The Reputation Risks Most Therapists Discover Only After a Negative Review Goes Unanswered

For most local businesses, responding to a negative review is straightforward: acknowledge the situation, apologize if warranted, offer a resolution. For therapists, that playbook creates a compliance exposure the moment you confirm the person leaving the review was ever in your care.

HIPAA's Privacy Rule (45 CFR § 164.502) prohibits disclosing protected health information without patient authorization. The identity of someone receiving mental health treatment is itself PHI. A response that says "We're sorry your experience in our sessions fell short of expectations" has just confirmed a treatment relationship—publicly, in writing, indexed by Google.

The APA Ethics Code adds another layer. Standards 5.01 through 5.06 govern public statements, advertising, and testimonials. Therapists may not solicit testimonials from current clients or from former clients who may be in a vulnerable position. This effectively rules out the most common reputation-building tactic used by dentists, lawyers, and nearly every other local service professional: asking satisfied clients to leave a review.

The result is an asymmetric challenge. Dissatisfied patients face no such constraints—they can write detailed, emotionally charged reviews freely. Therapists responding to those reviews must operate within a narrow compliance corridor.

This is not a reason to avoid reputation management. It is a reason to approach it with a clear, pre-planned framework rather than reacting in the moment. Therapists who have that framework in place respond consistently, calmly, and compliantly—and that consistency is itself a trust signal to prospective patients reading the exchange.

Educational note: The regulatory summary above reflects general interpretations of federal HIPAA rules and APA guidelines. State licensing boards may impose additional or conflicting requirements. This content is not legal advice. Consult a healthcare attorney and your state board for guidance specific to your practice.

Every response a therapist writes to an online review—positive or negative—should pass three tests before posting:

1. Does it confirm or deny a treatment relationship? If yes, do not post it.
2. Does it include any clinical detail, appointment reference, or identifying information? If yes, do not post it.
3. Does it represent your services truthfully and without misleading implication? APA Standard 5.01 requires that public statements not be false, deceptive, or fraudulent.

With those guardrails in place, compliant responses follow a consistent three-part structure:

Part 1: Acknowledge Without Confirming

Thank the commenter by first name if they used one, or address them generally. Do not reference the nature of your practice in a way that implies they were a client. Example: "Thank you for taking the time to share your experience."

Part 2: State Your Values

Briefly describe what your practice stands for—ethical care, responsiveness, patient-centered treatment. This reassures readers without engaging the specific claim. Example: "Our practice is committed to providing thoughtful, respectful care to everyone who reaches out to us."

Part 3: Invite Offline Contact

Offer a direct channel to resolve concerns privately. This demonstrates accountability without escalating the public exchange. Example: "We'd welcome the opportunity to address any concerns directly—please feel free to contact our office at [phone/email]."

For positive reviews, the same structure applies but the tone shifts. Acknowledge the kind words, reinforce a practice value, and express genuine appreciation. Still: no clinical details, no confirmation of the relationship, no specific service references that imply treatment.

Draft these responses in advance for the most common review scenarios—five-star, general negative, and specific negative. Having a pre-approved template removes the emotional pressure of writing in the moment after a critical review appears.

The APA's prohibition on soliciting testimonials from current or vulnerable former clients creates a real constraint—but it does not mean therapists must wait passively for reviews to appear. There is a meaningful difference between soliciting a testimonial and making it easy for patients to share their experience if they choose to.

Compliant review generation relies on passive facilitation: removing friction from the process without creating pressure or exploitation of the therapeutic relationship.

Intake and Discharge Touchpoints

At intake, a general notice that the practice is listed on Google, Psychology Today, and Healthgrades—included alongside standard paperwork—informs patients that reviews exist without requesting one. At discharge, some practices include a general statement: "If you found our work together helpful and feel comfortable sharing that, online reviews help other people find care." Whether this crosses into solicitation depends on the clinical context and your state board's interpretation—verify before implementing.

Optimize Your Profiles So Motivated Patients Can Find Them Easily

Many patients who would leave a review simply cannot find where to do so. A claimed, complete Google Business Profile with a direct review link (generated in your GBP dashboard) makes the action frictionless. The same applies to Psychology Today, Healthgrades, and Zocdoc—claimed profiles with complete information surface more easily in searches and lower the barrier for unsolicited reviews.

Excellent Care Is the Foundation

In our experience working with therapy practices, the most consistent driver of unsolicited positive reviews is not a tactical prompt—it is the quality of the administrative experience surrounding care: responsive intake, clear communication, easy scheduling, and prompt billing. Patients who feel respected before and after sessions are more likely to share that experience voluntarily.

Industry benchmarks suggest that service businesses with complete, active profiles receive meaningfully more reviews than those with unclaimed or incomplete listings—without any direct solicitation. For therapists, profile optimization is the safest and most sustainable review-generation strategy available.

Not all review platforms carry equal weight for a therapy practice. Monitoring and managing your presence across every possible directory is inefficient. Prioritize based on three factors: local ranking influence, patient discovery behavior, and the platform's credibility with your target patient population.

Google Business Profile

Google reviews are the highest priority. They display directly in local search results, influence Map Pack rankings, and are seen by patients at the exact moment they are comparing practices. A practice with more recent, substantive reviews ranks higher in the local pack than one with older or fewer reviews—all else being equal. Response rate and recency both appear to factor into Google's local algorithm, based on industry observation.

Psychology Today

For therapists specifically, Psychology Today's therapist directory often ranks on page one for searches like "therapist in [city]" or "anxiety therapist near me." It functions as both a directory and a content platform. Patients using it skew toward those actively researching—higher intent, more likely to convert. Reviews here carry strong credibility with mental health-oriented searchers.

Healthgrades and Zocdoc

Healthgrades is frequently consulted by patients who are insurance-focused or who found you through a referral and want to verify credentials. Zocdoc's review system is tied to appointment booking, which means reviews there come from verified patients—a credibility signal worth maintaining. Neither platform influences Google rankings directly, but both affect whether a patient who has already found you decides to book.

Yelp

Yelp's relevance varies significantly by market. In some metro areas it surfaces prominently for therapy searches; in others it is largely irrelevant. Check whether Yelp pages appear on page one for your target search terms before investing time there. Yelp's review filtering algorithm also tends to suppress reviews from accounts with limited activity—a frustrating reality for practices with genuine but infrequent reviewers.

A reasonable monitoring schedule: check Google and Psychology Today weekly, Healthgrades and Zocdoc monthly, and Yelp only when alerts fire.

Most negative reviews are expressions of dissatisfaction—frustrating but manageable with a calm, compliant response. A small number escalate into something that warrants a more deliberate protocol: a review that contains false factual claims, a coordinated negative campaign, or content that implies a HIPAA violation in the review itself (for example, a review that discloses details of another patient).

Step 1: Do Not Respond Immediately

The instinct to defend yourself publicly is understandable—resist it. A reactive response written under emotional pressure is more likely to inadvertently confirm PHI or make claims that violate APA advertising guidelines. Allow 24 hours before drafting any public response.

Step 2: Document Everything

Screenshot the review with timestamp before taking any action. If the review contains what appears to be a HIPAA violation (another patient's information disclosed by a reviewer), document this for potential reporting to the platform and consultation with a healthcare attorney.

Step 3: Assess Whether the Review Violates Platform Terms

Google, Yelp, and Healthgrades each have policies against reviews that are fraudulent, contain personal attacks, or violate privacy. If a review plausibly violates those terms, flag it for removal through the platform's reporting mechanism. Removal is not designed to and can take weeks—do not rely on it as your primary response strategy.

Step 4: Post a Compliant Response

Using the three-part framework described in the earlier section, post a calm, professional response. The primary audience for this response is not the reviewer—it is every prospective patient who reads the exchange afterward. A measured, values-focused response to a hostile review often builds more trust than a page full of five-star ratings alone.

Step 5: Consult Counsel for Defamatory Content

If a review contains demonstrably false statements of fact that are harming your practice, consult a healthcare attorney about options. This content is educational guidance, not legal advice—defamation claims are fact-specific and vary by state.

Online reputation and local SEO are not separate concerns for a therapy practice—they are the same concern measured in different ways. Google's local ranking algorithm weighs review signals including quantity, recency, rating average, and keyword relevance within review text. A practice that earns consistent, recent reviews outranks one that earned many reviews two years ago and has since gone quiet.

This creates an ongoing operational requirement, not a one-time project. The practices that hold Map Pack positions in competitive markets are not necessarily those that launched the most aggressive initial review campaign—they are the ones that have maintained a steady stream of authentic reviews over time.

Review Content Influences Keyword Relevance

When patients write reviews that naturally include phrases like "anxiety therapist," "CBT for depression," or "couples counseling in [city]," those terms contribute to Google's understanding of what your practice offers and where you serve. You cannot instruct patients to include specific keywords—that crosses into coached testimonials—but you can ensure your Google Business Profile and website clearly describe your specialties, which shapes the language patients naturally use.

Response Activity Is a Relevance Signal

Responding to reviews—even brief, compliant responses—signals to Google that the profile is actively managed. Industry observation consistently associates higher response rates with stronger local pack performance, independent of the review content itself.

For a deeper look at how review signals fit into a broader local SEO strategy for therapy practices, see our page on therapist SEO resources and the GBP optimization guide within that cluster. Reputation management within our therapist SEO services addresses how these signals are built and maintained as part of a coordinated practice growth strategy.