There is a particular kind of helplessness in reading something inaccurate about your work online and knowing that the information you would need to correct it is information you have a responsibility to protect. Your brain immediately starts composing a response: That isn’t what happened. There is important context missing. I could explain this. Then your professional obligations enter the conversation.
As a therapist, I understand why confidentiality matters. I believe in it. I also have a very human nervous system that does not enjoy being publicly misrepresented. Understanding the responsibility does not eliminate the frustration of being held publicly accountable for an account you cannot meaningfully address.
The uneven playing field
Online reviews operate on a familiar premise: someone describes an experience, and the business has an opportunity to respond. Readers consider both accounts and decide what they think. Therapy complicates that arrangement because the two parties have very different obligations about what they can disclose.
A reviewer can share information about their own experience. That disclosure does not automatically give a therapist permission to confirm a therapeutic relationship, discuss communications, or explain clinical decisions. Even acknowledging that someone received services can raise privacy concerns. The information that might clarify a dispute may be the very information the therapist must keep confidential.
The distinction matters: there is no universal rule that therapists can never respond to any review. A general response that protects confidentiality may be possible, depending on the circumstances and applicable professional requirements. But the detailed rebuttal a therapist most wants to write—the one that would actually address the inaccurate information—may be precisely the response they cannot provide. The American Medical Association explains this distinction: HIPAA does not categorically prohibit responses, but providers must protect patient information even when someone has already disclosed it publicly.
The consequences of crossing that line are real. In 2023, Manasa Health Center, a psychiatric practice, agreed to pay $30,000 and implement a corrective action plan to resolve federal allegations involving disclosures of patient information in responses to negative online reviews. The U.S. Department of Health and Human Services’ account of that settlement illustrates why a clinician’s impulse to explain can become a serious privacy problem.
So the therapist may remain quiet, and an online audience may interpret that quiet as agreement, indifference, or an inability to explain. What readers cannot see is the deliberation behind it: the decision to protect confidential information even when doing so carries a personal or professional cost.
“Just ask your happy clients for reviews”
This is standard reputation-management advice for other businesses. For counselors, it runs directly into ethical restrictions. The American Counseling Association’s Code of Ethics prohibits soliciting testimonials from current clients, former clients, or others who may be vulnerable to undue influence. ACA discusses the standard and its implications in “Ethical pitfalls of online testimonials and reviews.” Different mental health professions have their own codes, so the precise requirements vary by license.
There are good reasons for these restrictions. A client should never have to wonder whether their therapist wants public praise or whether declining a request might disappoint someone whose support matters to them. Therapy already involves vulnerability and an imbalance of professional power. Clients should not have to navigate an additional question about whether helping market the practice is somehow part of maintaining the relationship.
Even without a request, someone may feel deeply grateful for therapy and have absolutely no interest in attaching their name and photograph to a public statement about receiving it. They may be comfortable discussing therapy with friends but uncomfortable making that information searchable by employers, relatives, acquaintances, or strangers. Privacy does not necessarily indicate shame; sometimes people simply want their personal lives to remain personal.
That means a practice’s reviews are a self-selected collection of public accounts. It would be inaccurate to assume that only unhappy people post, but it would also be a mistake to treat those who post as representative of everyone who receives care. A handful of highly visible reviews cannot establish how an entire caseload experiences a therapist’s work.
Criticism still deserves to be taken seriously
Therapists can cause harm. Practices can mishandle communication, billing, boundaries, and access. People deserve ways to describe those experiences and hold professionals accountable, especially when raising a concern directly feels unsafe or has already proved unhelpful. A negative review should never automatically be dismissed as evidence that someone is unreasonable, unstable, or unable to understand therapy.
At the same time, an inaccurate statement does not become accurate because it appears beside a star rating. Readers generally do not have access to the information needed to distinguish among a factual error, a misunderstanding, a difference in perspective, and a legitimate account of harmful care. The intensity of a review cannot resolve that uncertainty, and neither can the absence of a response.
There is another ethical trap here: implying that a reviewer must have been angry about an appropriate clinical decision. Even when discussed in general terms, that explanation can become a convenient way to discredit criticism without examining it. Clinicians need room to acknowledge that inaccurate reviews happen while remaining willing to consider whether a complaint reveals something that needs attention.
The emotional work nobody puts in the job description
When your work depends on trust, public misrepresentation can land hard. You may worry about someone who needs help reading the review and deciding not to reach out. You may worry about existing clients questioning your integrity. You may find yourself rereading the same sentences long after you have stopped learning anything from them, as if the next reading might somehow produce an available response.
Then comes the second layer: the expectation that, as a therapist, you should be especially good at tolerating all of this. You understand emotional regulation. You help people work through shame, uncertainty, and the desire to be understood. Surely you should be able to close the browser tab and go about your day.
Unfortunately, professional training does not remove the human desire to say, Please get the facts right. You can be willing to examine your mistakes and still feel angry about an inaccurate accusation. You can respect someone’s right to speak and still wish the platform offered a fairer process for evaluating disputed claims. The responsibility is to manage those feelings without making clients responsible for soothing them or defending your reputation.
Google’s process leaves a gap
Google allows businesses to report reviews that violate its policies and offers a one-time appeal for eligible removal decisions. Its review-removal guidance also states that disagreement or dislike is not sufficient grounds for removal and that Google does not get involved in conflicts between businesses and customers.
That creates a difficult gap for healthcare professionals. A disputed public account may remain visible while relevant information is confidential. A therapist cannot assume that submitting clinical details to a platform’s review process is permitted simply because those details might support a removal request.
I would like platforms to take this problem seriously. A process designed for a restaurant disputing a complaint about a reservation does not adequately account for a clinician’s obligations around protected health information. Improvements worth considering include:
Clear explanations for readers that healthcare providers may be unable to address specific allegations because of confidentiality.
Dispute procedures designed around healthcare privacy, with clear limits on what information providers should submit.
Better ways to evaluate demonstrable factual errors without requiring disclosure of treatment information.
Consultation with patients, privacy experts, and clinicians about how to preserve accountability while reducing avoidable harm.
Allowing certain healthcare practices to disable reviews also deserves discussion. There is a legitimate concern that doing so could remove a valuable avenue for reporting harmful care. That concern needs to be considered alongside the limitations of a system that publishes allegations while constraining one party’s ability to address them. Patients need a voice, confidentiality needs protection, and platforms have a responsibility to think carefully about how their design affects both.
What I hope readers understand
Reviews can provide useful information, particularly about recurring concerns with communication, accessibility, or administrative practices. They can also leave important questions unanswered. When choosing a therapist, consider reviews alongside qualifications, areas of competence, practice policies, and your own experience during a consultation. Ask questions about the things that matter to you, including how the therapist handles concerns or disagreements.
A therapist’s silence does not verify an accusation. A high rating does not guarantee good care, and a low rating cannot tell you everything about someone’s competence or integrity. These are limited pieces of information being asked to carry substantial weight in a deeply personal decision.
If you are a therapist sitting with an inaccurate review, composing the response you cannot post, the frustration makes sense. Protecting confidentiality can require tolerating an incomplete public account of your work. We can honor that responsibility while asking platforms to build a process that better reflects the realities of healthcare.