Podcast Episode 12: Reviews

Enlightened Practice Podcast

Is word of mouth the best kind of review? Should you consider promoting reviews on public websites? Have you heard of insurance companies soliciting reviews of their clinicians? Sit back and relax while our hosts Dr. Ken Braslow and Dr. Kari Kagan cover these questions and more in this new episode of the Enlightened Practice Podcast.

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Transcript of the podcast

Ken: Hi Kari. Welcome back to the podcast.

Kari: Hi Ken. Thanks for having me.

Ken: Today we’re going to be talking about reviews and whether or not, as a clinician, you should be soliciting them, what we think about them conceptually, and where to go with all of this. In the old days, things were mostly word of mouth, and I would say mostly now that’s how it is in my practice. Most people come to me via word of mouth, but there’s a certain something to be said for reviews on public websites, social proof if you will. And you know, maybe help people pick when they’re overwhelmed and seeing a lot of different clinicians, and if somebody has good reviews, why not? And even insurance companies sometimes solicit reviews of their clinicians. 

Kari: Yes.

Ken: So, this is a little bit dangerous territory though because as opposed to like my dentist who has requested I review him on Yelp, as I’m walking out the door, we have to be really mindful of the challenges that we face in mental health and the overlap here of our business and our clinical work. 

Kari: Yeah. 

Ken: So, I would say, there’s different kinds of reviews that we should just be clear about. There are reviews where your business is being reviewed even if it’s about how you are as a clinician, that’s going under your business profile let’s say on Yelp or Google. And then there are non-public reviews that are outcome measures. I’m curious on your take on how you feel on… let’s start with the easy one, on non-public reviews outcome measures at the end of your work or halfway through your work with the client. What’s your take on those? 

Kari: Yeah. I think outcome measures can be really valuable clinical data. It’s not always easy for a client or a patient to give you direct feedback necessarily in a session. So, I think it’s nice as the therapist to provide an opportunity for clients to give you feedback in a more structured kind of way, like circling on a scale of 1-5 how satisfied are they and those kinds of questions, I think it can be really valuable for clinical information and also from a professional perspective. It’s important for us to understand what our client’s experiences are and that will help us learn and grow.

Ken: Okay. So, overall net-favorable on that? 

Kari: Yes.

Ken: What do you think about third-parties like insurance companies asking, let’s say it’s not going to be published publicly but for their own internal metrics, what’s your take on that?

Kari: I don’t have as much experience with how that process works with insurance companies asking their clients, if you will, to review the therapist that they’re seeing. I imagine it would be valuable information for a client to have access to that information, like what have other people’s experiences been with this therapist? I also don’t know how that works in terms of confidentiality. And also, I think the thing that’s kind of unique about therapy, although I guess it could be true for lots of professions, is it can be kind of subjective too. So, that’s where reviews are a little bit tricky, as one person’s experience could be really different than another’s. So, I just think it’s something that as you’re evaluating a therapist is worth considering, like there’s just unique experiences from each person’s reviews. I don’t know, as far as the insurance companies go, asking for reviews, I guess I can see the value in it to other clients who are considering starting with that therapist. You might have more experience with insurance companies. 

Ken: Well, I’m a little weary of what they’re doing with the data. Maybe it’s for the public good and that would be lovely, but are they using it to somehow set your rates to it down the road? The relationship with the insurance company is one of like overlapping zones of interest, but you’re not necessarily in alignment with them always. So, you don’t want that piece of data to drive a wedge in between the two of you should you need to come together, let’s say if there’s litigation or another non-optimal outcome where you want to be in alignment with them for whatever reason. 

Kari: Yeah.

Ken: That said, I think it leads to the bigger picture about reviews in general and the value of patients and clients publicizing good therapists or bad, but the overlap of how you’re getting that data out there. I guess, if a patient or client just on their own reviews you publicly let’s say on Yelp, for one, there’s nothing you can really do about it. So, maybe not much to say there, but should you be asking your patients or clients to do reviews or something more indirect like in the waiting room having a little flyer that says, if you had a good experience please review me here. If you didn’t, please discuss with me. Now it’s getting a little bit greyer. I think that it’s risky. For starters, what position does it put your client in if they don’t want to leave a good review, but they think you’ll be hurt or offended, or angry? And those are the issues they struggle with in the first place and it changes the therapeutic relationship from one of complete alignment to now you’re in opposition with each other.

Kari: Right.

Ken: Now, you could say psycho dynamically, that’s great. It’s more grist for the mill. They can process how uncomfortable they felt with you about your request to them. On the flip side, if they could do that in the first place they might not need you for therapy and that’s part of what they struggle with. 

Kari: Yeah.

Ken: So, it’s a precarious position to put the client in. And you think about restaurant reviews, most people leave one-star reviews and I think the second most common is five-star reviews. And then, a vastly lower quantity are three-star middle of the road because most people don’t go out, have an average meal and say, well, I’ve got to review that.

Kari: Right.

Ken: So, it’s like, what will you do if a review is left and it’s super positive, super negative, or in the middle? So, maybe we should go through that. Any other thoughts before we go to that, your thoughts on clinicians asking clients either directly or subtly for a review?

Kari: Right. Yeah, my initial thoughts on that are, the main issue that comes to mind for me is confidentiality. You would want to be really mindful to not make a client feel like they have to give a review just because you’re asking, especially if they prefer to be anonymous or confidential. So, I think that the client’s needs should definitely come before yours as far as the need for a review. So it’s just something, the ethics code of do no harm. So, if for some reason asking for that review would be harmful to the client in some way then I would caution against it. I think hearing a more indirect approach totally up to the client, that feels a little bit more like it doesn’t put a client in a position to have to say no, which could be really hard. And they can decide to do the review if they want, but they don’t have to. And they don’t have to directly say no, which can be really hard to do. 

Ken: Well, what would you think about a hybrid? If at the end of treatment they did a clinical outcome measure that you were going to do anyway for your professional growth and they said that they had a great experience, and you were terminating. At that point, do you think it’s reasonable to ask for a public review?

Kari: I’d have to think about that, but I still think because of the dynamic in the relationship between therapist and client, even though this is not necessarily true, but I think there’s a potential for the therapist to be viewed as an authority figure and in which case it just adds extra challenges to say no if you don’t want to disappoint your therapist. So, I think in general, I don’t want to put the burden on the client to have to say no, at any point, even at the end of therapy.

Ken: I think that’s reasonable. I mean, is there ever an end? 

Kari: Right, yeah. 

Ken: The door is always open for them to come back. Now do they feel they can’t come back if they didn’t want to do a review or were too busy?

Kari: Right.

Ken: Even if they wrote a good review, if they don’t know if it met your approval. 

Kari: Right.

Ken: And that creates anxiety. Okay, so, let’s say that you don’t ask for a review, but somebody posts a review spontaneously on their own or you did ask for a review. Either way, let’s run through the scenarios. Let’s say a positive review is left and you can tell because it’s not anonymous. You’re not posting anonymously usually. Would you say anything to the client at all?

Kari: I don’t think so. I mean, I think because of again, the nature of therapy and that confidentiality is an important thing. Whether it’s communicating through the domains, let’s say Yelp, or even if it was just on the side, I think in general, I wouldn’t necessarily initiate a casual conversation with a client outside of session, unless we have a plan to talk about some things. So, I would not necessarily do that in response to a review either. And yeah, through a public domain, of course, if I saw a client was unfairly disparaging, I think there are steps that someone can take through something like Yelp where you can request for a review to be taken down or something like that. I think there are some ways of navigating that in the case of a really negative review. But in the case of either positive or negative, I don’t think I would open the door to potential conversation between me and the client around the review. I guess, now that I’m thinking about it a little bit, I might send a quick thank you email just to acknowledge, but even then I’d have to think about it a little bit more. What are your thoughts there? 

Ken: I’m torn on this one. I feel like it’s a communication to you outside of session, and how would I handle any other communication to me outside of session? I would wait for the next session and then perhaps see what they wanted to talk about but maybe leave a little bit of time at the end to say, I noticed this review came in. I got alerted when it did and it’s under your name. Is this actually you and if so, would you like to discuss anything more about it? 

Kari: Yeah. 

Ken: I think if it were positive, I wouldn’t push them to tell me how glowing their experience has been. I think if it were negative, I might have a conversation with them about it. Not about the review, but about their experience and what it would have been like or meant to them to say that to me directly as opposed to indirectly and to try and use that material for their understanding and growth. 

Kari: Absolutely.

Ken: Assuming that I wasn’t so angry about the review that I wasn’t capable of continuing to work with them. And if I were, then I guess, I would process that with them and talk about the disconnect. What would you do if a patient left you a “fine” review? Not bad, but nothing great. Would you treat it any differently? 

Kari: Yeah. I mean, similar to what you’re saying, if they were an active client it would definitely be something worth at least opening the door to exploring in session together. If they were not an active client, I would probably just leave it and if they ever came back or something like that, then maybe it would be something worth talking about. Those are my initial thoughts to the average review. 

Ken: Yeah, that resonates. So, one more category of reviews and it’s not called reviews; it’s performance in practice feedback for the American Board of Psychiatry and Neurology. It’s one of the ways you can fulfill your continuing board requirements by asking patients to rate you. I’m curious, on the psychology side of things, if that comes up at all. 

Kari: Not that I know of. 

Ken: For licensure? 

Kari: Yeah, not that I know of. 

Ken: Okay. I feel like it’s interesting. This is a board that deals with psychiatrists and they’re okay with you asking for feedback from patients for your own purposes outside of the patient’s growth. In other words, if you’re telling the patient, I’m doing this so that I can continue my board certification. What is the patient supposed to think? Like, oh, if I don’t give you a good review you’re going to lose your board status and then go out of business and can’t work with me anymore. I’m going to ruin your career. 

Kari: Right, it’s a lot of pressure. 

Ken: It is a lot of pressure. So, I’ve hesitated to go that route with my clientele. There are other ways that we can maintain our board status without having to go that route. I’m curious if given the opportunity would you go that route with your clients at all or would you phrase it in such a way that this is primarily for my growth but also, I’ll be submitting this to my board certification body, or would you just skip it?

Kari: My answer might change on a case by case basis. I think in general, in the review topic, I err on the side of not asking because of the position it possibly puts the client in. Like you were just saying, responsibility, like, do I have to give you a good review or else there’s going to be a major consequence whether you lose your board certification or there’s some kind of relationship consequence. I think in general, I would err towards the side of not directly asking, but again, case by case because I can imagine there might be certain kinds of clients or like relationship experiences in which case it might, for whatever reason, feel more comfortable or make more sense to ask directly. But it would depend on a lot of different clinical factors.

Ken: Okay, so not a blanket approach but more of a case by case. I think that sounds reasonable. Okay Kari. Well, thanks so much for your thoughts here today. It was great chatting about this and looking forward to continuing our conversation soon.

Kari: Sounds good.

Ken: Take care. Bye. Kari: Bye.

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