Therapist reputation management works differently from every other kind of practice. Your ethics code discourages asking clients for reviews, and HIPAA means you can't reply in a way that shows someone was your client. That leaves three jobs: reply safely when reviews appear, report the ones that break the rules, and build trust in ways that don't depend on clients praising you in public. This guide walks through each.
Why therapy is different: testimonials and the ethics codes
In most specialties, asking happy patients for reviews is routine. In therapy, the codes treat soliciting praise from clients as a risk to the clients themselves: they may feel unable to say no to someone who holds their confidences, and a public review tells the world they're in therapy.
What the codes say, word for word where it matters:
- APA Ethics Code, Standard 5.05 (opens in a new tab): "Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence."
- ACA Code of Ethics, C.3.b (opens in a new tab): "Counselors who use testimonials do not solicit them from current clients, former clients, or any other persons who may be vulnerable to undue influence. Counselors discuss with clients the implications of and obtain permission for the use of any testimonial."
- NASW Code of Ethics, 4.07(b) (opens in a new tab): social workers should not solicit testimonial endorsements from current clients or others vulnerable to undue influence, including asking consent to use a client's earlier statement as an endorsement.
- AAMFT Code of Ethics, 9.2 (opens in a new tab) (revised code effective January 1, 2026): marriage and family therapists "do not solicit testimonials or endorsements from current clients or from other persons who are vulnerable to undue influence."
The codes don't use the phrase "online review." A review you ask a client to post works like a solicited testimonial, so treat it as one unless your licensing board says otherwise. The ACA's ethics page (opens in a new tab) says the 2014 Code stays in force while a revision is prepared.
Can a therapist ask clients for reviews?
For current clients, the answer under all four codes is no. Beyond that, it depends on your license.
| Code | Current clients | Former clients | Others vulnerable to undue influence |
|---|---|---|---|
| APA (psychologists) | Don't solicit | Not named; judge vulnerability | Don't solicit |
| ACA (counselors) | Don't solicit | Don't solicit | Don't solicit |
| NASW (social workers) | Don't solicit | Not named; judge vulnerability | Don't solicit |
| AAMFT (marriage and family therapists) | Don't solicit | Not named; judge vulnerability | Don't solicit |
Two more limits apply to everyone. Google's contribution policy (opens in a new tab) says businesses may not "selectively solicit positive reviews," may not offer anything in exchange for a review, and may not discourage negative ones. And the FTC's final rule on reviews and testimonials (opens in a new tab) bans fake reviews, undisclosed insider reviews and incentives tied to a positive review; our summary of the FTC's fake reviews rule covers the details.
Clients may still post reviews on their own. You can't prevent that and shouldn't try. What you control is how you respond.
Replying to reviews without confirming a client relationship
Under HIPAA, information that identifies a person and relates to "the provision of health care to an individual" is individually identifiable health information (45 CFR 160.103 (opens in a new tab)). Thanking someone "for trusting us with your care" confirms they received care from you. So does disputing their account of a session.
How to reply, step by step
- Wait a day. A reply written while stung tends to say too much.
- Decide whether to reply at all. Silence is allowed, and for a vague or angry review it's often the safest choice.
- Write one reply that would fit any reviewer, client or not. No "your sessions," "your treatment," dates, diagnoses or names.
- Point offline. Invite the person to call the office, without suggesting you know who they are.
- Use the same wording for positive reviews. A warm "thank you for your session feedback" confirms a relationship just as much as a rebuttal does.
- Keep a record of the review and your reply under your practice's policy.
Illustrative example (reply from a fictional practice): "Thank you for taking the time to write. Privacy law and our professional ethics prevent us from confirming whether anyone is a client or discussing anyone's care. If you'd like to talk about a concern with our practice, please call our office manager at the number on our website."
Common mistakes
- Correcting the reviewer's version of events, which confirms there were events.
- Mentioning no-shows, billing disputes or "our records show."
- Replying from a personal account or signing with your first name, which makes it personal.
- Asking clients in session whether they wrote a review.
More reply templates across specialties are in our guide to responding to patient reviews.
Negative and fake reviews: reporting and removal
Google removes reviews only when they break its policies. Its Business Profile help (opens in a new tab) says "only those that violate Google policies are eligible for removal," so disagreeing with a review isn't grounds.
Reviews worth reporting include fake engagement, reviews from someone with a conflict of interest (Google's examples include current or former employment and other professional or personal affiliations, which can include a competitor), off-topic rants, and reviews that post someone's personal information. Note the last one: a review where a third party names your client can be reported to protect that person.
How to report a Google review
- Open your Business Profile, choose Read reviews, select the report option beside the review, pick the reason and send. Or use Google's Reviews Management Tool.
- Check the status in the Reviews Management Tool. Google says evaluation "typically takes several days."
- If the report is rejected, submit the one-time appeal from the same tool (up to 10 reviews at a time).
Don't fight back off-platform. The FTC's Q&A on the rule (opens in a new tab), in effect since October 21, 2024, says it bars unfounded legal threats, intimidation and certain false accusations used to suppress reviews. Don't bury a bad review with purchased or staff-written good ones either. Our guide to fake reviews covers spotting and reporting them.
This is general information, not legal advice. Confirm how it applies to your practice with a qualified advisor.
Building trust without client reviews
If clients can't be asked to vouch for you, your materials have to do it. Each of these shows fit directly:
- A bio in your own voice: license type, training, who you work with best and a real photo.
- A page per specialty that describes what therapy for that issue looks like with you.
- Published fees and insurance status, plus how a consult works.
- Fast, warm replies to inquiries, ideally the same business day.
- Professional signals that don't involve clients: specialty training, talks, articles, podcast interviews.
- Referral relationships with physicians, school counselors and colleagues, whose word can matter more to a prospective client than any star rating.
Your Google listing still matters even with few reviews: complete categories, hours, telehealth details and a link to your consult page. Our guide to Google Business Profile for therapists covers setup.
Directory profiles and AI assistants
Some people now ask AI assistants to suggest a therapist, and those assistants draw on websites, directory listings, Google profiles and reviews. With few reviews to go on, your Psychology Today profile and website carry more of the weight. Keep specialties, ages served, insurance and telehealth states identical across all of them.
Medfy doesn't run review requests or reputation management. Its free marketing audit reads public information only: it checks your Google listing, including the reviews visible to the public, scores it alongside your website, SEO, AI visibility, social and ads, and lists the top five fixes. For the full plan, see our therapist marketing guide.
Frequently asked questions
Can therapists ask clients for Google reviews?
Generally not current clients. APA Standard 5.05, NASW 4.07(b) and AAMFT 9.2 bar soliciting testimonials from current clients, and ACA C.3.b extends that to former clients. A requested review works like a testimonial, and posting one tells the world the person is in therapy. Google also bars asking only happy customers. Check your licensing board's rules before any review request.
How should a therapist respond to a negative review?
Calmly, briefly, or not at all. Never confirm or deny that the reviewer was a client, and never mention care, dates or details, because that can disclose protected health information. A short statement that privacy rules prevent you from discussing anyone's care, with an invitation to call the office, is enough. If the review breaks Google's policies, report it instead of arguing.
Can a therapist remove a bad review?
Only Google can remove a Google review, and only if it breaks Google's policies, for example fake engagement, a conflict of interest or posting someone's personal information. Report it from your Business Profile or the Reviews Management Tool, check its status, and use the one-time appeal if needed. Don't threaten the reviewer: the FTC's rule bars unfounded legal threats and intimidation used to suppress reviews.
Do therapists need reviews to get clients?
Not necessarily. Reviews are one trust signal among several, and therapists can't solicit them the way other businesses do. A specific directory profile, clear specialty pages, published fees, a real photo and fast, warm replies show fit directly. Referrals from physicians and colleagues build trust without any client having to go public about being in therapy.