The review a therapist cannot answer, and what to build instead.

A two-star review appears on a therapy practice's listing. The instinct is immediate and it is a good instinct: reply politely, take the tone down, show anyone reading that the practice is reasonable. In almost every other industry that is the correct move and it works.

In mental health it is the one move you cannot make, and the reason is not tone. It is that a reply confirms the relationship.

When you respond to a review, in any words at all, you are publicly acknowledging that this person was in your care. That acknowledgement is a disclosure of protected health information, and it is yours, not theirs. The reviewer chose to disclose something about themselves. They did not give you permission to confirm it, and the fact that they disclosed first does not transfer that permission to you.

This catches the good reviews too, which is the part people miss. Thanking someone publicly for a five-star review confirms exactly the same thing as replying to a bad one. The warmth of the exchange does not change what it discloses.

There is a second layer that closes the other half of the playbook. The APA Ethics Code, Standard 5.05, prohibits psychologists from soliciting testimonials from current therapy clients, and from anyone who, because of their particular circumstances, is vulnerable to undue influence.

The reasoning is worth stating because it is not bureaucratic. A therapeutic relationship has a power differential built into it. A client asked for a favour by their therapist may feel that saying no has consequences for their care, and may not be able to tell the difference between wanting to help and feeling obliged to. The rule exists to remove that position from the client entirely, which means it is not something a well-worded request can solve.

Former clients are not covered by the same explicit prohibition, but the vulnerability analysis does not stop at discharge. Someone who may return to care, or who is still processing the work, is not obviously free of undue influence. The safer reading is that the whole testimonial channel is closed to a mental health practice, and treating it as closed costs you nothing you cannot replace.

So take the standard local marketing playbook and remove: asking clients for reviews, replying to reviews, quoting testimonials, and showing case results. What remains looks thin at first glance and turns out to be sturdier than what was removed.

On reviews specifically, there is one thing you can do, and it is worth setting up before you need it. Publish a standing policy rather than individual replies. A single statement, visible on your site and used identically everywhere, saying that the practice does not confirm or discuss whether any individual is or has been a client, and giving a direct route for anyone with a concern about their care.

That statement does the work a reply would have done, without the disclosure. A reader who sees it understands immediately why there are no responses under the reviews, and the silence stops reading as indifference. Keep it identical for every review, positive and negative, because a policy applied selectively is not a policy.

Then build proof through the channels that are actually open, of which there are three worth the effort.

The first is referral from colleagues, which for this profession is not a nice extra but the primary channel. A referral carries more weight than any review, because it comes from someone who understood the case and made a professional judgement. It also compounds: colleagues refer repeatedly, reviewers write once.

The second is your own thinking, published. Not advice, and not technique the reader is meant to apply alone, but how you reason. What distinguishes one approach from another and why you work the way you do. What a first session actually involves. How long a process tends to take and why any honest answer to that is imprecise. What therapy does not do. When you refer out.

The third is professional visibility of the ordinary kind: writing, teaching, supervision, speaking to other clinicians. It is slow, it does not spike, and it is the thing that makes referrals arrive without you asking.

The commercial argument for all of this is simpler than it looks. Reviews are a channel where you cannot compete, by rule. Referral and reasoning are channels where the constraint does not apply to you and where your actual skill is the input. Spending effort where you are allowed to be excellent beats spending it fighting a rule that is not going to move.

The honest note, and here it argues hard against my own trade: if anyone offers your practice a reputation management package built on collecting and responding to client reviews, that is not a marketing service with a compliance footnote. It is a licensing risk with your name on it, not theirs. Ask any provider what they know about the testimonial rules for your profession before you discuss anything else. The answer tells you whether the rest of the conversation is worth having.

A necessary note. This piece reflects the APA Ethics Code standard on testimonials and generally published guidance on confidentiality in practice marketing, as available in August 2026. It is not legal advice. State licensing boards set their own advertising rules, HIPAA obligations apply independently of any ethics code, and your board and your own counsel are the authorities on your situation.