Your stomach drops. Someone left a one-star Google review. Your first instinct is to defend yourself, explain what really happened, or point out that this person is misremembering. Do not do any of that. Here is why, and what you can actually say instead while staying fully HIPAA-compliant.
I will never forget my first negative review. I was three years into private practice, had dozens of happy clients, and then one morning I saw it: one star, a lengthy complaint about my "unprofessional" cancellation policy, and my name attached to it for the whole internet to see.
My hands were shaking as I typed a response defending myself. I was halfway through explaining that the reviewer had actually no-showed three times before I enforced my policy when a colleague stopped me.
"Delete that. You just confirmed they are your client."
She was right. And that near-miss taught me everything I am about to share with you.
The HIPAA Problem With Review Responses
Here is the thing most therapists do not realize until it is too late: HIPAA does not just protect medical records. It protects the fact that someone is your client at all.
When you respond to a negative review with any detail about the therapeutic relationship, you are disclosing Protected Health Information (PHI). Even confirming someone received services from you is a HIPAA violation.
This creates an incredibly frustrating situation. The reviewer can say whatever they want about you. They can lie, exaggerate, or misrepresent what happened. And you? You cannot correct the record without breaking federal law.
What Constitutes PHI Disclosure
- x Confirming someone was or is your client
- x Referencing any appointment dates or times
- x Mentioning treatment details or diagnoses
- x Discussing billing or payment disputes
- x Referencing conversations you had with them
- x Describing their presenting concerns
What You CAN Safely Say
- ✓ Thank them for their feedback
- ✓ Express that you take all concerns seriously
- ✓ Invite them to contact you directly
- ✓ State your general practice policies
- ✓ Describe your commitment to client care
- ✓ Offer to resolve concerns offline
Why Negative Reviews Hit Therapists Harder
For therapists, negative reviews carry a unique sting that other businesses do not experience. The therapeutic relationship is deeply personal. When someone publicly criticizes your work, it feels like an attack on your competence, your character, and your calling.
There is also the power imbalance. You know the full story. You know the context, the clinical rationale, and the boundaries you maintained. But you cannot share any of it. You have to sit with the frustration of being publicly criticized while holding your professional obligation to silence.
Add to this the fact that potential clients are reading these reviews to decide whether to trust you with their mental health. The stakes feel enormous because they are.
A Helpful Reframe
If you have never received a negative review, you probably have not seen enough clients. Every therapist with a substantial practice eventually gets one. It is not a sign you are bad at your job. It is a sign you are actually doing the job. Some therapeutic relationships end poorly. Some clients project their pain onto the therapist. Some people leave reviews that have nothing to do with the actual quality of care. This is normal.
HIPAA-Compliant Response Templates
Here are word-for-word templates you can use. These have been reviewed for HIPAA compliance and strike the right balance between professionalism and warmth.
Template 1: The Standard Response
"Thank you for taking the time to share your feedback. I take all concerns seriously and am committed to providing quality care. Due to privacy regulations, I am unable to discuss specifics publicly. If you would like to discuss your experience further, please contact my office directly at [phone/email]. I welcome the opportunity to address any concerns."
Template 2: The Empathetic Response
"I appreciate you sharing your experience and am sorry to hear you are dissatisfied. It is important to me that everyone who interacts with my practice feels heard and respected. While I cannot discuss private matters in this forum, I would genuinely like to understand your concerns better. Please feel free to reach out to me directly so we can discuss this further."
Template 3: For Clearly False Reviews
"Thank you for your feedback. I am unable to confirm or discuss any details about who I have or have not provided services to due to strict privacy requirements. If you believe this review was posted in error, or if you have concerns you would like to discuss, please contact my office directly. I am always willing to address questions about my practice."
Template 4: For Policy Complaints
"Thank you for your feedback. My practice maintains policies around [scheduling/cancellations/fees] that are standard in the mental health field and designed to ensure I can provide consistent, quality care to all clients. These policies are discussed at the start of any professional relationship. I am sorry if there was any confusion, and I am happy to clarify my policies for anyone considering services. Please feel free to reach out directly with questions."
Your Pre-Response Checklist
Before posting any response to a negative review, run through this checklist. Print it out if you need to. This is your safeguard against a costly mistake.
HIPAA-Safe Response Checklist
- ✓ Does my response avoid confirming or denying they were a client?
- ✓ Does my response avoid any specific details about treatment, dates, or interactions?
- ✓ Does my response avoid defensive or argumentative language?
- ✓ Would this response reflect well on me to a potential client reading it?
- ✓ Have I waited at least 24 hours before posting (to avoid emotional reactions)?
- ✓ Have I offered a way to continue the conversation privately?
- ✓ Have I had a colleague or consultant review my response?
When NOT to Respond at All
Sometimes the best response is no response. Here are situations where staying silent is likely the smarter choice.
Consider Not Responding When:
- - The review is clearly from someone you never treated
- - It appears to be spam or a competitor attack
- - The reviewer seems unstable or threatening
- - You are still too emotional to respond calmly
- - You already have many positive reviews that drown it out
Alternative Actions:
- ✓ Flag clearly fake reviews to Google for removal
- ✓ Ask satisfied clients to leave honest reviews
- ✓ Document the review in case of future issues
- ✓ Consult with a healthcare attorney if concerned
- ✓ Focus on building more positive reviews over time
How to Flag Reviews for Removal
Google does remove reviews that violate their policies, though the process can be slow and inconsistent. Reviews that may qualify for removal include those containing hate speech, spam, conflicts of interest, fake content, or reviews clearly intended for a different business.
To flag a review on Google, go to your Google Business Profile, find the review, click the three dots, and select "Flag as inappropriate." Be prepared to wait several weeks for a decision. If Google denies your request, you can appeal once.
Pro Tip: Document Everything
Screenshot negative reviews immediately, including the date and the reviewer's profile. If the review is later removed or the situation escalates, you will want this documentation. Some therapists keep a folder of all reviews, both positive and negative, for their records.
Building a Review Strategy That Protects You
The best defense against negative reviews is a strong foundation of positive ones. A single one-star review looks very different when it is surrounded by twenty five-star reviews. Here is how to build that buffer ethically.
First, make it easy for satisfied clients to leave reviews. Include a direct link to your Google review page in your email signature, on your website, and in any follow-up communications. Never ask for reviews during sessions, but it is appropriate to mention at the end of a successful therapeutic relationship that reviews help other people find the right therapist.
Second, time your requests wisely. The best time to ask is after a client has expressed gratitude or noted positive progress. Some therapists include review requests in their termination paperwork or post-therapy surveys.
Third, never offer incentives for reviews. This violates FTC guidelines and Google policies, and it undermines the authenticity of your reviews. Simply ask, make it easy, and let satisfied clients decide.
Ethical Review Building Checklist
- ✓ Add your Google review link to your email signature
- ✓ Include review requests in termination paperwork
- ✓ Never ask during active treatment sessions
- ✓ Never offer discounts or incentives for reviews
- ✓ Respond to positive reviews with brief thanks
Legal Considerations Beyond HIPAA
HIPAA is the primary concern, but it is not the only legal consideration when responding to reviews. Defamation lawsuits against reviewers are rarely successful and often backfire, creating more negative publicity. The legal standard for proving defamation is high, and courts tend to protect opinion-based statements.
Some therapists have considered having clients sign social media policies or review waivers. These are generally unenforceable and can create a negative impression with clients. The better approach is to focus on building a strong practice and handling reviews professionally.
If you are facing a review that contains false statements of fact that are causing demonstrable harm, consult with a healthcare attorney before taking any action. Document everything, but do not threaten legal action in your public response.
Managing the Emotional Impact
Let us talk about the real human experience of getting a negative review. It hurts. Even when you know intellectually that you did everything right, seeing yourself criticized publicly can trigger shame, anger, and self-doubt.
Give yourself permission to feel those feelings. Talk to a colleague or your own therapist about it. Do not let a review send you into a spiral of self-criticism or defensiveness. One review is one data point, not a verdict on your worth as a clinician.
If you find yourself ruminating on a negative review, set a boundary with yourself. Read it once, draft a response, have someone review it, post it, and then stop going back to reread it. The review will fade into your history, but obsessing over it will keep the wound fresh.
Self-Care Reminder
You became a therapist to help people. A negative review does not undo that mission or erase the clients you have helped. Take care of yourself the same way you would encourage a client to: with self-compassion, perspective, and appropriate support.
Frequently Asked Questions
Can I ask Google to remove a negative review?
Yes, but Google only removes reviews that violate their policies, such as spam, fake reviews, or hate speech. Negative but genuine reviews typically will not be removed. You can flag reviews through your Google Business Profile and wait for their review process.
What if the reviewer reveals they were my client in their review?
Even if a client self-identifies in their review, you still cannot confirm the relationship or discuss details. Their disclosure does not waive your HIPAA obligations. Respond with a generic template that does not acknowledge the therapeutic relationship.
Should I respond to every negative review?
Not necessarily. If a review is clearly spam or from someone you never treated, flagging it may be more appropriate than responding. For legitimate client complaints, a professional response shows potential clients that you handle feedback with maturity.
Can I sue a client for a defamatory review?
Technically yes, but it is rarely advisable. Defamation cases are difficult to win, expensive to pursue, and often generate more negative publicity. Courts protect opinion-based statements, and what may feel like lies to you may be legally protected as subjective opinion. Consult a healthcare attorney before considering this route.
How long should I wait before responding?
Wait at least 24 hours. This gives you time to process your emotional reaction and craft a thoughtful, professional response. Responding immediately while upset increases the risk of saying something you will regret or that violates HIPAA.
Key Takeaways
- 1 HIPAA applies to reviews. Confirming someone is your client, even implicitly, is a violation. Never reference specific details about the therapeutic relationship.
- 2 Use generic, professional templates. Thank them, express concern, and offer to discuss offline. Never defend yourself with specifics.
- 3 Wait before responding. Take at least 24 hours to process your emotions and have a colleague review your response before posting.
- 4 Build a review buffer. Proactively collect positive reviews from satisfied clients so one negative review does not define your online reputation.
- 5 Your response is for future clients. The unhappy reviewer may never be satisfied, but potential clients will judge your professionalism by how you handle criticism.
The Bottom Line
Negative reviews are painful, but they are manageable. The key is remembering that HIPAA protects client confidentiality even when clients themselves go public. You cannot defend yourself with specifics, but you can respond with professionalism and grace.
Your response is less about the unhappy reviewer and more about the potential clients who will read it later. Show them you are calm under pressure, respectful of privacy, and open to feedback. That is the real audience.
And remember: one bad review rarely defines a practice. What defines you is the pattern across all your reviews, and how you handle the difficult ones.
Managing Your Online Reputation Takes Time
TheraFocus helps therapists spend less time on practice management and more time on what matters: your clients. Our platform handles the administrative burden so you can focus on providing excellent care and building those positive reviews.
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The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.