Let's TalkLet's TalkDirectories own the search results, insurance panels set the price, and the platforms restrict the targeting - which leaves three levers and most practices pull none of them.
For most of the searches that matter, the first page belongs to directories rather than practices. We will show you which queries you could realistically own, which you cannot, and what your directory listings are actually delivering compared with what they cost.
Four failures we see repeatedly in this vertical, and what each one actually costs.
Search for a therapist in almost any city and the first page is directories, not practices. A practice competing head-on for those terms is bidding against businesses whose entire model is owning them. The winnable ground is narrower and more specific - modality, population, presenting problem - and almost nobody targets it deliberately.
Panel reimbursement decides the session fee, which leaves volume as the only lever and caps what you can spend acquiring a client. Practices growing margin have built a private-pay layer, usually around specialisation, and market it separately from the panel work rather than hoping clients find it.
Advertising that implies knowledge of a person's mental health condition is prohibited, targeting options are deliberately limited, and creative that names conditions directly gets rejected. Most mental health advertising that performs is advertising that will eventually be restricted. It is workable, but only if written to the policy rather than corrected after it.
For addiction and some intensive outpatient programmes, Google requires LegitScript certification before ads will serve at all. It is an application process, not a setting, and it catches out treatment centres that budgeted for a launch date without knowing the gate existed.
Business outcomes rather than dashboard metrics. None of these is a guaranteed number - where we do guarantee something, it is written into the offer above.
The real deliverables, not a list written to make a proposal look thicker.
Not the general agency pitch. The reasons that only apply to this kind of business.
Clients choose a person to talk to, not an organisation. Detailed clinician profiles - specialties, approach, who they work best with, availability - do more to convert an enquiry than any practice-level message. We build the marketing around the people, because that is how clients actually decide.
In a group practice some clinicians often have waitlists while others have openings. Generic marketing sends demand to the busiest names. We aim campaigns at the specialties and clinicians with capacity, and give every new hire a plan to reach a full caseload rather than leaving them to wait.
Retargeting a person across the internet because they read a page about depression or trauma is invasive, even where it might be technically possible. It erodes exactly the trust a therapy practice depends on. We keep sensitive pages out of any retargeting entirely, and build demand through content and search instead.
Which searches the directories have locked up and which a practice can realistically own - usually modality, population and presenting problem rather than the generic terms.
What your listings deliver per enquiry against direct acquisition. Sometimes they are good value and sometimes they are a subscription nobody has reviewed in years.
Specialisation marketed on its own terms, because panel reimbursement caps what the practice can earn and therefore what it can spend to grow.
Creative that does not imply knowledge of a condition, produced against the policy rather than corrected after rejections that also slow the account down.
In this category a delayed reply does not postpone the client, it loses them - often to whoever answered first while they were still willing to ask.
The parts of this that come from having run it in this industry before rather than from running it well in general.
Someone reaching out for therapy has frequently hesitated for a long time, and the response they receive shapes whether they follow through. A warm, human, prompt reply - and an intake process that does not feel like paperwork - converts more enquiries into first sessions than any change to the advertising.
Employee assistance programmes, primary care practices, school and university counselling services all refer clients onward and often lack good local options. Relationships with them bring steady, well-matched referrals that no search campaign can replicate - and they rarely appear on a marketing report.
Clients who feel well matched with their clinician are more likely to keep attending. Matching thoughtfully at intake - rather than simply assigning the next available slot - supports continuity for the client and steadier caseloads for the practice. It is an operational choice with marketing consequences.
Persistent waitlists for particular specialties show exactly where to hire next, and where marketing spend is currently wasted. Pairing that signal with the capacity data from the rest of the practice turns hiring and marketing into one decision rather than two made separately.
Not a mental health practice, and in this category we would rather be conservative about comparisons. The transferable element is the compliance and measurement work: an account kept live across a multi-state expansion, with the conversion on the booked appointment rather than the form fill, cutting cost per lead 57% in two weeks. Where the platform rules are this restrictive, an account that keeps running is a large part of the outcome.
Read the full case studyWe were bidding against Psychology Today for our own name terms. Nobody had said we could not win that.
Our ads kept getting rejected and we did not know why. It was naming the condition in the headline.
Building a private-pay specialty line was the only thing that moved our margin. The panels will not.
Not for the generic terms, and it is better to accept that than to spend against it. Directories exist to own those searches and they are very good at it. What a practice can win is specificity - a modality, a population, a presenting problem, a niche the directories treat as a filter rather than a page. That ground is narrower, cheaper and converts better, and almost nobody targets it deliberately.
Measure them rather than assume. For some practices they are the most efficient acquisition available; for others they are a subscription nobody has reviewed in three years while delivering enquiries that never convert. The comparison worth making is cost per started episode of care from the directory against direct acquisition - not cost per enquiry, which flatters the directories.
Advertising must not imply knowledge of a person's mental health condition, which rules out the direct second-person framing the category reaches for instinctively. Targeting options are deliberately limited, and creative naming conditions in headlines commonly gets rejected. What runs is describing what the practice does and who it helps, rather than addressing what the reader supposedly has.
If you operate addiction treatment or certain intensive outpatient programmes, very likely yes - Google requires it before the ads will serve at all, and it is an application process rather than a setting. A standard therapy or psychiatry practice generally does not. We check before a campaign is built, because it is the most avoidable launch delay in this category.
Because the willingness to ask for help is often temporary. Someone who enquires about therapy and gets a reply two days later has frequently moved on, and not to another provider - they have simply stopped. A response within minutes rather than days is not a conversion optimisation in this category so much as the difference between a client and nobody.
The board that governs your advertising depends on the licence you hold and the region you hold it in. These are the states we have written up.
Written for owners weighing this up, whether or not they work with us.
This is one part of a bigger service. Here is the whole of it, and the closest neighbours.
No pitch deck, no discovery call you have to sit through. Tell us the situation and we will tell you whether we can help.