Read This Before Yelping for a Therapist

Would you use a rating website to pick a partner?

We live in an age where computers (including our phones) are portals for more and more things that we used to do through direct human interaction. The benefits are obvious, which is why so many apps and services have propagated like wildfire. The downsides are more subtle but worth thinking about. I worry that our very capacities for relating to each other are being eroded as children grow up increasingly mediating so much through technology, but that’s for another story.

One area where I think this is particularly important is psychotherapy. Therapy is first and foremost a relationship. While most service relationships involve degrees of trust, psychotherapy is deeply dependent on trust. It is perhaps one of the most personal choices one can make.

In finding a therapist you are asking someone to help you with your very essence: what makes you you, with all your joys, faults and secrets.

It is intimate and private, and like any serious relationship takes time to develop and deepen. It involves that sometimes very delicate balance of being accepted and understood, yet coaxed just enough to grow, learn, and stretch your comfort zones. And more than almost any other relationship, how you respond to the therapist becomes an object of focus itself, as this can be fertile ground for learning more about yourself.

Don’t get me wrong about Yelp. We’ve found some great restaurants in unfamiliar towns with Yelp (though sometimes you do have to consider the standards of the raters). And my son found a smog station with strong Yelp reviews which diagnosed a problem with the car that expensive mechanics hadn’t figured out in over 5 years.

In the online therapy-search realm, let me contrast listing services and rating services. Listing services, like Psychology Today, are less problematic, though it can be challenging distinguishing between similar descriptions of therapists. What I’ll be addressing here are the rating, or review sites, with Yelp being the most prominent and commonly used.

Testimonials for psychotherapy — an essential feature of rating sites — are considered ethically questionable by mental health boards for substantial reasons.

For starters, there is the confidentiality issue. Since therapy is such a private matter, many people would prefer not to publicly air their experience of therapy, so many viewpoints about a particular therapist may not even be represented. People may be able to make testimonials and ratings anonymously (though sometimes involving convoluted workarounds), but then the authenticity of those statements becomes more questionable. And of course the genuineness of any rating or testimonial is difficult to determine for similar reasons.

Another ethical consideration applies to what kinds of pressures may have been exerted on a therapy client to provide a review, and especially a positive review. One of the key virtues of therapy, which separates it from other relationships like friendships or partnerships, is that the therapist strives to minimize his or her own self-serving needs or demands on clients. This allows the client to be as free as possible to attend to their own experience without having to worry about the other person. If a therapist pressures a client for a testimonial, even subtly and even at the end of therapy, it could taint the therapeutic relationship, and even the gains of therapy, by creating a sense of unwanted obligation in the client. In addition to possibly polluting the relationship retrospectively, it could further prevent the client from returning to the same formerly trusted therapist at a later time of need, due to that subtle shift in the expectations of the relationship.

Public testimonials can also create unrealistic expectations of therapy, especially when clients feel a responsibility to give “rave reviews,” which is one currency of the online review environment.

Therapy can definitely change lives, and sometimes dramatically. However, a one or two paragraph review in praise of the therapist is bound to be an oversimplification, and can make it sound like there is little effort, difficulty, or time involved in the therapy, which is rarely the case for significant and lasting change.

A certain amount of discomfort, sacrifice, and challenge is normal in therapy. While therapists try to titrate and work through these more difficult parts of the experience, things are not always predictable and a person’s ability to persist and trust the process may not prevail. This can occasionally result in clients leaving therapy precipitously, before they have a chance for repair, or even before being able to say goodbye in a more measured way. Rather than working it out with the therapist, a client in that situation may instead choose to vent their experience via a negative review. This again will almost certainly be an oversimplification.

Of course there are bound to be cases in which therapists did not handle the situation as well as they could have, but on reading a review it may be hard to distinguish meaningful complaints from more subjective ones. This is true to some extent for all reviews, but I believe there is more potential for destructive reviews of therapists both because therapy can be a very subjective experience and because the emotional stakes are higher. (For serious breaches of therapeutic responsibility there are formal channels of reporting, such as state licensing agencies).

Another problem is that many therapists avoid online review sites for these reasons or from other ethical concerns.

According to a poll conducted by Psyched In San Francisco in 2015, almost half of the therapists that responded said that they refused to participate in review sites. So relying on those sites alone could eliminate one out of two therapists from your consideration. Furthermore, many of the most experienced therapists don’t need online or review-site exposure since they have established practices. By using these sources one could easily be missing some of the most qualified practitioners.

Though certainly fraught with their own problems and shortcomings, online dating and apps like Tinder have become major breeding grounds for relationships — close to the same rate as meeting through personal connections. These are equivalent to the listing sites for therapists. But would you start a relationship with someone based on online ratings and testimonials from strangers? Maybe that day will come, but I for one, am not looking forward to it.

Consider the old-fashioned way: word of mouth. This might mean risking a little more vulnerability, but people who care about you will appreciate your reaching out for help. And people you trust are more likely to recommend a therapist that you would trust also. If you know someone who is or has been in therapy you can ask them for a recommendation, especially if they’ve had a good experience. If their therapist isn’t right for you, or you don’t want to see the same person, maybe the therapist can recommend some others. A trusted internist or family doctor may also be able to give you some referrals.

Thanks for reading! If you found this helpful or interesting please ❤ below.

Robert Solley is a psychologist with a private practice in Noe Valley, San Francisco

Image Credits: Talking to Bob Newhart, Frowny Guy, Kids Whisper