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Mental health-care law attorney Bruce Hillowe, JD, PhD, gets at least three calls a month from distraught psychologists and other therapists with the same crisis — a negative review about their services or practice from a patient on a Consumer Reports-style rating website such as ZocDoc.com, Yelp.com or HealthGrades.com.

Feeling powerless, they want to find out how to remove the comments before they scare off new or existing clients.

Psychologist and attorney Eric A. Harris, EdD, JD, of the Trust, a firm that insures psychologists, gets similar nervous calls from psychologists who also desperately want to tell their side of the story. "Some psychologists really want to respond," says Harris. "They really feel furious and betrayed. I understand it perfectly."

The concerns are so widespread that San Francisco psychologist Keely Kolmes, PsyD, who researches how psychology practice and social media intersect, has been asked to launch a support group for clinicians struggling with their negative online reviews. Lately, online review anxiety is the No. 1 reason psychology colleagues seek her expertise. "Psychologists are not used to having our private work discussed so publicly," she says.

But when it is, there are steps psychologists can take to preserve their professional reputation once the initial shock has passed, she and others say. One way to do that is to collect patient-satisfaction data from clients as they complete their treatment to post on your professional website to promote a positive online presence. It's also wise to reach out to colleagues who can help you process the emotional ambush. They might have been there, too.

Cease or persist?

Most of the time, there's no quick legal fix for a bad review, however unfair or nonsensical it is. Yelp, for one, won't remove a review unless it's required to do so by a judge or if the review violates its terms of service or content guidelines — such as by including hate speech or threats. A defamation lawsuit is only worth pursuing if the review reaches a certain level of maliciousness or deceit, says Hillowe, who has only had one client whose case qualified.

But there are other ways to handle a negative public review. Here's what experts recommend:

  • Step away from the keyboard. Feeling defensive is natural, but the smartest first step is ignoring the comments because acknowledging the therapeutic relationship violates patient confidentiality, says Harris.

Responding could also make the situation worse if the patient decides to strike back to get the last word, adds Harris. "You create controversy, which is what people are much more likely to focus on," he says.

Soliciting testimonials from other clients isn't an option either, says Harris, pointing to APA's Ethics Code. "That would be asking your client to do something to protect you, so it would extend the boundaries and be a conflict of interest for you."

A better approach is to establish a strong, positive online presence of your own, says David Ballard, PsyD, MBA, director of APA's Center for Organizational Excellence and a member of the advisory board for the Mayo Clinic's Center for Social Media.

"Rather than being forced into a defensive stance, take control of your professional image with regular postings to your blog, website and social media channels," says Ballard. "When you provide lots of good-quality Web content yourself, a negative review will get buried over time and will carry less weight as just one of many results that come up in an Internet search."

  • Explain why psychologists can't respond to reviews. For websites such as Yelp where you can edit the information in your business profile, Kolmes recommends educating consumers by noting on your profile that psychologists can't respond directly to a bad review because Health Insurance Portability and Accountability Act privacy laws and your duty to protect a client's confidentiality prohibit it.

Kolmes includes this disclaimer on her Yelp page: "Unlike other business owners who may respond to their Yelp reviews, as a psychologist I must provide confidentiality to my clients. That means I am restricted from responding in any way that acknowledges whether someone has been in my care."

She uses her Yelp page to spell out grievance alternatives for clients who are dissatisfied with treatment, such as speaking to her directly or contacting the state licensing board.

She goes a step further by linking her Yelp page to her professional website where she has client-satisfaction data she's gathered from people she's treated.

  • Do a self-analysis. View a negative review as free advice on how to improve your practice, says Div. 42 (Psychologists in Independent Practice) Past-president Steven Walfish, PhD, of The Practice Institute in Atlanta. Rating sites are a good reminder that psychologists are in a service business, he says.

"If there's one negative review, I would treat it, in my best cognitive therapy response, as a slight annoyance," he says.

Several negative reviews mean it's time to consult a trusted colleague about what you might do better, he says. Ask him or her to read the review and weigh in on possible solutions, such as reducing your caseload if patients say they feel rushed or spending more time educating clients about what they can expect from psychotherapy, he says.

  • Tap your clinical training. Reading personal criticism can test anyone's patience. Just ask Alex M. Siegel, JD, PhD, who, long before Yelp existed, experienced an online assault from a former client that went on for years.

"I was tempted, in the beginning, to respond and to clear my name and hire agencies to bury the content," recalls Siegel, who is director of professional affairs at the Association of State and Provincial Psychology Boards. Instead, Siegel stayed calm and hired an attorney to advise him. Doing so was particularly helpful when his former client contacted the governor's office when Siegel had been reappointed to the Pennsylvania state licensing board. Siegel stayed the course and sorted out the occasional professional nuisances, such as fielding concerns about the online comments from other clients, while protecting the patient's confidentiality. "It was the right choice," he says. "If you fall back on your clinical skills and clinical competencies, you can ride these things out."

  • Keep the critique in perspective. While it's hard to determine if and how a bad review could affect your practice, most experts agree that one negative review won't cripple it. "If you have a successful private practice, your best source of business is still [traditional] word of mouth referrals from satisfied clients and colleagues," says Harris. While research on how such online word of mouth websites are perceived by consumers is still lacking, one 2011 study published in the Journal of Medical Internet Research found that most patients rate physicians well on such websites.

Also, keep in mind that today's consumers are often savvy enough to ignore the outliers, says Kansas City, Mo., psychologist Ann M. Becker-Schutte, PhD, who is active on social media.

"Even when it comes to restaurants and clothing, I don't give a ton of credibility to the most glowing or scathing reviews," she says. "I am always looking for a global average and I trust most of the people who are going to work with me to be able to do the same thing."

While many of her clients have found her via her professional blog or Twitter account, only one client has found her via a rating site, she says.

  • Seek support. If multiple reviews coming in from the same person start to feel like harassment, consult your malpractice carrier's attorney, as well as colleagues with expertise in ethics and social media. It's also wise to seek out other clinicians to lean on, says Kolmes.

"Reconnect with former supervisors and other people who know and believe in your work who can be supportive," she says.