Chances are that an online review of a product or service has significantly influenced your decision to purchase something (or not purchase something) recently. In fact, one research study reports that 84 percent of Americans say online reviews influence such decisions (see www.saurageresearch.com/online-consumer-reviews-drive-sales/). Furthermore, 63 percent of customers say they are more likely to make purchases from a site that has user reviews (see mycommerce.com/blog/item/309-use-customer-reviews-to-drive-sales). Many marketing and research firms point to even negative reviews as a positive marketing opportunity. They suggest that the presence of negative reviews makes the reviews as a whole seem more realistic and believable. This opportunity can be especially beneficial if the business responds to negative reviews in a courteous and helpful manner.

No data exists on how reviews influence consumers’ choice of a counselor, so we don’t know exactly how these findings translate to our field. What we do know is that such findings are pretty consistent across the board for other businesses. In addition, the presence of a business on sites such as Yelp, Google Places and others, along with corresponding reviews, has been shown to be beneficial in terms of search engine optimization. This can result in a business appearing more prominently in searches. If we stop there, it would seem to be a no-brainer for counselors to participate in review sites and post testimonials on their own websites.

As professionals responsible for protecting client privacy/confidentiality and doing no harm, however, it’s imperative that we not stop there. Instead, let’s start with the ACA Code of Ethics and see what it has to say about testimonials in Standard C.3.b.: “Counselors who use testimonials do not solicit them from current clients, former clients, or any other persons who may be vulnerable to undue influence. Counselors discuss with clients the implications of and obtain permission for the use of any testimonial.”

It is interesting to note that the second sentence was added in the 2014 revision of the ethics code. The summary is that counselors can use unsolicited testimonials as long as they have discussed the implications with the client and received his or her permission.

This would seem to create a very narrow window of opportunity. First, a client has to offer a testimonial, completely unprompted, and then still agree to its public use after the counselor explains how this use might affect the client’s privacy. Here begins an interesting dance between advocating for client autonomy and ensuring that no harm is done. Following are just some of the questions that might come up when exploring this situation.

• Is there any potential for harm, regardless of how minor, in asking the client if the testimonial can be placed online or in marketing materials?
• What is your responsibility for informed consent in this situation?
• Does the client understand the implications and potential ramifications of placing the testimonial online, even if the client’s name isn’t attached?
• Is the testimonial so generic that no one will possibly be able to identify the client? (Imagine that a client’s friend, boss or co-worker comes across the testimonial. Might they recognize who wrote it based on what is said?)
• If the testimonial is from one member of a couple or family you have worked with, how do the other family members feel about this? Should they not also be included in the informed consent?
• Do you or your business stand to truly gain anything from anonymous or anonymized testimonials? (I’m pretty certain that testimonials with real names attached to them carry much greater weight, although I wasn’t able to find conclusive data. For example, Amazon even goes so far as specially marking reviews from people who definitely purchased the product).
• How might the existence of testimonials affect other current and potential clients? Although we know reviews can be influential for many individuals, might the presence of these reviews also raise privacy concerns?
• Does any review or testimonial from one person truly represent how well you can establish rapport and an effective counseling relationship with another person, especially without revealing personal and confidential data?

It is especially important to explore these questions before making your decision because the primary motivation for using testimonials is to benefit your business. Meanwhile, there is likely little identified benefit to the client.

I’ll leave the exploration of ethics to the individual reader and instead focus on additional information and considerations, should the counselor decide to proceed with testimonials or need to address an online review.

Informed consent not optional

It is important to note that even if counselors don’t post testimonials or participate in online review sites, they still have responsibilities as long as they maintain an online presence. Specifically, in this age of online interconnectedness, it’s critical to have a social media policy. The ACA Code of Ethics even requires it. Standard H.6.b. (Social Media as Part of Informed Consent) says, “Counselors clearly explain to their clients, as part of the informed consent procedure, the benefits, limitations, and boundaries of the use of social media.”

Lest counselors insist that they don’t utilize social media (“I don’t have a website, Facebook, Twitter or other accounts”), it should be noted that the presence of a business on social review sites isn’t always voluntary. With a site such as Yelp, any user wanting to write a review can add a business. Keely Kolmes has an excellent example of a social media policy available on her site at drkkolmes.com/social-media-policy/.

Testimonial vs. review

Because we’re branching into reviews, let’s examine the two basic differences between testimonials and reviews.

1) Location: Testimonials typically will be presented by the business on its marketing materials (brochures, websites and so on). The business chooses which testimonials to use. Reviews, on the other hand, can be found on any number of websites that specifically offer reviews, on other social media sites such as Google Places, on blogs or even on someone’s Facebook wall.

2) Objectivity: Reviews are supposed to be objective opinions offered by customers. Reviews may be positive, negative or neutral. Testimonials tend to be hand-chosen, positive comments, often solicited for a specific purpose. Testimonials are a sales tool meant to highlight the benefits of the business, product or service.

As it relates to the ACA Code of Ethics, there is essentially no difference between reviews and testimonials. They offer an equal likelihood of compromising confidentiality/privacy or causing harm. This calls into question whether a counseling practice should be listed on sites such as Yelp at all. Because such sites exist solely for the purpose of people reviewing businesses, couldn’t listing your business there equate to soliciting reviews?

Regardless of your take on this question, we’ve already established that a business can end up listed on such sites involuntarily. So, given this gray area, how can counselors address reviews?

Acceptable testimonials

One way that I’ve seen counselors approach this issue is by seeking testimonials or reviews from other professionals. Nothing prevents us from soliciting such statements from colleagues and other professionals who are familiar with our work, in part because there are no privacy concerns to be addressed.

Although there is some question about whether this is as effective as a review from someone who directly participated in counseling with you, it is likely to have some positive effect. When taking this approach, counselors should still clearly state what the relationship is between them and the person offering the testimonial. In particular, it should be abundantly evident that the reviewer is not a current or past client. Both for effectiveness and to avoid an ethical dilemma, it should also be clear from the description and testimonial why this other professional is able to speak to the counselor’s qualifications and abilities.

Proactive education

Counselors have the opportunity to provide a form of informed consent on many of the current online review sites. For example, business owners can “claim” their listing on Yelp, which enables them to post and edit information about their business and respond to feedback. Although the ACA Code of Ethics prevents us from doing the latter, we can make it clear that we operate differently from other businesses by doing the former. For example, in the statement about our business, we can inform readers that because of our responsibility for ensuring confidentiality and privacy:

• We are unable to respond to any review, positive or negative
• We encourage our current and past clients to, as difficult as it may be, address any questions, concerns or complaints about our services directly to us so that we may properly address them
• We encourage readers not to post a review, but if they feel that they must, to do so using every precaution to protect their identities (for example, by using a pseudonym and private email address and taking care not to reveal any personal information)

Roy Huggins, a licensed professional counselor and my co-host on Therapy Tech With Rob and Roy, has a great example of such a statement for his Yelp account, which he modified from Kolmes’ template. You can find a link to it and additional thoughts about the topic at http://bit.ly/1Fm6dbd.

As each counselor considers how to approach this situation, note that a Nielsen poll recently determined that “recommendations from personal acquaintances [were] cited as the most trusted form of advertisement by U.S. Internet consumers (76%). Forty-nine percent said they trusted consumer opinions posted online.” So, although the Internet and social media continue to grow in importance in the marketing realm, they still lag behind the effectiveness of solid word-of-mouth advertising.

I know I have clients who openly and gladly tell their friends, family members and acquaintances that they are working with me or have worked with me in the past. They are not concerned about keeping that information private or confidential, and I’m confident they would gladly offer a testimonial. So I don’t want to give the impression that this is an open-and-shut case against testimonials and reviews. I do think it is important, however, for counselors to think through all of the ramifications before going down that road.

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editor: ct@counseling.org