Mystery Shoppers Make their Way to the World of Mental Health

The idea of the mystery shopper is fairly prevalent within the world of retail; paid professionals wander stores, seek employee assistance, and go through the motions of making a purchase, all with the intent of scoring the performance of the store involved and filing a report which can help the store to find new ways to improve. Those who are “tested” by mystery shoppers tend to be of mixed in their reaction to the idea; some see it as an honest opportunity to find potential problems, while others feel that it is an infringement on their trust and is a poor way to assess performance. Whether you’re for or against this method, if you’re a mental health professional, you may be hearing about it a lot more often.

The idea of the mystery shopper is being transferred to the platform of mental health treatments, wherein “fake” clients would be staged in care facilities and other treatment settings for the purpose of investigating the quality of care and the professionalism of those involved. The idea, strongly supported by Arthur Lazarus, an important figure within the psychiatry community, has been discussed in the journal Psychiatric Services, and may gain momentum in coming months as more and more therapists and mental health clinics seek to improve their offerings, both on the basis of integrity and under the increasing competition for clients.

Those who oppose the idea have suggested that the practice could present ethical problems within the sphere of psychotherapy and mental health treatment, including the possible issue of mystery clients using resources that those genuinely seeking help could otherwise use. As the debate heats up, it’s clear that the motion to start incorporating mystery clients isn’t final quite yet, but either way, this discussion may yield valuable insight into the ethics of sessions as well as the quest for strengthening professional skill.


Medical News Today. (2009, June 30). Psychiatric facilities encouraged to use “mystery-patients” to improve services. Retrieved from


© Copyright 2009 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • thomas


    July 6th, 2009 at 9:29 AM

    Actually, I think this is a really good idea, something that should be subsidized by state licensing boards to in effect test therapists. If all therapists knew they could have a mystery shopper evaluating them at anytime, there would be far less ethical violations and boundary crossings. Unfortunately, therapists are as in any other profession and therapists are not always motivated by pious ideals. instead therapists are too often guided by their own unconscious baggage that lead them to get their own psychological needs meet by their clients… if therapists cannot be required to do their own therapy, then this kind of oversight via mystery shopper should be considered a very good idea!

  • Austin


    July 7th, 2009 at 10:11 AM

    Who on earth is sponsoring these visits? Potential clients?

  • Melissa


    July 9th, 2009 at 5:47 PM

    I’ve had two people contact me recently for distance counseling who asked kind of odd questions about it, and neither one followed through. After the second one, I realized – they were probably “mystery shoppers.” Be prepared to ask questions of even casual callers/emailers.

  • Rick


    July 10th, 2009 at 1:12 AM

    To whom will these “shoppers” report? Also, if they haven’t got a “problem” but are just pretending to have an issue, then how can they evaluate if they have been helped or not?

  • Melissa


    July 10th, 2009 at 8:14 AM

    Good point, Rick. I think what’s closer to my experience is that they seemed to be collecting information with an agenda other than engaging a therapist. Each time I had agreed to contact the person by email after a few days, because they wanted to “think it over” and “compare counselors” (which are good ideas) – but the email addresses given were bogus.

    I apologize – wrong response to a “shoppers” post.

  • Lacey


    July 13th, 2009 at 6:30 PM

    I agree with thomas. Why shouldn’t therapists be kept on their toes? Getting too comfortable with your job and set in your ways makes Jack a dull boy (or Jill a dull girl). Knowing you could undergo this kind of assessment could motivate you to keep your skills sharp and up to date. Why fight improvement?

  • Melissa


    July 14th, 2009 at 4:27 AM

    I believe therapy is effective based on the quality of the therapeutic alliance – which is a matter of the development of trust. Admittedly, a stronger/deeper alliance is required with some clients than others. The development of the therapeutic alliance requires something unique in the presence of the therapist, which I believe is largely why some technically proficient therapists are not successful, and other perhaps less technically proficient therapists are very successful and help many people over the course of their careers.

    I would not feel free to go to the depths of alliance (requiring my commitment to a significant level and type of presence) necessary with a client if I knew he/she might be a mystery shopper. I engage sincerely, and expect my clients to do the same. My clients fill out paperwork, including a disclosure statement and contract for services. Isn’t it fraudulent to lie on such paperwork?
    At what point in the fake therapy would the assessment be made, and what would be covered? Is it appropriate to evaluate someone without their knowledge and knowing input? What if the fake client really became engaged, and “therapy” started which I thought was real (so I innocently continued in that vein), but the “client” got hurt because he/she wasn’t really there for therapy?

    Allowing mystery shoppers in the field of therapy would have a 2 part effect – supposedly on our future clients, but also on the therapist in terms of trusting that the client is who he says he is. I think raising that level of suspicion in the therapist can do nothing but cause damage.

    Finally, if I think of all the therapy sessions being conducted each day, the amount of abuse is very small. Although none should be tolerated, I question whether or not “mystery shoppers” are an appropriate avenue for reducing such abuse. What may be considered appropriate in the corporate world is not necessarily appropriate in therapy.

    There are at worst many hurdles to overcome in making mystery shoppers a viable part of the field of therapy. And at best, in my opinion, it would be impossible to overcome any of the hurdles. I believe it will ruin the field if such a thing is allowed.

  • HarrietR


    July 18th, 2009 at 9:41 AM

    With all due respect Melissa, what would be appropriate if not mystery shoppers for checking therapists? Or do you support no random checks ever on therapists.

    “Is it appropriate to evaluate someone without their knowledge and knowing input?” Therapists would be out of a job if not. They draw conclusions, make evaluations and don’t always immediately share them or their thoughts with the patient.

    A corporate mystery shopper doesn’t use the same checksheet for a visit to McDonalds as they would for a bank. I don’t see why the formula couldn’t be shaped to fit therapy as well. Would you be in favor if the state licensing board created and/or approved the framework for the checklist?

  • Melissa


    July 18th, 2009 at 12:31 PM

    Hi Harriet,
    Thank you for your reply, and your concern about this issue.
    Although it’s true that therapists make assessments of their clients that are not always immediately shared with the client – that’s the reason we have jobs, not a reason that rules us out! The huge difference is: that’s what our clients hire us to do – they have been unable to do it for themsleves, so they come to us for the assessment, treatment, and hopefully resolution of their difficulties.

    Also, they know ahead of time what they’re getting (all that and more is in my disclosure statement, along with how to register a complaint with my boss, my state Board, and any other appropriate governing body – in my case, the NASW and other organizations to which I belong). So I support full disclosure so the client can make an informed decision before deciding to work with me.

    You are correct – I do not support any kind of random checks on therapists, ever. I do support strong education in providing therapy, continual training in ethics/boundaries/documentation/malpractice issues/etc. I would also support a legal requirement that therapists have case supervision/consultation
    throughout their careers, not just for a few years.

    I would not sanction a Board developed assessment tool – there are too many inherent ethical and developmental difficulties to make a valuable, ethical, assessment tool possible, in my opinion.

    One last thought – when I think of the risk I’m taking – seeing mentally ill, traumatized, victimized, neurotic, or psychotic clients in a closed room with no window in the door – I’m the one taking the much bigger risk.

    I have enough basic trust and confidence in myself and my clients that if I’m who I say I am as a person and therapist, and if I provide full disclosure to the extent possible, the risk is not too high for me to want to contiue this wonderful work for as long as I can.


  • Honey


    November 14th, 2009 at 7:03 PM

    From what I’ve seen based after a recent Licensing Board complaint I had filed, there are not too many therapists out there that would have a problem passing an evaluation from a “mystery shopper”. The bar for unethical behavior is now set extremely low. A therapist literally has to harm at least a few clients before his/her license can be revoked. I was told by the Licensing Board investigator in my State that in order for insurance fraud to be proven several clients must first file a complaint about it. In my case two were not enough. The therapist had also violated non-sexual boundaries in several ways, including forming a dual relationship with me and I was again told I was only one person “complaining”. The therapist “got off” with an advisory letter and a recommendation to take ceu’s in client/therapist boundaries and in office practices.
    So ….not much to be concerned about…

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