When she was 16 years old and struggling with suicidal thoughts, Lizzie (not her real name) began seeing a therapist in her home state of Arizona. During weekly appointments, Lizzie told the counsellor about her "deep depression" and her previous attempt to end her life – desiring, as many do, to be as "open" as possible with her mental healthcare professional.
If you search this therapist online now, the very first thing you will see is a damning rating underneath his name. A single Google review has earned the therapist in question one star out of a possible five.
That review was written by Lizzie nearly a decade after she first visited this therapist as a teen. Now 25 and working as a stripper, Lizzie says dealing with this therapist made her "hesitant to ever seek help again" because it left her thinking "therapy was useless". Lizzie says the therapist laughed at her and was condescending to her as a teenager, asking her outright how bad a 16-year-old child’s problems could be before ending their sessions because he felt she was "fine".
Scrolling through poorly reviewed therapists can make online reviewing seem like a powerful tool.
"My mum randomly brought him up – I hadn’t thought about him in years – and while we were reminiscing, I felt a lot of old emotions resurface," Lizzie says when asked why she left a one-star review, nine years on. "I just didn’t want anyone else to get hurt. I didn’t want anybody to deal with the invalidation and embarrassment of pouring your feelings into someone who would be condescending about it."
Today, there is a host of ways for patients to critique mental healthcare professionals online, from Yelp or Google reviews like Lizzie’s to feedback left on specialist platforms like Zocdoc, Healthgrades or Vitals.com. It’s easier than ever for patients to make their opinions heard, meaning the industry is becoming more accountable. Which, when you think about how important therapy and counselling can be during a time of crisis, is a good thing.
Scrolling through poorly reviewed therapists can make online reviewing seem like a powerful tool – there is one counsellor and psychiatrist in New York with 27 one-star Yelp reviews who is described as "terrible", "awful" and a "public health risk". Reviewers report that she forgot their name mid-session, interrupted them and acted bored. "AVOID AT ALL COSTS," one patient wrote in February. Perhaps these reviewers could be saving other people not only from wasting their money but from putting themselves in a situation which could actually make them feel worse.
Yet while reviews like these are necessary in extraordinary circumstances, professionals claim that patient reviews can cause a number of problems in practice. In 2011, Bay Area psychologist Dr Keely Kolmes wrote an opinion article for The New York Times in which they lamented how online reviews harm both the health provider and patients. Not only can poor reviews damage a therapist’s business, they can also put off patients who might have otherwise found their ideal therapist, particularly as therapy is a highly emotional and personal experience.
Not only can poor reviews damage a therapist’s business, they can also put off patients who might have otherwise found their ideal therapist.
"I believe that in most cases, people are pulled to write reviews because they had a powerfully positive or powerfully negative experience," Kolmes says now. Kolmes explains that mental healthcare professionals aren’t ethically permitted to solicit testimonials from current clients, meaning reviews don’t often paint the whole picture. Additionally, it is tricky for professionals to respond to negative reviews. "The online review system poses unique challenges to healthcare providers who are bound by confidentiality and, therefore, cannot typically respond to the review in the same way another business can," Kolmes says.
Matt Lundquist, a psychotherapist who runs a mental health clinic in New York, saw his first negative review in December 2011. Immediately, he felt concerned for the patient, not his own business. "I was actually most concerned that a patient would feel they couldn't speak with me about a negative experience they'd had, meaning: what did that inability to raise this with me say about our treatment?" he says now. In the last 10 years, he's had four bad reviews, and has also dealt with malicious fake reviews from competitors. While he doesn't take bad reviews personally – "People feel hurt by and get angry at their therapists all the time – it's an important part of good therapy" – he's uncertain about the current reviewing model.
"Do I think the universe is served by bad therapists having bad reviews out there so potential patients can run away? Absolutely," he says. "But something about Yelp (and I'm not saying Yelp in particular is at fault here) seems not to work that way. I've heard horrendous stories from patients over the years about terrible therapists they'd worked with and not one has a negative review.
"I don't pretend to have the solution, but a tool that is designed to review dentists and coffee shops may not be the answer for something as intimate as psychotherapy."
Problems also arise when reviews are inaccurate or defamatory. Bruce Hillowe is a mental healthcare lawyer in New York who told the American Psychological Association in 2014 that he received "three calls a month" from "distraught" therapists who received negative online reviews. Hillowe says the number of calls remains the same five years on, and also reveals that he mostly hears from younger professionals. "They rely more on referrals from the internet than older folks who have established networks that are largely more personal and less electronic," Hillowe says. But do these young professionals actually have any legal recourse?
"It’s only possible to pursue anything legally if the patient has identified himself or herself, and they have stated as fact something that is falsifiable," Hillowe says, adding that viable defamation cases in this area are rare. It is equally rare for an online review service to remove comments, so Hillowe advises professionals to undertake their own patient outcome studies and publish these online to counteract negative reviews.
"Even if something is potentially actionable, you may make things worse rather than better, because some of these may end up being publicised if you attack a patient – people read newspapers, there’s almost no good possible outcome that can come of it," Hillowe says. In 2017, South Carolina psychiatrist Dr Mark Beale sued an anonymous critic who left him a one-star review on Google, and asked Google to unmask the reviewer. After the media picked up the story, people around the world flooded him with negative reviews – he now has 1.2 stars on Google from 169 reviewers. "He should have better empathy for his patients and be able to deal with his own hurt feelings," one writes. Another says: "He has no place being in a position of power if he sues people for a Google rating."
If I’m leaving a review, it’s because I feel like I’ve been wronged – deeply.
For Dr Sheri Jacobson, founder of HarleyTherapy.com, a UK-based platform that allows patients to book appointments with qualified mental health professionals, online reviews are imperative for "transparency". Harley Therapy has Trustpilot reviews embedded on its website. They’re the first thing you see along with a therapist’s credentials, and staff also respond to negative Google reviews, asking reviewers to contact the company personally so it can address any concerns.
"I really, really value these review systems because it gives clients a voice and pinpoints to us how we can improve constantly," says Jacobson. "We can’t change therapists’ personalities but we can certainly try and make a substitution."
Nonetheless, Jacobson notes that poor reviews can be upsetting for professionals who have no recourse to defend themselves. "Because of confidentiality, we can’t often address the points accurately, because we don’t want to expose the nature of the client’s issues," she says. "So for example, if one of the client’s presenting issues is impatience and anger, and then they blow up at us, it’s actually partially symptomatic – but we certainly can’t say that."
Lizzie says she initially felt "petty" leaving her review, but is now "proud" because "the public deserves the truth". Ayana, a 26-year-old marketer from Florida, also felt she had to leave a negative review of her psychiatrist on Zocdoc in 2016 in order to "warn" others. She saw the doctor in question for her anxiety and depression and while she did not have talking therapy, she relied on him to prescribe medication. After he became unreliable and cancelled a couple of appointments, she says she felt "defeated".
"I wasn’t in a super great place mentally, so not feeling like the doctor cared at all about whether or not I was doing okay was really rough," she reflects. "I remember when I booked him he had 4.5 stars, and I didn’t want anyone else to have to go through this. Because I did feel like he was dismissive of my symptoms and didn’t listen to me."
Overall, though, the area remains contentious, perhaps unsurprisingly, due to the sensitive nature of mental health treatment. Poor reviews continue to distress professionals; Dr Kolmes first began researching the area after stumbling across their own Yelp page in 2009, and continues to study it today.
Therapy is a highly subjective experience which, as anyone who has ever been through it knows, doesn’t always feel good at first.
However, in a recent paper that may relieve healthcare professionals, Kolmes surveyed 305 psychotherapy patients about their experiences looking up clinicians online. They found only a quarter of those surveyed looked at reviews, and that "most didn’t believe reviews had an impact on their feelings" regarding their psychotherapy.
Kolmes has since set up their own review system, Getting Better, which incorporates information about a patient’s number of sessions, the treatment they sought, and their experiences. When asked what patients who feel compelled to leave reviews should do, Kolmes adds that "a frank conversation" with therapists can also be useful for closure, and in extreme circumstances, patients can report professionals to a licensing board (although in these cases, you may have to reveal details of your therapy).
"This is a helpful finding because it may lay some providers’ fears to rest and it suggests a higher level of sophistication in psychotherapy clients’ ability to be discerning consumers and readers of online reviews," Kolmes and colleagues wrote in the paper. "Online reviews may not have the type of negative impact that psychotherapists fear."
Nowadays, we’re able to review absolutely everything and everyone with just a few clicks – but should we? While there can be no doubt that there are some substandard therapists out there, the truth is that therapy is a highly subjective experience which, as anyone who has ever been through it knows, doesn’t always feel good at first. It’s fine to review a restaurant after one bad visit, but is it okay to review a therapist after one session? As with therapy itself, there are a lot of personal and uncomfortable questions we must ask ourselves.
Lizzie has since visited another mental health professional and her faith in therapy has been restored. Ayana has also sought help elsewhere. "I know there are a lot of people who are just complainers, but I’m not someone who goes out of my way to leave a two-star review," she says. "If I’m leaving a review, it’s because I feel like I’ve been wronged – deeply."