Episode 142 - VBT Study Hall: Client Testimonials and Reviews

Social proof has become a crucial element of consumer decision making in the Internet era. So why don’t the vast majority of therapists ask their clients to give testimonials or leave reviews? We ponder the frustrating tension between psychotherapy ethics codes and literature on marketing in the 21st century, and we do our best to advise therapists about what to do in response to a bad online review.

Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Sentio Counseling Center – high-quality, low-fee online therapy in California with immediate availability for new clients.

Show Notes:

• Work and Identity in an Era of Precarious Employment: How Workers Respond to “Personal Branding” Discourse

• To Solicit or Not to Solicit? Key Issues to Consider Before Soliciting Testimonials and Reviews from Patients

• How Did It Go? A Comparison of Experience and Outcome-Focused Online Reviews on Treatment Expectations

• Change My Mind: The Impact of Online Client Ratings and Reviews on Perceptions of Therapists

• Yelped: Psychotherapy in the time of online consumer reviews.

• Digital Marketing Excellence: Planning, Optimizing, and Integrating Online Marketing

• The Truth About Using Testimonials to Market Your Practice

• Scope and Ethics of Psychologists’ Use of Client Testimonials on Professional Websites

• Navigating the ethics of soliciting reviews for mental health professionals

• Responding to a Yelp review can cost you

• Psychotherapists in danger: The ethics of responding to client threats, stalking, and harassment.

• New Orleans psychologist sues over negative Angie’s List comments

• Transcript

  Carrie Wiita [00:00:00]:

  Welcome to very bad therapy. A closer look at what goes wrong in the counseling room and how it could go better, as told by the clients who survived.

  Ben Fineman [00:00:09]:

  From Los Angeles, I'm Caroline Wiita. And I'm Ben Fineman legally encouraged to say that this podcast does not constitute therapeutic advice. but it will get interesting. Let's get started. Carrie, I know we've had some episodes lately that we've described as being controversial. At least the topics are controversial, and the emails we've gotten Something I've learned is that when we get angry emails from people, but they're on either sides of an argument, it makes me feel almost better than if it's just

  Carrie Wiita [00:00:44]:

  does that make sense? No. What do you mean? Wait. Like, yes. You feel like we've done a balanced job if we're if we're angering both sides of the aisle?

  Ben Fineman [00:00:52]:

  Kind of, like, with the the most recent episode about, like, can evangelicals be ethical therapists? We got an email being, like, how how dare you call out Christianity. Right? And then we also got an email being, like like, obviously, this is not okay. Right. And there's something this may sound strange, but that's something that feels good if we are getting negative feedback from people. But we're kind of in the middle of the, like, the stream perspectives that are being thrown at us? Yeah. I think that that's I no. I I'm right there with you. Okay. I I feel like we've done a good job if both people are angry at us Yes. Yeah. And I feel like that's a lot of the the, quote unquote, controversy that we've invited recently is -- Right. -- a nice a nice balance of disagreement. Yeah. I have a sense that that that run of controversial episodes might be ending here because I I don't think this topic of testimonials and reviews is that controversial, but you can push back. Are you kidding me? And it's it's not as, like, evocative for people as as politics or as religion or as, like, the concept of trauma.

  Carrie Wiita [00:01:59]:

  Have you been opting out of the therapist Facebook group slightly?

  Ben Fineman [00:02:03]:

  I try I try to.

  Carrie Wiita [00:02:05]:

  No. I think that this is, like, one of the most hot button issues. in therapy land today.

  Ben Fineman [00:02:12]:

  Interesting.

  Carrie Wiita [00:02:13]:

  Oh, yeah. I think there's a lot of judgment on both sides. which I get. I totally get it. Yeah. Wait. I'm so curious. Okay. If you don't think this is controversial, what do you think the, like, monolithic, like, attitude towards testimonials is? I think it maybe it's more where I'm coming from is more that it's not something that people incorporate into their identity.

  Ben Fineman [00:02:35]:

  it's not a controversial topic insofar as if we disagree with somebody's perspective, they feel personally attacked because we have like, I don't think there's any therapist or or, like, a client of therapy walking around that thinks to themselves, I feel so strongly about giving testimonials about therapy that I will, like, advocate tirelessly to get people to see that my perspective is right. I think people I disagree. Really?

  Carrie Wiita [00:03:00]:

  A 100%. I think this falls into the category of one of the things that is most central to therapist identity, which is either you fall into marketing for therapist is okay or marketing for therapist is not okay.

  Ben Fineman [00:03:15]:

  This this makes me realize that the research I did for this episode was about, like, the more concrete stuff, the nuts and bolts of it, the ethics codes. Yep. Like, research that's been done. And the research that you did goes more into, like, the what would you call it? Like, the the social sciences, like, how to use marketing and sales to influence perception, And I think the stuff I like that is maybe just more boring and uninteresting than when you looked at. So -- No. -- I feel more detached than you do about this. And you're like, oh, people care. Well, here's what I think. Here's here's why I think people care about it.

  Carrie Wiita [00:03:48]:

  And this actually leads me to one of my one of my favorite things, my favorite things that came up in in my reading for this was actually something that I read a long time ago for my thesis. So so the re the reason why this is interesting to me is because therapists, it's a very hot button thing. You either, like, just load therapist marketing. You hate other therapists who do marketing, you think it's, like, disgusting and craven and awful. Capitalized. Uh-huh. Exactly. -- serving and Self serving vanad. Yes. It's a vain thing to do. Yes. Exactly. Or you are a therapist. Like but this is like, I need to advertise my business. People need to know why I exist, and, like, this is what everybody else is, so I need to, like, tell people how else are people gonna find me. how are clients gonna find out therapists therapists can help, like, if we don't talk about it. And it's it's a tension that is It's it gets really vitriolic. And it becomes, I think, central to therapist identity, in large part, and I'm not gonna get into this in-depth But in large part, because our our whole field, from since its inception, wanted part of the therapist identity to be like, we don't need to ever ties. And what that is called in this in this study that I that I read, this was a study from sociology that was about how do workers respond to personal branding rhetoric And so this wasn't specifically about therapists. But it was a qualitative study, and so they did these deep interviews with people. In one of the people they interviewed, was the former director of a mental health agency. And they were just asking these people what they thought about about personal branding rhetoric. And and one of the quotes from this person was It's junk. It's just words as an employer. If somebody's resume was full of all this marketing hyperbole on the top of their resume, presenting their skills as if it was an advertisement, I'd probably laugh. I might look at their resume anyway, but I would think it would take away from my feeling about them as a professional. So this person just, like, really like that. The it's so stupid. I would laugh at it because that's not what it is to be a therapist. Right? Therapists don't market. That is something that is silly. Right? And the way that the authors of this paper described it is that the people who have how do they say it? Okay. The people who hate personal branding this much and refuse to engage with it in, like, a client way. Like, I'm not gonna do that. The people who did that were US employees whose backgrounds exposed them to occupation based norms, encouraging them to expect autonomy from market imperatives. Okay? And what that means is that there are these certain fields, these certain occupations where the culture of the field encourages the people in them to think that they can they should operate outside of what other fields need to do. Other people need to market in order to make their way in capitalism, but we don't have to. And this is what cultivates this attitude, and you see it on the therapist Facebook groups where people are like, oh my god. I would never ask my client for testimonial. How terrible? Who would do that? And the way they the the I love it in this. It's so snarky, but in this study, the authors mentioned that this this therapist, the former director of the mental health agency who was, like, so shitty about personal branding, they, like, slyly mentioned she'd been unemployed for months. The study mentioned that. Yeah. I thought there's, like, included that point. But that's I think that that's the tension. Right? It's like on the one hand, our field, there's this culture in our field that's like, you shouldn't do that. People there's there it's unethical. Right? Isn't that what everybody always says? And that's what we're gonna dig into. is, like, how how is it unethical? Is there an ethical way to do it? But it's unethical to solicit testimonials. You shouldn't do that. And then the tension is, as I will talk about, is that it's actually one of the most important pieces of marketing. and it's one of the things that consumers value the most. So therapists are put in this untenable position of, like, our sis our field is like, don't fucking do that. But then capitalism's all like you better do that if you wanna make money.

  Ben Fineman [00:08:06]:

  So can we define what a testimonial is in the context of like, therapist marketing. because I think what you were saying is right that this is a piece of therapist marketing. Yeah. But it's it's the most likely to piss off the people who have to do it because it extracts something from a client. And I think it can feel like that. Like, I'm using very biased language, describing it that way. but it's it's a kind of therapist marketing that is saying, I am going to get something from a client, and that just, for so many of us, goes against the feeling of what we're trying to do. It's it's like that same internal piece that feels uncomfortable saying, if it's okay with you, I'm raising my fees by $1 in 6 months, and I just wanna let you know if you have any problems we can probably just not do. It's it's that same piece for therapist that feels like we shouldn't take Yeah. From clients. Yeah. Yeah. Yeah. No. I think you're totally right. So the the definition that I wanna throw out there for testimonials comes from Camp, the California Association of Marriage And Family Therapy. And we're gonna come back to Camp because they might be the most progressive professional organization in this context of testimonials, and I would bet if, you know, we look 10 years into the future that Camf will have set a trend in terms of expanding what is allowed or even encouraged. So this is their definition. They say, generally speaking, a patient testimonial is a statement in which the patient describes their therapeutic experience with a particular therapist or their experience as a patient of a therapy practice or agency. Therapists typically use patient testimonials for marketing purposes, for example, a written patient testimonial appearing in print or web advertisements, a video recorded patient testimonial posted on a treatment center's website, etcetera. And so here, what they are describing is you are having a client you're asking a client to either give you something to use to then show to prospective clients Mhmm. Or if a client says something, you're saying, oh, can I use that, etcetera? Right. Then Camp's definition expands on this and says, alternatively, popular websites such as Yelp and Google allow people to post reviews detailing their experiences with businesses, including therapy practices and counseling agencies And then they, you know, they talk about the the rating system and blah blah blah. And then how patients often use these websites to publicly discuss their experience with their therapist. So this is less of a, like, therapist or organization led process where they are saying, give me a testimonial or if you don't mind, give me a testimonial. Right. But instead, this is something that is happening unbeknownst to the therapist often that a testimonial is happening because a client is saying, I want to go and publicly describe my experience so that other members of the public will know. Right. Now the last sentence when Canfor is talking about testimonials here is However, the practice of therapists soliciting reviews and testimonials from their patients presents multiple legal, ethical, and clinical questions for partitioners to consider. And there is a whole world of this, and it is I think, like, a lot of the things we dig into on these episodes carried surprisingly

  Carrie Wiita [00:11:05]:

  Yes. Absolutely. One thing I wanna add to this definition of testimonials, I I think it fits here, is that these are actually really important that consumers will say that they're very important. There's a study, Nettle Horse et al, 2022, This is citing research on health care providers and consumers. So 60% of health care consumers say that ratings that they find online are somewhat or very important when deciding on a health practitioner. So it's over half take they think that the ratings are are influenced their decision in some impactful way and that a third of sampled consumers reported that a glowing rating for a specific medical practitioner motivated them to seek their services, but about a third reported a lackluster rating would prompt them not to obtain their services. So it's very it's it's noted. It's like demonstrated that it's these are important when you're talking about mental health care providers. or medical providers. But there hasn't been a ton of research to, like, examine this for therapists specifically, But the the authors of this study say, arguably, the importance of such reviews would be magnified when seeking the services of a mental health therapist given the intensely per the personal nature of the therapeutic relationship. So there's there's some acknowledgment that these things, these testimonials have bearing in weight and maybe a critical part of the decision people make when they decide to find a therapist.

  Ben Fineman [00:12:38]:

  Okay. Since you're going there now, I I wanna skip ahead in my outline a little bit because I had some studies about client perspectives on these of testimonials or reviews? Like, how how does it influence their perspective? And so I pulled up the study because I wanted to make sure we weren't looking at the same one. 1 of the 2 I have is also this metal horse person, Steven C NettleHorse, but this is from 2019. And Yeah. It's the 2019 1. Yes. Some colleagues. Oh, so you found this as well? I did. Yeah. Oh, I didn't know. I didn't read that one. He siked it in his 22 article. Oh, so we're definitely gonna end up saying the same conclusions then because we're citing somebody who cited him self? Yes. The this study from 2019, they created a fictitious social media profile for a therapist. to then have members of the public review and see how do comments on this public profile influence their perception of the therapist. So they have, like, a social media profile. I don't know if that was like Yelp, Facebook, whatever. They put comments on there and then ask the participants of the study how did reading those comments, you know, social proof? How did reading what the public said about this fake therapist change your perception of the therapist? And it's unsurprising. and it feeds into what you were just saying that clients were were very much swayed, the the quote here was the results showed that the valence of the comments significantly affected participants' perceptions of the therapist for each outcome. So in other words, what a therapist puts online is maybe less important than what clients, people who have visited that therapist, are saying about them on their public facing pages. Right. And then there's a second study that NettleHorse did not have anything to do with. maybe he was, you know, on sabbatical that day. But this was a study that looked at it was a 131 respondents clients or potential clients of therapy who had left a review or found a review about a therapist. And the takeaway here for me is that If somebody is an active client of therapy and they see a review of their therapist online, they are much less likely to be swayed by what they see than if they are trying to find a therapist. So for example, I'm looking for a therapist. I see some bad reviews. I will say no. Thanks. I hear some good reviews. I might go and seek out this therapist. But if I've been working with somebody for a few months and then I come across reviews, it's not gonna have that much of an influence on it because I've already built my relationship with the therapist. So this is that, like, social proof, first impression, what you're taking in about this person based on what other clients of the therapist have publicly said, makes a big difference way more so if it's someone who's seeking out a therapist than if you've just already been working with somebody for

  Carrie Wiita [00:15:19]:

  Exactly. Exactly. Okay. Good. I wanna dive into this now. I wanna give, like, situate this in the under standing of consumer reviews that is not from our field. There's everyone knows in not in our understands that testimonials are critically important for both marketing and sales. And this is gonna explain why the studies that you just talked about, like, why this is. Right? So on the marketing side, testimonials are a part are are a form of of marketing kind of. Marketing can be described. There's 3 main, like, categories of it. Marketing includes paid media, owned media, and earned media. that. So paid media is like advertising. You pay for that marketing. Right? Owned media is stuff that you own, right, that you are in control So that's, like, your website, a a company's website, a blog, or the the social accounts, like an Instagram account. You own the content that you put on that. Nobody else can come in and, like, make a post on your Instagram feed, right, or on your Instagram account. Right? But earned media is includes engagement and word-of-mouth stuff like testimonials. So engagement, it's like, no one can post content on your Instagram account, but they can like They can comment. They can share things. And you don't have control over other users doing that. Right? And word-of-mouth. You can't control word-of-mouth. It's including stuff like testimonials. And it is commonly acknowledged that in earned media and and word-of-mouth is the most difficult media to get and it's also the most valuable. And it's because of what you're saying here that reviews are an evidence of social proof. That's what social proof is. it's society, other people are demonstrating, giving proof of their experience or what this company is. There's this idea that, like, advertising, marketing that the company puts out, whatever people want to say proactively say about themselves, in the world online, whatever, is less trustworthy than what other people are saying about that brand or person or whatever. Right? So that's, like, just in terms of, like, from a marketing perspective. But in when you're talking about sales, that's when this kind of social proof becomes super important. Therapy from a sales perspective is called a high involvement purchase. And so that's a high involvement versus a low involvement. A low involvement purchase is, like, buying a bag of chips. Right? Like, not a lot of thought necessarily goes into it. But a high involvement purchase is like a car or picking a therapist. So they have different models for for this, but, like, a general model of the customer journey when making a high involvement purchase is they start with a problem I identification. And, actually, there are there are studies in psychotherapy talk about this, but they look at it from, like, a clinical perspective. It's very interesting, and they haven't looked at it from, like, a business perspective, which is hilarious to me. But So first, they identify consumers identify a problem. Oh, I have this problem. I need to fix it somehow. Then they engage in an information search, So that's where they're, like, looking for solutions to this problem. Finally, they land on 1. In our case, it would be like therapy. Oh, I think therapy could help me with my problem. So then they start to evaluate the different options for solving this problem. Then they have to make a decision. They decide they they evaluate, okay. Like, is it Do I do therapy? Do I buy a self help book? Do I, you know, download an app? Whatever. But if they decided, okay. Talk therapy, that's what I That that's the one I want. Then they're looking at a decision, and they're evaluating their, like, their different options. They have to make a decision about a therapist provider, like, who they're who they're gonna hire. then they move into the action or buying stage. And then there is a stage after that called post purchase. And in, like, the regular world, like, not our world, There's an acknowledgment that, particularly for brands that have, like, multiple products, they wanna keep people buying their products over and over again, the post purchase stage is an important part of the buying thing. It's just as important as selling the product is what you do with the client or the customer after you purchase. It is completely acknowledged that at the heart of this any high involvement purchase is the social proof. is this stage where people who consumers are trying to decide what to do. They don't trust what we put out there as much as they trust what other people are saying about a brand or a product. That makes total sense. In in, like, a capitalist system, you you know that

  Ben Fineman [00:19:51]:

  some entity, some corporation, some some seller, is trying to give you value. Right? Because -- I mean, that is necessary to be successful if to deliver some value. Right. But they are, at the end of the day, focused on their bottom line. And so you have a healthy skepticism of, is this right for me, or are they just telling me it's right for me? Like, I think you you need that filter in your brain to function in in this version of society or else whoever has the largest and most spend at, like, the loudest voice and the most money pumped into it would just win every election get all the business. because you wouldn't have any yeah. You you'd be like, well, I'll just I'll just go along with this. Right. Exactly.

  Carrie Wiita [00:20:35]:

  And so there's there's this is, like, completely acknowledged. Right? And so there have been plenty of studies. Now, again, this is not in therapy land. but, like, commerce. Their studies have found that increases in the sheer number of reviews has a direct correlation with increases in sales. So the more reviews that are out there, the better sales are. Right? And I thought that this was so interesting. There was this one research firm that demonstrated that increasing the number of available reviews from 0 to 50. And, again, this is for product sales, but still from 0 to 50, increases the general conversion rate from 2% to 4%. Does it sound like a lot? But when you think about, like, the number of, you know, leads you have to have in order to convert, like, a certain amount of of those into a sale. That's pretty significant. That's doubling. the conversion rate, right, from 2% to 4%. That's 50 reviews. Now what they found is that just going from 0 reviews to 10 reviews resulted in an increase from 2% to 3%. So having any reviews at all makes a huge impact a significant impact in sales. Right? And, of course, like, when you're just what you said, Ben, this makes sense. If there's no input from un uninterested parties, like, from 3rd parties about a certain product or service. all you have to go on is what that company or brand is saying about themselves. And this is how I shop on Amazon is

  Ben Fineman [00:22:12]:

  I make sure like, I sort 4 stars or higher. Yep. And I will always try and find something that's, like, four and a half stars. Yes. to rate. And then if there's some product that has, like, 17 reviews versus 80, I'll look at both, but I'll be so heavily skewed towards the one that has 80, and it's an automatic process. And perhaps, sadly, Justin and I were trying to figure out what movie to watch last night. And I'm I'm the worst. Like, I will see the movie on the screen, I will disregard it if it's under 4 stars. Uh-huh. And then if it's, like, four and a half stars, but there's only 17 reviews, I will ignore and then I will go and Google the movie to make sure that the reviews are verified on, like, IMDb and Ron Tomatoes, and it takes serious effort for him to convince me to watch something that has not independently been verified as high quality by many, many people. And saying this out loud, it sounds and it is absurd. But I don't think I'm that unique. I think most people operate like this because how do you make a decision? You have a billion choices. If you're not finding some criteria to narrow down your options, And that's what I use. And, I mean, I think that's what most people use. It is what most people use. It is so established.

  Carrie Wiita [00:23:21]:

  And I'm quoting, a high volume of reviews make the aggregate score seem more trustworthy. And and and this is for I I can't remember the name of it. Oh my god. There's a it ill it'll be in the show notes. there's a textbook that I'm pulling all of this from. A a marketing digital marketing textbook that I'm pulling this from. They they argue that it's in any brand's best interest to maximize the number of available reviews and particularly to do whatever you can to generate positive reviews because of exactly what you're talking about then. because everyone does this. There's a common sense. If there's 4 reviews and it's all four stars, that's not as trustworthy as there being 2000 reviews and it's four stars. Right?

  Ben Fineman [00:24:04]:

  This is the farthest show where we say thank you to the listeners. You can support very bad therapy by leaving us a 5 star rating on Apple Podcasts or wherever you wherever you get your podcast. make sure to to write your review about how great we are.

  Carrie Wiita [00:24:20]:

  What what Ben is doing what Ben is doing is considering the buying process as ongoing. Securing reviews should be added as another component in the buying model. Actively soliciting reviews generate vital customer feedback, nurtures brand loyalty, and encourages other prospective buyers to buy your product or service. So it is completely fucking established, and every other business and field other than our own that soliciting reviews should be a part of getting someone to buy your product or service. It's it's it's critical to the livelihood of your company.

  Ben Fineman [00:24:59]:

  Let's talk about ethics. because you have just made a wonderful argument for why why this is the norm in almost every field outside of Right? Mental health, why it should be the norm. And yet not only do most therapists not solicit or use testimonials, Most therapists groups, ethics codes, etcetera, actively prohibited in a number of settings. Mhmm. now that we've made the argument why this is important and necessary, we can, I think, layer in some context about why it's different for therapists because it is. Right. Right. This is not just, like, oversimplification saying, we should do this because they're -- No. Totally. -- are very real ethical concerns. So let's dig into them and how the how our field has responded over time, largely by saying, don't do this. Right. So the the obvious ones. Right? If you ask a an active client to give you a testimonial, you can lean into a power imbalance. Right? Clients might feel pressured to do this. they even might feel like their their therapy depends on it, right, that your engagement with them depends on them giving you something beyond just the fee that they're paying. I think this is especially true, and you see this in the ethics codes as well, for for vulnerable clients. For clients who may have attachment struggle, for clients who may have a hard time asserting boundaries where you may actually be leveraging something you know about them to get something that benefits you that may not benefit them in any way. You may know that they'll say yes because that is something that they're working on in therapy -- Right. -- is having boundaries. that can't be okay. Like, that directly contradicts the the the mission of therapy, which to help people stand more strongly within themselves. I think there's another ethical scenario here, which is how it represents the field as a whole. And this is what you see so many people pushing back on publicly when the idea of testimonials and therapy comes out, which is does this make our field seem like we're we're prioritizing money, we're prioritizing self promotion, we're prioritizing ourselves over clients, over client welfare. And these are very good and valid concerns that need to be addressed. And and I would argue, need to be kind of erring in the side of caution when setting ethics code. But it depends on who you're asking. Right? And so there's a great article from doctor Ben Caldwell that will link in the show notes and carry certain that he is gonna love this episode. We're gonna get one of those texts where he's like, great episode.

  Carrie Wiita [00:27:21]:

  I hope so. Yeah.

  Ben Fineman [00:27:23]:

  This is a quote from him. He says, ethical guidelines make distinctions between groups of people you might ask for a testimonial. Asking current clients requires the most caution, and some codes put a blanket prohibition on doing so, asking former clients is more often allowed, and every code allows you to ask colleagues and others who may be familiar with your work, but who aren't clients and never have been to vouch for your skills. So what Ben is saying here is that you can pretty much always ask like, colleagues, you know, former supervisors, etcetera, to to write you a review, not pretending to be a client, obviously, but saying, you know, Carrie has great skills. She has wonderful ideas and helps so many people. You know, she's a wonderful like, I could write that. You actually wrote a review like that for me when I was starting in private practice a few years Yeah. Many of the ethics codes say you can go and ask former clients -- Mhmm. -- but there's an asterisk there. And very few ethics codes say you can ask current clients for testimonials. And this is frustrating because it's outdated. Right? These ethics codes were first written before the Internet existed.

  Carrie Wiita [00:28:27]:

  Right.

  Ben Fineman [00:28:28]:

  These ethics codes existed when you looked for a therapist not by, like, searching on Yelp or looking at websites, but by finding somebody in the phone book, and there aren't spaces for testimonials. So we're we're kind of dragging ourselves to get caught up to the modern era. I think for good reasons, in part because we're trying to protect clients, and that is most important at the end of the day. But also, I think for bad reasons, and those reasons are change takes time. changes slow.

  Carrie Wiita [00:28:57]:

  I think there's other bad reasons.

  Ben Fineman [00:28:59]:

  Okay.

  Carrie Wiita [00:29:00]:

  Oh, I yeah. No. I think that all of the reasons that you've talked about thus far are super righteous. Right? But I think there are nefarious reasons that, like, if we actually talked about it, most therapists wouldn't actually be on board with this. But it has to do and I've talked about this on the show for, but it has to do with, like, how therapy land wanted to to define our field and define our our culture and status as a field in the very beginning. Because, like, back in the day so when therapy for the masses was becoming a thing post World War 2, We were struggling to argue that you didn't have to be a doctor. You didn't have to be a psychiatrist to do therapy. Right? And so we created this whole field where you had not doctors doing therapy. But we wanted to be taken as seriously as doctors. So the APA They was created and largely modeled all of their original codes of ethics on the American Medical Associations. they basically like, our field wanted us to be seen like we were doctors. We had the status of doctors, and we were taken seriously like doctors. And that's why we adopted, for example, the medical model that so many therapists hate and and philosophically reject But we adopted it because it meant that we were on par with doctors in, like, society's eyes. Right? Well, that also meant adopting the culture. And the medical community saw doctors. Like, they they saw themselves as exalted. Right? This goes back to the idea of occupation based perspectives that norms occupation based norms that encourage and expectation of autonomy from market imperatives. Right? Doctors were encouraged to think, like, you don't need to mark it because you're a duck. You're not like a plumber. You're not like a grocery store. You're a you're a doctor. So therapists were given were written into our ethics codes were these things where marketing was considered declasse. You shouldn't market. And, yes, it's it's couched in all this language of, like, you you you're gonna unconsciously influence your clients with advertising. Right? But, really, there's this classest element of it as well that we're not plumbers. Okay? We shouldn't have to put ourselves out there that. We shouldn't grovel to consumers. And we don't talk about this aspect of it. We couch it all in but it's bad for our clients. But that's that's so disingenuous. There is this element of we're too good for it also.

  Ben Fineman [00:31:29]:

  That's so interesting.

  Carrie Wiita [00:31:30]:

  I know.

  Ben Fineman [00:31:31]:

  So let me talk about some of the specific association ethics codes. Yes. And I'm gonna get to the American Psychiatric Association because I I think what you were just saying in the context of what their language is is very interesting.

  Carrie Wiita [00:31:44]:

  Yeah.

  Ben Fineman [00:31:45]:

  For anybody listening, this is very American centric. Right. I'm pretty sure this is all up to date, but it's possible that some of these codes of ethics have been rewritten since what I had found was published. But Starting with the American Psychological Association and also the National Association of Social Workers, NASW, and a s w. And a lot of this comes from Ben Caldwell's writing as So those 2 organizations, very big organizations, just flat out prohibit therapists from soliciting testimonials from current clients or anybody who may be vulnerable to undue influence. Right? So you cannot ask current clients for testimonials. And if you have a former client, or even a colleague who might be vulnerable to undue influence, like somebody who works for you, you cannot ask them, or you should not ask them because of these circumstances. and then the American Counselors Association actively prohibits asking former clients for testimonials. So they're even more firm in saying you can't ask current clients. You can't ask former clients full stop. The Canadian so I I guess for more North America than just America. Sure. the Canadian Psychological Association prohibits the use of client testimonials in any kind of promotional material. We're gonna hold off on talking about CAFT, right, the California association, marriage of family therapy for a minute. But let's talk about the American Psychiatric Association Care because you're talking about doctors and how we model ourselves after doctors. So as recently as 2023, the American Psychiatric Association does not actually explicitly address this topic of soliciting reviews or testimonials. They they make reference to it. They say they indirectly asking clients for reviews is okay. And here's a quote from the American Psychiatric Association. I love this. The ethics committee has opined that these solicitation practices are ethical, so long as the same information and opportunity to comment is given to all patients without coercion, and no patient is directly asked to provide a review. So you can't say like, a psychiatrist can't say to a patient, Will you write a a review for me? Right. Can I have you say something to use as a testimonial? But they don't explicitly prevent any of this if it just kinda happens. So -- Right. -- if a patient is like, wow. Thanks. I really enjoy working with you. Can the psychiatrists say, hey. Do you mind if I use that for my literature? Like, they they lead it They can't say that? Well, they don't explicitly prevent that and leave it very vague. They just say you can't directly ask to provide you can't directly ask a patient to provide a review. But you could put a sticker, a Yelp sticker in your waiting room that says we we love feedback on Yelp. Absolutely. You could do a lot of things. They have way more ambiguity than any therapist organization. And I wonder, Carrie, and this is why I found what you were saying so fascinating, has the American Psychiatric Association recognized the necessity of this and pulled away from their initial very rigid -- Yes. -- starting points, and we, as therapists, are catching up. And we're like, no. We're gonna be like this because wanna be like doctors -- Yes. -- not realizing that doctors have called up to the times and said,

  Carrie Wiita [00:34:49]:

  no. You you kinda have to do this or else. I a 100% believe that. and it is why I am so angry at our ethics committees because it it's true that there is this tension. Right? We need fucking guidance. And there is this this this difficulty of, like, yeah. Like, there is some kind of weird pressure that could be put on if you say to a client, oh, I'm so glad. Like, you know, if you're doing routine outcome monitoring and you get, like, a lot of really high marks, it would be fucking awkward if you went to your clients and said, oh, like, you had a great session today. Would you mind tell it talking about that on Yelp? That would be fucking weird. But there's a lot of fucking gray area that comes before that. You know what I mean? And, yeah, the the doctors are like, oh, gee. For our field to continue and for doctors to keep making money, for this to be a viable job option, we're gonna have to do this thing that is so central to businesses in every other fucking field. But our ethics committees have just, like, dragged their heels and, like, opted out of the discussion. And I think it's out of this, like, yes, they are there's this, like, cloak of, like, oh, but it's bad for clients. But I really think at its core is nobody wants to do marketing. Nobody wants to be in a field where, like, you mark it. And that's part and and soliciting testimonials becomes part of it. Right? But I think that that is a huge abdication of responsibility on the part of our professional organizations. because ostensibly, their whole reason for existing is to advocate for the field that they represent, and they are doing a piss poor job of They're just leaving us to our own devices to function as independent service providers in capitalism and cutting us off at the knees.

  Ben Fineman [00:36:35]:

  so people listening understandably might say, I agree with you, but but, like, how? Because how do we how do we make sure this is okay? And this is where we need to take a moment and shout out Camp, the California Association of American Family Therapists. Because as far as I'm aware, And this this might be incorrect. But as far as I'm aware, TAMP is at the absolute forefront of this in recognizing this trend and say, we need to get ahead of it but do so in a way that still supports our clients, protects our clients. So in 2019 so already 4 years ago now. Camp revised their codes of ethics, and now the only prohibits solicitation of testimonials from current clients who are, quote, subject to undue influence. So you can ask any of your colleagues, you can ask any former clients And you can ask current clients as long as they are not subject to undue influence. Now there is ambiguity here. What does that mean? And camp does not further define it in their ethics codes. I I have some language about what that means from a separate campfire ago. We'll get to it in a sec. Oh, okay. But camp is trusting therapist here to say, listen. we recognize that this is probably helpful, if not necessary, to thrive as an organization, as a business, etcetera. Just don't do this in a way that harms your clients. And and if you are a therapist, you probably have enough common sense from a law and ethics perspective to know how to navigate this I'm sure some will take advantage of it, but I would argue that those people probably already take advantage of it, which there's a fun study from Canada where you're not allowed to do this and yet, like, 5% of therapists still did this? Yeah. What camp is saying is this is necessary. It's helpful Please just have common sense around how you're doing this and don't ask current or former clients where they're subject to undue influence. And just to add on this real quick, clarifies, like, in a separate article. This isn't in the ethics codes. Yeah. They talk about how this idea of undue influence comes more from the legal arena. and they they cite a case from 1990 where the definition is about a situation in which extraordinary and abnormal pressure subverts independent free will and diverts it from natural course in accordance with the dictates of another person. So this would be a therapist recognizing a client won't be able to say no, but might otherwise want to say no. And basically, coercing them into writing a review -- Right. -- giving a testimonial. I think can't hits the nail on the head here. It's the closest to what the American Psychiatric Association is doing, which is saying, like, do this in a way that protects clients in his common sense But you can do this. Like, this is okay.

  Carrie Wiita [00:39:08]:

  It's great, but it's not it's nowhere near enough because If it was, you and I would not be needing to do this episode. Nobody knows what is okay. The reality is, like, I think that that is an abdication of response. But I think thank god Camp is doing it, and I'm all I'm, like, so proud of them for at least making that change. I think it's excellent. but there needs to be camp sponsored workshops on what is okay? What isn't okay? What does it look like? They need to have concrete suggestions. They need to stick their necks out ethically and take a stand and say, here's what we mean when we say do it in a common sense way. Oh, wait. They post an article. Great. Great. Then why is it when freaking out on the Internet? Is it okay or not? You mentioned testimonials in a therapist Facebook group, and I will tell you why. But you mentioned that, and there will be 50 therapists being like, oh my god. I would never pearl clutching. Like, you know what I mean? And and it's because camp is a State MFT Professional Organization. That is a small subset of the therapist population that has been given the okay to do this. The rest of the marriage and family therapist in the United States hadn't been given that much leniency. And the counselors and the social workers, they haven't been given that leniency. you know, what's interesting is because this was

  Ben Fineman [00:40:27]:

  was per made permissible in 2019. Yeah. And so if you are already licensed, you likely came up in an era -- Totally. -- but this wasn't. And if you're not yet licensed, you are still in grad school or in supervision or both, receiving instruction from people who came up when this was not allowed. And so if this information isn't more publicly disseminated, like, more widespread publicly disseminated, People will still be getting the message. It's not okay. Even if, like, if you are a marriage and family therapist in California, I'd be willing to bet the majority of marriage and family therapist in California do not know that is allowed, is it not exerting undue influence on a client because they either came up when it wasn't or the message they're getting from their instructors and their supervisors is that it's not okay. Yes. But it is okay, and it should be okay for all the reasons that we've gotten into. Right. Exactly.

  Carrie Wiita [00:41:15]:

  And it is I I feel like it is so this is what makes me so angry about, like, you know, paying money to these organizations because they I they do great work, I'm sure, in some areas, but, also, like, this is pretty critical to a lot of therapists' livelihoods because there are so many therapists who are private practitioners, or now they're fighting against

  Ben Fineman [00:41:39]:

  the better help, talk space, whatever whatever the names are. Yeah. I mean, anybody who is not governed by these regulations where they're like -- Yes. -- can absolutely have reviews and testimonials and just create my own and, you know Completely. Yeah. Exactly.

  Carrie Wiita [00:41:53]:

  And so it is it it my frustration is like, this is not I want therapists to know. It's not your fault that it's confusing. It is not your fault that it seems like really difficult to navigate because it is. It's difficult to navigate just there's not a lot of guidance on what is isn't isn't okay. There's a lot of fucking judgment from everybody else in your field about what it is and isn't okay. And even I would argue, like, there's not a lot of evidence to point to, but I would argue that consumers are actually Ben, I think it's in that article, the the combs and towels article. That clients are a little like, there is there was some ambivalence about the idea of therapists requesting testimonials. Like, on the one hand, fucking, I guarantee you every consumer, everybody at the point of looking for a therapist, wishes they could read reviews. But once you're a client of therapists, you probably feel kinda weird about giving 1 or being asked to give 1. Right? And so it's it is. It's a it's so nuanced. It's so hard, and somebody needs to fucking do the work to figure out how do we navigate And it should be our professional organizations, and it's not.

  Ben Fineman [00:43:01]:

  So if you're in if you're in MFT in California, go start soliciting ethically, start soliciting testimonials. Absolutely. if you're a therapist anywhere else where it's prohibited, I I'd be willing to wager that in 5, 10 years, this will everybody's gonna catch up to camp because it's such a necessity. Absolutely. Here is the the article I mentioned that can't put out. We're gonna link that, of course. But here is, I think, the key quote in terms of how can you ethically solicit a testimonial My guess is this will apply to just about all of us eventually as, you know, this change happens. So they say that before soliciting a patient review or testimonial, an MFT,

  Carrie Wiita [00:43:40]:

  a MFT? Yes. An MFT.

  Ben Fineman [00:43:43]:

  Well, I have been I have been grammatically incorrect about this for a long time. Before soliciting a patient review your testimonial NMFT, should consider documenting their clinical rationale for believing the patient is not vulnerable to undue influence. So my aside is it's just a short note in the client's file to say, this is why you think this is okay. So if there's any -- Right. -- or legal concern you're protecting yourself. Right. In this way, should an MFT face an allegation that they solicited a patient review or testimonial inappropriately, the MFT's record will clearly demonstrate that they assess the patient's vulnerability to undue influence and came to an appropriate clinical judgment on that issue. Furthermore, prior to utilizing a patient testimonial containing identifiable patient information on their website or in marketing materials, a therapist must obtain written authorization from the appropriate party or party So if you're going to ethically ethically solicit a testimonial, make sure the client isn't subject to undue influence, document your rationale for this, and make sure you're getting a release of information if you're gonna anything that could be even remotely identifying. And that's it.

  Carrie Wiita [00:44:47]:

  Wait. Great. I think it's great.

  Ben Fineman [00:44:49]:

  So something we haven't yet gotten into here is when a review or a testimonial is unsolicited and it is negative. Right? And this is something that so many therapists fear. I think that keeps some therapist moving having, like, a Yelp page or, like, a Google My Business page is that fear of what if I get a bad review? Right.

  Carrie Wiita [00:45:10]:

  Understandable. Right. And that fear is so strong because we cancel is a good reviews. So just throwing that up. Oh, great point. Yeah.

  Ben Fineman [00:45:18]:

  So maybe this is skipping ahead of it. But when you look online about, like, what should you do related to bad reviews, or why is it important to get good reviews? Yeah. You can't respond to a bad review. Just like you flat out can't respond to a bad review, and we'll talk about that in a moment. So the solution that you see online about what to do about a better view is to, like, jam your Yelp page or your Google My Business page so full of good reviews -- Right. -- that it it kind of drowns out the bad review. very interesting that the the the solution here to a bad review, because you can't legally do anything about it, is to be very proactive about getting good reviews so you don't have, 2 one star ratings. We have 30 ratings, and 2 of them are one star, and the rest just kind of, like, suffocate them. Well, this is the advice even in

  Carrie Wiita [00:46:07]:

  instances in fields and industries where you could there's no problem responding to bad reviews, but that the advice is the same. that they it has been established that negative reviews can give a skewed view. This is again from that textbook that I'll be citing. Negative reviews can give a skewed view of a product or service, which often destroys trust and confidence. Quarterly managed reviews can misrepresent a brand. as it often takes just 1 or 2 negative reviews created by competitors or a negative customer to reduce sales conversions significantly. So it's acknowledge. And they may in this in this textbook, they really drive home. Like, negative reviews are bad, so you gotta do something about it. And I think that they really, like, drive home this point. because they were assuming you can do something about negative reviews, namely solicit, more good ones. Unfortunately, we are our hands are tied a little bit because, yes, there is this ethical point where you can't respond to a negative review because you can't acknowledge in public that somebody is your client. You can't betray the break confidentiality. Right? Right. And so we can't respond. But the this is like, we act like, oh, because of this, we can't do anything. No. That's every other industry already knows. That's not worth it anyway. Responding to negative reviews is never going to be seen as trustworthy as the 3rd party review. So everyone already says, like, yeah, obviously, like, you know, you see it on Twitter and everything all the time. The company's oh, no. We're so sorry. Please contact me, DM us, and we'll solve this for you. But they don't try to hash it out in the comments because it doesn't do any good. The only antidote to the negative reviews is positive reviews. I have a I have another antidote, but we'll get to that in a minute. What you said about like, on Twitter companies responding to bad reviews or therapists can't even do that. But even if a client

  Ben Fineman [00:48:04]:

  says in the review that they were or are a client of you, it violates client confidentiality to simply reply to that review and acknowledge the message. Right. You cannot reply. And I think it feels a bit gross. the implication that for a therapist, if they have an aggrieved client -- k. -- or a family member or a client or who knows, who writes a bad review, I think it feels gross for a therapist to say, well, what I'm gonna do then is go ask 20 of my friends to write a review saying how great I am. Like, I don't think that feels good for anybody. Sure. So the obvious solution here, right, isn't that we should be able to, like, debate our clients on the review page, because that's not gonna work. The obvious solution is for us to have permission to solicit testimonials when there is not undue influence, so that when the inevitable bad review comes, there is an honest representation of your body of work because some clients have wanted to volunteer that they had a good experience. and that doesn't feel gross. That feels normal. That feels healthy. It just isn't allowed in so many instances in our field because we're just not caught up yet. And and, Kai, real quick, when we talk about therapist can't reply to clients, there was a case in 2015. Right? This is in California. where a client posted on the therapist Yelp page a bad review. The therapist responded to the client, realized that it was a bad idea and took it down within 5 minutes. But on Yelp, you can have automatic notifications hit your inbox when somebody responds to a review of yours. Right. And so the client knew that the therapist responded and took action. And so the therapist ended up actually being fined $750 for violate violating confidentiality. So this is this is no joke. Like, there are no other resources a therapist have other than flooding their page with good reviews.

  Carrie Wiita [00:49:52]:

  There's gotta be a better way. Well, I I do have a a meager solution. And some I don't think it's that eager. But, like, it's it's the only thing the the real solution would be to be able to to solicit positive reviews. That that make tell us how we can do it. That's that's the answer full stop. Great. But the other solution is well, there's there's 2 things. I wanna say, number 1, is if like, it it has to do with the spectrum of bat reviews. Right? There is one study that I read or a paper that that I read. that pointed out, like, some bad reviews rise to the level of, like, harassment. Right? Sometimes bad review the concern isn't just about your business. The concern is, oh, shit. This person's, like, talking shit about me in, like, a really aggressive scary way. Right? And this paper that I was reading. This is Ericsson Cornish at all 2019. They were talking about they're using the APA American Psychological Association code of ethics. And they give a vignette, like an example, where an a disgruntled client left terrible reviews everywhere. But in some of them, the reviews rose to the level of, like, a threat credible threat. So something like this bitch better walk watch out. Was that in the in the paper? Yes. It was. It was in the paper. It was great. I'm pretty sure it was, like, like, asterisk style, but it was great. Was this a, like, a a real case? The journal paper. Oh, no. It's a no. It was an invented vignette.

  Ben Fineman [00:51:20]:

  Fascinating.

  Carrie Wiita [00:51:21]:

  I know. I love it. But so they argue, if something like this happens, you are ethically correct. You're you're you can ethically contact the police and divulge only the necessary information for police to contact the client Again, this is because all of our fucking codes of ethics are different. This is specifically for psychologists. But they argue that, yeah, in in that instance, if the review is, like, threatening it's okay to contact the police and give them the information needed to identify the individual. termination is with the client, if it's an active client, is also okay. And they say that if the behavior even continues, then seeking a restraining order is is also okay. So it's like, if your bad review is to the point where you're, like, scared, it's a different thing. It's not just, like, I'm worried about my business. If you're worried about your safety, then you are on different ethical grounds. Right?

  Ben Fineman [00:52:14]:

  And I think there's like, this line between, is this somebody who is threatening you, or is this somebody who is just leaving in, like, an honest negative review of the service they received. I think this speaks to something very, very important, and it's it's it's a whole can of worms that we definitely aren't gonna get into in the context of this episode. But the ability for clients who have had bad therapy to leave reviews saying that is a very good thing. Right. Right? It is some level of accountability. Right? Yes. Not a not a ton. The, you know, the complaint like, the complaint board like, board complaint process does not always go well, and sometimes it is at least some recourse that a client can take. clients like, the stories we hear all of the time -- Right. -- it is good for that person to be able to write a review that's public to say this was the experience I had.

  Carrie Wiita [00:53:04]:

  Wait. I think this is a significant part of this conversation. Can we come back to this point? Like, stop now or come back like, No. Go ahead. Go ahead. See what you're gonna say. But but no. I think that this I I you said that you just wanted to share this one thing, and I this is something a conversation that I wanna have. So Well, the reason I think it it it kind of goes into something bigger

  Ben Fineman [00:53:22]:

  and and very dicey is that if we just take all bad therapy experiences at face value and say, these clients should put online that they had a bad experience. Right. So other consumers can be warned about it, and it accurately reflects the therapist failures as a therapist, their ethical violations, etcetera, then it it's very good that a therapist can't engage, bury it, you know, very easily, etcetera. Totally. totally. But, I mean, this this is the dicey part. Is that carried by doing this podcast, you and I, I think, have been made aware what a lot of therapists feel, which is Sometimes bad therapy happens and it's the therapist's fault. But sometimes bad therapy happens, and it is a manifestation of a client's psychological challenges. Totally. And I think the risk in naming this here and calling attention to it is that, yes, everybody who's had bad therapy, I think there is a good reason for them I mean, first try and talk to the therapist before trying to, like, torpedo their career unless it's, like -- Right. -- like a serious ethical violation. But there is a problem that all therapists can identify, which is the fear of a client who comes in with significant psychological distress, some personality disorder, some significant challenge where they are going to be more likely than not to try an exact revenge even if nothing, you know -- Yeah. Objectively bad happened. That is a a a bit of a problem in saying, yes, go write negative reviews. Because sometimes the negative reviews are just a reflection of what the client is struggling with as opposed to any failure on the therapist part. And that I mean, it's something that we face in having this podcast is sometimes we get emails, we get stories where we're like, I really can't tell if this was bad therapy or if this is just a reflection of a personal psychological challenges. The same thing is true for reviews, and it's great for clients to, like, call out bad therapy, but it's not great for therapists to have their careers threatened because a client is struggling with something and the therapist becomes the target of their ire. Yeah. And here's good news about that.

  Carrie Wiita [00:55:21]:

  There's a lot of literature in the business world on word-of-mouth, like the nature of it, how impact full is it, all of those things. And a lot of that literature reveals that consumers actually are often much savvier than we on our side give them credit for. So a lot of times, they take online reviews with grains of salt. Right? And so you you know, you've you've read the Amazon reviews where you're like, oh, that's a crazy person. Right? Like, you've read those reviews where you're like, oh, I can't take that review seriously. So I'm not gonna factor negative review into my accounting of this product, right, because, clearly, they've got an axe to grind. This it's called word-of-mouth literacy. And in consumers, we have we have decades now, right, of experience where our our word-of-mouth or or ewom, e Eli chronic word-of-mouth, that literacy has been honed on sites like Amazon, Yelp, etcetera. Right? And so the there is a level of consumer consumer savviness in sorting through reviews and identifying, oh, this is something that can actually that should wounds my purchasing decision, or, oh, this is a person with way too much time on their hands. This is a keyboard warrior who I you know, whatever. That's probably not gonna be my experience with this product or service. Right? Yeah. I I mean To some extent, to a small extent. I'm not saying this is a blanket like you don't need to worry about negative reviews because there are some. And your you are absolutely correct. There are there are some folks who maybe, like, their reaction to therapy may be a manifestation of, like, they came to therapy for in the first place. And those people may be they may very well be capable of writing a review that sounds very credible. Right? And then sounds like it really was the therapist's fault. And you're right. You can't guard against that. The only the only real antidote as we've talked about. is generating plenty of positive reviews to change the aggregate perception.

  Ben Fineman [00:57:17]:

  I mean, this is probably, like, painfully obvious to everybody listening, but it's like a light bulb just went off of my head, which is as a field, historically, we have done nothing to keep Agreeve clients from writing reviews, which I think in aggregate is a good thing. Yeah. But we have done everything to minimize our ability to get satisfied clients in the door to write good reviews. And so it's it's almost inverse as to how it should be or or underrepresented on the positive side that if you just read reviews of therapists that are out there, you'll walk away being like, well, most of them are usually fine, but, boy, some really, really fail. And I don't think that's inaccurate, but I think It's misrepresented in what these reviews and our ethics codes permit that our our hands are tied behind our back in terms of having an honest representation from a social proof perspective about what we do as a field.

  Carrie Wiita [00:58:13]:

  And that feels like just a failure of the professional associations to see us coming and get ahead of at a 100%. And and this is why I suspect it's this, like, ego attitude thing that has kept them from doing it. Because if it was really about preserving the viability of our field and protecting therapists, they would have gotten on it by now. But I don't think I think that what's why they're dragging their feet is, like, they don't you know, I don't wanna be, like, the plumbers and, like, whatever.

  Ben Fineman [00:58:40]:

  It now reminds me when we started this podcast, and every time I would do the support pitch, you'd have to give me a pep talk, and and now I'm just, like, a total mercenary. Like, believe us ratings and reviews. Goddamn it. Exactly.

  Carrie Wiita [00:58:51]:

  This is exactly right. I'm over it. I'm over the ego. I now recognize the need to gravel. You recognize that, like, you know what? We we've gotten enough positive feedback from people who appreciate the work that we do on this show, that you recognize that, like, it's worth it to get it out there to more people. Right? And that is what our fucking that's that's what we should be. That's how we think about therapy. That's ostensibly what our professional organizations think about therapy. It's great for people, and everyone should do it. well, then act like it and protect therapists and help us. But in the absence of that fucking showing up by the people who made it a problem for people to give reviews in the first place. The people who the the and by people, I mean the general, like, organizations that have, like, caused this problem. Here is what I think. This is what I encourage, like, my clients to do in to, like, as an antidote quasi antidote to to bad reviews. And this is where I think it becomes important. This is why I think it's important for therapists to develop like, put more information out there on the Internet for consumers to use when making a purchasing decision. Because if you don't if you don't make any information available, if you don't let let give consumers a way to get to know who you really are and what kind of therapist you really are, then these things become it's it doesn't matter. it become these small pieces of evidence become magnified. Right? It becomes a much a much bigger piece of the purchasing decision. And so I I call what I call everything that you that you create or put out there in the world to get you and your brand, if you wanna use that word, to get that out in the world. I call it the infrastructure. This is the infrastructure of your, what I call, the interpersonal brand. Right? And these are like, testimonials are part of that, for sure, but a small part. And if you put lots more if you are available in a public way to your consumers, then they can use that information as well as the reviews that are available. So it means, like, having a website where it's really authentic and, you know, gives them access to who you are as a therapist. you know, doing anything like, any social media that you wanna do, only if you wanna do it. I only think you should do what you want to do. Otherwise, it's an authentic. But I think like, any social media. YouTube, like, stuff. Like, if you wanna do videos or, like, demonstrations of an intervention, that's what I I think is great. for therapists who use, like, guided meditations or any any sort of common interventions they use a lot with their clients. I record yourself doing that. and have a video of that on the Internet. So if some disgruntled client leaves a negative review that says, I hated my therapist's voice. She was you know, gave me anxiety, whatever, then they can go find other infer information that's available and judge it for themselves. Yes. You're running into this problem where that the information that you as a therapist put out there about yourself is not judged as trustworthy as information put out there by third party. It's it's you making more of an effort to be to make contact with folks and to make yourself available. And and this is this is also my, like, kind of suspicion. Right? This is a little suspicion that I have. It's not backed up because there's not been enough research done on this, but this is a suspicion I have. So we know from the first impressions literature, right, that, like, essentially, as soon as a first impression is formed, it's really kinda hard to change it. You have to, like, actually kinda work to change it. So most people, what happens after you form a first impression of somebody, is you double down your your confidence in your first impression increases over time. And part of this may be confirmation bias. you pay more attention to the evidence that supports the conclusion you came to, and you kind of, like, disregard or don't give as much weight to evidence that disproves your impression. So if someone is at the point where they've got your name and they're searching for reviews, I think chances are better than not that they have a positive impression of you. I I generally think that, like, they've already decided, like, god, I hope this works out. And now they're just looking. They're doing making an informed purchasing decision. They're trying to gather more information to ease the anxiety of that purchase. Right? And so I think that if you have enough information out available, when you they Google your name, here's what shows up. If you have enough stuff out there that they can be like, oh, I really do like I I I really like this, but I think I think this might be a good therapist for me. and then they go read reviews. I think they're going to be more likely to wait positive reviews over negative reviews that doesn't fucking help if there are no positive reviews. If there's only negative reviews, that's where it becomes a real problem. So does that make sense?

  Ben Fineman [01:03:51]:

  Yeah. I mean, a 100%. And there's the voice in the back of my head, and I think a lot of people can relate to this, which is Yes. I know this helped get people in the door. Yeah. And I understand the significance there, but I just wanna help people. I became a therapist to help people. I get the need to get people in the door, but let's say I can get plenty of clients elsewhere.

  Carrie Wiita [01:04:11]:

  Is this still even necessary or connection? Let's say you can get plenty of clients elsewhere.

  Ben Fineman [01:04:16]:

  I'm trying to segue to the next part of our outline story. Oh, alright. Alright. Go ahead. Sorry. But, no, obviously, what you're saying is the most important part is you can be, like, the most well intentioned ethical great therapist. If you can't get one client in the door, you don't help anybody.

  Carrie Wiita [01:04:31]:

  Exactly.

  Ben Fineman [01:04:32]:

  But it goes one step further, which is this question of if if you just wanna help people and you wanna swear off all of this stuff -- Right. -- is it possible that these kinds of things, getting testimonials, having reviews, etcetera, actually helps you help people improve client outcomes. And I don't think this has ever been studied, I think you can connect studies to have this look very obvious. And I think that it it is very obvious that we know from the therapy literature, the client expectations are correlated to outcomes. So it is reasonable to say that if a client comes to therapy expecting you to be able to help, they will have a better outcome than if they feel neutral or skeptical. And if clients see positive reviews of you, they are more likely to come to therapy expecting it to help, which studies have shown that that is how reviews work. That you can connect those 2 themes and say, a client who sees positive reviews of you will have increased expectations that you can help them and therefore, therapy is more likely to be helpful. So the argument there's no study to support this that I'm aware of, the argument can be made that soliciting testimonials, ethically, having a lot of reviews, ethically, will actually make you a more effective therapist And I'm curious if you found anything about this or have any thoughts because IE came up against, like, a total blank when trying to see, has anybody actually studied those?

  Carrie Wiita [01:05:56]:

  Yeah. It's a thesis published in 2021. This is the this is my this is my entire point. My entire point is that for a service like therapy, Part of the services you're marketing because that's where the therapeutic relationship is established. That's where all the expectations are set and managed in the run up to therapy, and that's where preferences can be accommodated by giving the client the opportunity to approach or avoid based on the information that's out there, including positive or negative reviews. So, yeah, I a 100% believe that marketing is is the is the first part of therapy. It's what happens before it's, like, session op. Right? It's what happens before the first session. And I think it's critically important You're right. There's no fucking studies, and it drives me batch it crazy. But if you cobble together hundreds of studies from different disciplines think you can make a fairly compelling argument that that is true. There is one other way that I do think the other significant way that I think that testimonials impact outcome. is if you take if you agree with the perspective, that feedback informed treatment positively impacts outcomes, because I argue that all of the data that you get from clients is feedback constitutes feedback and can be fed back into your work as a therapist. to impact positively impact outcomes if you're gonna respond to it. So I think a negative if if you take that perspective, a negative testimonial, a negative review on Yelp, that's that's feedback. That's feedback about the work that you're doing as a therapist. And I think that you can and should fucking listen. This Yeah. Go ahead. You want oh. Yeah. It's just the thought that, like,

  Ben Fineman [01:07:43]:

  yet another reason why it's helpful to solicit feedback from clients as part of the therapeutic process. Absolutely. You can add this to the list of that somebody who is aggrieved and wants to say something without a bad experience will be more readily willing to bring it to you than to put it online -- Right. -- and that gives you a greater chance of improving the experience and giving the client what they need and deserve. It also helps make you know, mitigate the odds they're gonna blast you online. And soliciting feedback and getting good feedback opens the door to say, Are you open to writing a testimonial so I can use, like yet another, you know, check check mark for why feedback and phone treatment is a wonderful

  Carrie Wiita [01:08:20]:

  Right. And you can take the perspective if you want and say that that's so cynical. You can be like, I'm not gonna do inform treatment to keep people from writing negative reviews. You can look at it that way, but we you and I, obviously, take the perspective that feedback and form treatment is just like the fucking right thing to do. It also lets you respond to it and try and do something about it because once it's posted, like, you're done. You can -- Well, no. Once it yeah. Well, once it's posted no. This is what's super complicated. Right? Because this is in that in that Holmes and Town article, they address the issue of, like, if a client is in therapy with you and is actively a client, and they go leave a negative review. And you have a Google alert set on your name, and that pops up and you fucking find it, right, as a therapist. But the client has not said anything to you. you're in a pretty pickle. Oh, an active client. Not a farm client. client. Right? Because now you have feedback. But for whatever reason, that client didn't feel comfortable giving you that feedback. So now you either have to ignore the feedback, pretend you didn't hear it, or you have to acknowledge that you found it. You came across something on the Internet that your client didn't feel comfortable telling you directly. And what do you do as a therapist? Like, how what what do you do with that information? It would be better for therapy. It would be better for the client if you incorporated that feedback and made their therapy better. My client.

  Ben Fineman [01:09:42]:

  my anecdotal not anecdotal. My empirical research on this, i e, what I've seen online in the therapist Facebook groups. to answer the question, what do you do with that, is apparently write a panic post -- Yes. -- and then get a 100 responses being like, oh my god. I'm so sorry. This happened to you. and nobody's there being like, well, could you have done anything different to make sure this doesn't happen next time? It's it's like

  Carrie Wiita [01:10:06]:

  big group hug of, like, oh, that horrible client. Right. But why? Yeah. No. No. No. Why? Because they're livelihoodist threat. because what's what's panic inducing in that moment is, like, oh, fuck. This negative review is out there, and now I'm never gonna get well yeah. Yeah. And I'm never gonna get clients again. And, oh my god. whereas it's it it could be seen as like a, oh, this is something that I can moderate or respond to or, you know, accommodate in the therapy room. And this brings me to my final point. My my final point is that I really and this is what I I encourage my marketing clients, right, to to to see it to think of this this way. All of the data that you get as a therapist, vis a vis your therapy business and your clients. is feedback about your work as a therapist because it's all everything that you do, business wise, marketing wise, everything. It's all part of your work as a therapist. And so you can think of marketing as this gross thing you have to do to get clients in the Or you can think of it as part of the treatment. And if it's part of the treatment, and if you want to engage in feedback and form treatment, which I think every therapist fucking If you if you if you don't think that, I can't help you. But if you think feedback and form treatment is a good thing to do vis a vis your clients, then marketing becomes an exercise in reading the feedback. Right? And so if you are getting negative reviews online, that shouldn't be something you need to panic about. You need to start thinking about, well, what do I need to change? How do I need to shift and accommodate my client's expectations and preferences. How am I letting my clients down? Right? If you, for example, say you have great response to your psychology today profile. Tons of people are calling you with inquiries based on your psychology today profile. That's great feedback. You've done something right. There's something that's encouraging. It gives people hope that you might be the therapist for them. But if you get them on a phone call and do a 15, 20 minute free consult call, right, and you get have an abysmal conversion rate from that. You have, like, maybe a 1%. Like, nobody they call you, but then once they talk to you, they don't they don't wanna with you. That's some feedback. That says something. It could be that what the therapist they expected you to be based on your psychology today profile is not the therapist that you are on the phone. Where's the disconnect? Right? That's on you as a therapist to manage. It could be that what when you quote finally quote them the price, it's too high. That means that the service offer that you're offering, right, is not a good fit. There's there's some disconnect between what a client can or wants to pay and what you are offering for the amount of money. but that's feedback. Right? And it means that you need to change something. Like, if if you're if you're charging If it's if if what you're experiencing is I'm pay the client is thinking that's too much to pay for therapy, then maybe you need to diversify your service offers. But that is you can see it as a way of how can I meet my client. Right? How can I address the needs of the client? And that's how I think you should be taking negative reviews, any negative data about our businesses or marketing anything. That's my soapbox.

  Ben Fineman [01:13:25]:

  I love it. also love the quote you have here at the the end of our outline for Oh my god. From Bank Caldwell. Do you wanna read this? You can read it. I just talked for Oh, because my my conclusion is more just a hilarious article I found. Oh, okay. Great. Alright. So my favorite quote is, yes, Ben Caldwell's article,

  Carrie Wiita [01:13:42]:

  a bad this issue of testimonials on the simple practice. I think it's called pollen. Is it called pollen? I think that's the name of it. It's a blog or something. Anyway, He the great article about this, I encourage you to read it. He ends it with this quote that I fucking love. So if a colleague judges you for using testimonials, asks them to consider widening their stance as testimonials can be used effectively without splitting vulnerable people or misusing your position. You can also just thank them for the feedback and enjoy all the new clients you'll be getting as a result of using social proof

  Ben Fineman [01:14:19]:

  So good. The best revenge is living well. Yeah. Exactly. I have no conclusions whatsoever here. But there's no other place in the episode to put this, and I I just want to add this. This is a link I found from the Louisiana record when I was researching for this episode. from 11 years ago. The title of the article is New Orleans Psychologist sues over negative Angie's list comments Oh my gosh. And I'm sure there was a lot of stress and frustration, and, you know, I can't imagine this was fun for anybody involved. But I So this psychologist sued I I can't tell if it was a client or a colleague, but it was another doctor who posted reviews on Angie's list about this guy, the plaintiff, calling him a joker and a quack. And so the plaintiff here sued both Angie's list and this guy. I I assumed this was not a client because I think as a client, you probably have more jurisdiction to do something. I think this was a competitor or just another professional with a beef -- Yes. -- who just went to Angie's list, and I was like, this guy blah blah blah. So he sued him. Oh my god. I tried to Google to see how this played out, and I ended up with, like, in some legal database looking at the the legal I carry I have a newfound respect for lawyers. I tried to make sense of what I was looking at, and I just gave up. On a cliffhanger, are you serious? I'll put a link to the Louisiana record article in case anybody wants to go digging and understand the the legal ramifications of this article. But -- Oh, man. can. When things go sideways, if if you all the advice that we are giving in this episode is not heated, and you end up in an untenable situation, there is always the option of simply suing the person who writes the review.

  Carrie Wiita [01:16:06]:

  I do not co sign that, by the way.

  Ben Fineman [01:16:10]:

  I I think it's fair. Like, if it's completely in bad faith and it's not even a client, it's somebody trying to undermine your business. No. That's true. If it's some competitor yeah. I could see it being fair. That's hilarious. If it's like a therapist with a hair trigger who got a mildly bad review and is hyper litigious as a result,

  Carrie Wiita [01:16:27]:

  not the best. Well, you know, I have seen some shit in the therapist Facebook groups where I I am so sure that that commenter has gone to the their nemesis', like, Yelp page and tried to leave a bad review. I am sure that that has happened. Mhmm. I'm sure of it.

  Ben Fineman [01:16:48]:

  How about a bit of listener mail to put a bow on this Oh, that sounds great. So related to our recent controversial episodes, we do get some very thoughtful and kind email. else. And one of those came from Tom Rose, and he wrote in. Hi, guys. I just listened to the latest episode about religious trauma. This is something that I have personal experience with as a former evangelical, and I, as a therapist myself, love working with people who have experienced religious trauma. My answer to the question that Josh wouldn't answer on the record is that I don't think a person can both follow evangelical beliefs closely and be an ethical therapist. I think many evangelical therapists choose to ignore or suppress the impulse to try to convert everyone in order to be an ethical therapist. In other words, think it might be impossible to be both ethical therapist and a good evangelical Christian. Wow.

  Carrie Wiita [01:17:37]:

  Yeah.

  Ben Fineman [01:17:38]:

  Yeah.

  Carrie Wiita [01:17:40]:

  I mean,

  Ben Fineman [01:17:41]:

  sounds about right. Yeah. So thank you, Tom, for your feedback. And thank you for sharing your perspective without telling us how much we suck because we don't agree with you.

  Carrie Wiita [01:17:51]:

  Not that we're not open to all feedback.

  Ben Fineman [01:17:53]:

  Right, Ben? I I will be honest. Like, when we started this podcast, I took every email. I know. I took it to heart. I wrote out thoughtful responses. I know. And now it's like if somebody is just projecting their own anger about something onto us and they're not coming at it with curiosity, or kindness is just telling us why we suck. Yeah. I'm over it. I'm just over it.

  Carrie Wiita [01:18:18]:

  I got I gotta be honest. It blows my mind that, like, a free podcast. Like, it's free. I've I've never been moved to write an angry email.

  Ben Fineman [01:18:30]:

  to somebody who's making something that for free. But it makes sense. Like, if if you feel like somebody is causing harm because they're putting something out in the world that strongly goes against what you know.

  Carrie Wiita [01:18:41]:

  Oh, I'm not talking about I'm not talking about those. I'm talking about the ones that are like, Carrier Voice sucks. I'm like, stop listening then.

  Ben Fineman [01:18:51]:

  I know. I have this this fleeting thought. I've never done this, but I have this fleeting thought of responding and being like, I'm so sorry you had a bad experience. We'll happily send you a refund. Please let me know where to send the money that you could be good. Bye. That's that's when I I think I give up when I've just gotten so snarky that I'm responding with sarcasm to our agreed audience.

  Carrie Wiita [01:19:13]:

  There was one not too long. Somebody had a god, I hope you're still listening because you're you have no idea how how much fun I had with this. But one one one of the emails we got was very concerned about my relationship with my brother -- Oh, yeah. -- after Pat, friend of the show.

  Ben Fineman [01:19:31]:

  Yeah.

  Carrie Wiita [01:19:32]:

  I had had a good time with that one. Yeah.

  Ben Fineman [01:19:35]:

  Boy, oh, boy. Should we end the episode before we get ourselves in trouble somehow? Yeah. Yeah. Yeah.

  Carrie Wiita [01:19:41]:

  We've already done that. then. Thank you for listening to very bad therapy. The views and opinions expressed do not constitute therapeutic or legal advice nor do they represent any entity other than ourselves or our guests.

  Ben Fineman [01:19:59]:

  Visit us at very badtherapy.com for more content, ways to support the podcast, or to let us know a few of a story you'd like to share on the show. If you'd like to join our Patreon community and get access to our monthly bonus episodes, check us out at patreon.com/verybadtherapy.