Can Therapists Ask Clients for Google Reviews? A Legal and Ethical Analysis
In an era where online reviews significantly impact business success, many mental health professionals wonder whether they can ethically and legally request Google reviews from their clients.
Unlike many other professionals, therapists (Licensed Mental Health Counselors (LMHCs/LPC), Licensed Clinical Social Workers (LCSWs/LICSWs), Psychologists, and Marriage and Family Therapists (LMFTs/MFTs) operate under stringent confidentiality requirements and ethical codes that govern virtually every aspect of the therapeutic relationship. The question of soliciting reviews sits at the intersection of modern marketing practices and traditional professional boundaries, creating a gray area that requires careful navigation. While most jurisdictions don't explicitly prohibit requesting client reviews, the practice must be carefully evaluated against existing legal and ethical frameworks.
Confidentiality
At the heart of any discussion about client reviews is the issue of confidentiality. State laws universally protect the confidential nature of communications between mental health professionals and their clients. The mere act of soliciting a review can indirectly acknowledge that a therapeutic relationship exists, potentially compromising this confidentiality.
For example, in Massachusetts, statutes such as G.L. ch. 112, § 135A emphasize the protection of client communications with very limited exceptions. Most state laws limit disclosure without written consent except in specific situations like imminent risk of harm or reporting child abuse/neglect. Even when the client has the choice whether to leave a review, the therapist's request itself may cross confidentiality boundaries. When a therapist asks a client for a review, they're evealing that a professional relationship exists, something that clients have an expectation will remain private.
Ethical Codes
Beyond state laws, mental health professionals are governed by ethical codes established by their professional organizations. These codes provide clear and often strict guidance on soliciting client testimonials and reviews.
National Association of Social Workers (NASW)
The NASW Code of Ethics addresses testimonials in Standard 4.07(b), stating: "Social workers should not engage in solicitation of testimonial endorsements (including solicitation of consent to use a client's prior statement as a testimonial endorsement) from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence."
This standard explicitly prohibits social workers from soliciting testimonials from current clients. Additionally, Standard 1.07 cautions against posting any identifying or confidential information about clients on professional websites or social media, which extends to the context of online reviews.
American Counseling Association (ACA)
The ACA Code of Ethics takes an even stricter position in Standard C.3.b, which states: "Counselors who use testimonials do not solicit them from current clients, former clients, or any other persons who, because of their particular circumstances, may be vulnerable to undue influence."
This prohibition extends to both current and former clients, making the ACA's guidance one of the most restrictive among professional organizations. The code emphasizes that even if a client volunteers to provide a testimonial, counselors must educate them about the risks and obtain informed consent, ensuring the testimonial is accurate and not misleading.
American Psychological Association (APA)
The APA Ethics Code addresses this issue in Standard 5.05: "Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence."
Like the NASW, the APA prohibits solicitation from current clients but does not explicitly extend this prohibition to former clients. However, psychologists must still consider whether former clients might be vulnerable to undue influence at the time of solicitation.
National Board for Certified Counselors (NBCC)
The NBCC Code of Ethics provides specific timeframes in Standard 62: "NCCs shall not solicit testimonials from current clients or their families and close friends. Recognizing the possibility of future requests for services, NCCs shall not solicit testimonials from former clients within two years from the date of service termination."
The NBCC is unique in establishing a specific waiting period—two years—before counselors may consider soliciting testimonials from former clients. (Note: Some recent updates to the NBCC code extend this period to five years.)
These professional ethical codes share several common themes:
Universal prohibition on current clients: All major professional organizations prohibit soliciting testimonials or reviews from current clients without exception.
Vulnerability standard: The concept of "undue influence" is central—therapists cannot solicit reviews from anyone who might feel pressured due to their particular circumstances.
Power dynamics: Depending on the circumstances, the inherent power imbalance in the therapeutic relationship means clients may feel obligated to comply with a therapist's request, even when no obligation exists.
Importantly, these ethical codes apply regardless of state law. A therapist could be in full compliance with state statutes while still violating their professional organization's ethical standards, which could result in disciplinary action, loss of certification, or professional censure.
Additionally, some state regulations explicitly incorporate these ethical codes, essentially making them operate like state law. For example, regulations governing licensed independent clinical social workers (LICSWs) in Massachusetts define “unethical or unprofessional conduct” as “ . . . engaging in any course of conduct which is expressly prohibited, or which constitutes a failure to conform to: (a) any provisions of the Code of Ethics of the National Association of Social Workers, as adopted by the 1979 NASW Delegate Assembly and amended from time to time hereafter, to the extent that said provision is not inconsistent with federal or state law; or (b) any other generally accepted standard(s) of professional conduct”. See 258 CMR 20.00.
Advertising Laws and Marketing Regulations
Some jurisdictions have specific statutes governing healthcare advertising and marketing practices. Connecticut's Conn. Gen. Stat. § 53-340a, for example, prohibits the use of "runners" or intermediaries to solicit clients in certain ways, though it doesn't explicitly address client reviews. These laws aim to prevent deceptive or coercive marketing practices in healthcare.
While most advertising regulations don't directly address online review solicitation, the general principles apply: marketing practices must be truthful, non-coercive, and must not exploit vulnerable populations or professional relationships. Therapists must ensure that any approach to reviews complies with both the letter and spirit of these regulations.
Risk and Benefits
Potential Benefits:
Increased visibility and credibility for the practice
Helping potential clients make informed decisions
Competitive advantage in a crowded marketplace
Potential Risks:
Violation of confidentiality requirements
Ethical violations and potential licensing board complaints
Damage to the therapeutic relationship
Professional discipline or legal liability
Best Practices
Given the complex legal and ethical landscape, therapists should proceed with extreme caution. The following guidelines can help mental health professionals navigate this terrain:
Understand your specific code of ethics: Review the exact standards from your professional organization (NASW, ACA, APA, AAMFT, NBCC, or others) as requirements vary by credential and organization.
Never solicit from current clients: This is universally prohibited across all major professional organizations without exception.
Exercise extreme caution with former clients: Some organizations (like ACA) prohibit solicitation from former clients entirely, while others (like NBCC) require waiting periods of two to five years. Even where not explicitly prohibited, consider whether the former client might be vulnerable to undue influence.
Never respond to reviews: Responding to a review—even to say thank you—can confirm the therapeutic relationship and violate HIPAA and confidentiality obligations.
Post a policy statement: Consider adding a statement to your website and review platforms explaining that you cannot solicit or respond to reviews to protect client confidentiality.
Respect confidentiality absolutely: Never acknowledge a therapeutic relationship publicly or take any action that could identify a reviewer as a client.
Consider passive notification (with caution): Some therapists display subtle, non-coercive information about their online presence (such as "Find us on Google") without making specific requests. However, even this approach should be carefully considered against your specific ethical code.
Focus on colleague reviews: You can ethically request reviews from professional colleagues, referral sources, and others with whom you do not have a therapeutic relationship. These reviews can speak to your professional competence without ethical concerns.
Build your presence through alternative means: Invest in marketing methods that don't involve client solicitation, such as professional networking, educational content creation, community presentations, and referral relationships.
Document your approach: Whatever policies you establish, document them and ensure they demonstrate thoughtful consideration of applicable laws and ethical codes.
Consult your licensing board: When in doubt, reach out to your state licensing board for guidance specific to your jurisdiction and license type.
Seek legal counsel: Consider consulting with an attorney who specializes in healthcare law and mental health regulations for guidance tailored to your specific situation.
Jurisdiction-Specific Considerations
While the principles discussed above apply broadly, specific state laws and regulations vary. Therapists practicing in states like Massachusetts, Connecticut, Colorado, and others should consult their state's statutes governing mental health practice, confidentiality requirements, and professional conduct. State licensing boards can provide guidance on how general ethical principles apply to specific marketing practices in your jurisdiction.
If you're a mental health professional navigating the complex intersection of healthcare law, professional ethics, and business practices, our firm can help. We provide counsel on compliance, regulatory matters, and professional conduct standards across multiple jurisdictions.
Contact Lubeth & Saperstone, P.C. for a free consultation.
This article is provided for informational purposes only and does not constitute legal advice. The laws and regulations discussed may change, and their application depends on specific facts and circumstances. Mental health professionals should consult with legal counsel and their licensing boards for guidance on their particular situations.
