonials.
And this is almost the introduction text on our Google Business Profile. It’s a blanket statement that lets people know, hey, we can’t respond to reviews and we’re not even allowed to solicit reviews. So you’re going to see some negative reviews here, but just trust [00:17:00] we’re actually a nice practice and we’d love to show you how we operate.
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Let’s get back to the podcast.
All right, let’s talk about optimizing your Google Business Profile to minimize the impact of reviews. And then, [00:19:00] in a bit, we’ll talk about what to do if you get a false, misleading or unfair review.
Here’s the thing, with Google Business Profile, Google is going to prioritize active, well-optimized business profiles. And if you don’t know what Google Business is, it’s easily googled. You should have a Google Business Profile.
Here’s what you can do to help your practice stand out even without reviews:
1. Fully complete your Google Business Profile. That means address, services, website link, contact information, et cetera. It’s very easy to sign up.
2. You can use Google posts. These are weekly updates like blog links, FAQs or educational content. You can do a lot with Google posts and it’s pretty cool. A lot of people overlook it, but it’s an easy option to optimize your Google [00:20:00] Business Profile.
3. Add high quality images and videos. You could take high quality pictures. You can hire someone to come in. There are plenty of people out there who will take photos of your office space. So office space, team photos, you can post your headshots, workshop presentations.
Videos are great. If you, as the practice owner, want to make a short, less than 1-minute video that you can post to your profile, just describing your practice and what you do, that goes a long way.
4. Utilize the Q&A feature. There’s a Q&A feature on Google Business Profile. You can preemptively add common questions and answers, like, do you take insurance? What’s your wait time? What are your specialties? Who do you like to work with? Things like that. So you can preemptively add common questions and answers to your profile.
5. Build [00:21:00] citations on other professional directories. You can be active and do a Psychology Today profile, a TherapyDen profile, or even Healthgrades or RateMDs, those sites that I discussed earlier. You can proactively create profiles on those sites.
6. And then the last thing is that you can drive website traffic through search engine optimization. So blogs, resources, appointment links, that kind of thing. You can post all those things to your Google Business Profile and it will help optimize it and minimize the negative impact of reviews.
A lot of us, if you get a negative review, there’s always an outside chance that it is not correct, not fair or not accurate. I have a lot of stories of clients who just get upset and may or may not have even been seen by the [00:22:00] practice and they write a review.
So let’s talk about what to do if you get a false or unfair review. First things first, what counts as a fake, defamatory, or misleading review? A fake review is something like a review left by a competitor or disgruntled individuals who were never clients. An example might be a negative review from someone you’ve never seen that says, “They misdiagnosed my child.” So that’s a fake review, pretty straightforward.
A defamatory review is a false statement that damages your reputation. This would be a review saying, “This psychologist is a scam artist who lies on reports to help parents win IEP meetings.” This type of review might qualify for a legal removal request via Google, and I will talk through that policy here in just a second, but defamatory is going to make statements that damage your reputation.
This did happen to [00:23:00] me on a third-party site. I think it was RateMDs, but someone posted a statement saying, it’s so interesting. In the statement, they said, “I don’t know this person, but he’s running a practice that is taking advantage of individuals and billing them inappropriately.”
In this client’s case, they just didn’t understand the billing process and we billed them correctly, but here we are. So that threaded into the territory of defamatory.
The third option here is misleading or confidentiality breaching reviews. This will be something that whether the client actually contains or includes personal health details. An example would be like, I saw Dr. Sharp for an ADHD evaluation and they got my diagnosis completely wrong. In this case, you can also flag that [00:24:00] review citing confidentiality violations.
So here’s the thing. It’s going to be hit or miss as far as responding to anything that you flag. I think Google is often unresponsive and to be honest, your best bet is probably to bury the bad review by taking some of the actions that I described earlier rather than relying on the review getting removed.
Let’s close by understanding Google’s review policies and instances that might count to get them reviewed. First of all, here’s what will not get removed. Google will not remove reviews simply because they are negative, even if misleading or if you can’t verify the reviewer was a client. Google now [00:25:00] allows anonymous reviews and we can’t break confidentiality anyway.
What will Google remove? They will remove fake or spammy comments. So if they were left by bots, competitors or options like that, they are clearly fake. They will remove hate speech. So if there’s offensive language or discrimination in the review, they will possibly remove it.
They will consider removing irrelevant content. So this is something that’s not related to your business, but like a personal attack, for example. And then they might remove confidentiality violations. So if a review discloses a diagnosis or private health details, you might have a case.
So how do you do that? One, you go to your Google Business Profile and click reviews. You find the problematic review, and then there should be a three dot menu there and you can [00:26:00] select report review. You choose a violation reason like inappropriate content, fake, spam, or whatever. And then you ask colleagues, staff, or anybody you trust to also report the review because Google is likely to take action if multiple reports are filed.
If the review includes PHI, Protected Health Information, mention that in your report. So you can say, this review contains personal health details violating confidentiality laws. As a psychologist, I’m legally prohibited from responding and this review puts my practice at risk of violating privacy regulations.
So after you do that, what happens? Google may take weeks or just never respond. And if that happens, you can move to the next phase in the process. So you can escalate the review with Google support.
So if flagging the review doesn’t work, you can escalate it. [00:27:00] You can go to your Google Business Profile help center, click contact us, select reviews and photos, and then manage customer reviews. And then you request a call or a chat or an email response.
Once you get on the phone with them, just be professional, be concise, reference their review policies, especially if there’s PHI involved. Mention how you’re ethically restricted from responding, which makes the review unfair.
If this doesn’t work, you have one last resort, and that is legal removal. So if the review is defamatory, false, or violates privacy laws, you can file a Google legal removal request.
How do you do this? You go to Google’s content removal form. You select Google search and defamation of personal information. And then you have to clearly explain why the review is harmful, false, or problematic. And then if applicable, you can reference [00:28:00] HIPAA or the APA ethical guidelines.
This might work if the review contains PHI or private information, or if it’s clearly defamatory and harms your professional reputation. Some attorneys have had some success sending formal demand letters to Google, though that approach is slow and rarely guarantees removal.
All that said, is there a way to preempt future negative reviews? I think so. You can add a no online reviews disclaimer in your informed consent. Just saying to protect confidentiality, we do not request or respond to online reviews. If you have feedback, please contact us directly.
And then you can encourage positive reputation reviews without asking specifically. So private feedback through surveys, like I mentioned, workshops, build relationships with other professionals [00:29:00] and so forth.
There is a lot to take away here. This may be one of those episodes where you can check the transcript in the show notes, which will have links to each of the resources and sites that I mentioned.
So here’s the thing, don’t ask for reviews from clients. I think it’s ethically risky no matter how you structure it. I would not respond at all to negative reviews, if you do, keep it incredibly generic and don’t even address the client directly.
You can use your Google Business Profile to optimize your listing and direct traffic away from the negative reviews and rank higher in Google. And if you do get a negative review, there are lots of steps that you can take to try to get it removed or deal with it, or eventually just bury it with reviews from local professionals.
[00:30:00] I would not rely on Google to remove the review for you. It never happens. I think I’ve requested two or three times and just never heard back on any of them.Thank you as always for listening and Godspeed when it comes to online reviews. I hope that you never get a negative review, but if you do, maybe now you have some sense of how to go on.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.
And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind [00:31:00] groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a [00:32:00] substitute for professional, psychological, psychiatric or medical advice, diagnosis or treatment. Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.
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