Therapist forums are buzzing about our piece on the drop in Psychology Today referrals, and emailing and clicking on over to read and share their thoughts.
The piece from December documented the situation: The Psychology Today directory of therapists has worked so well for so long that it’s often the primary or only place a therapist is listed online for easy discovery by potential clients. But in the past year or two, therapists have started to complain in online forums and elsewhere that they’re not getting the traffic they used to get. Psychology Today, in email comments responding to our queries, said they have changed nothing.
Claiming to be the largest such site with 80,000 therapist listings, Psychology Today offers for a $29.95 monthly charge not just a listing with a therapists’ introduction, intro video, insurances accepted, address and free messaging or phone listing for a potential introduction, but also a free privacy-compliant telehealth platform and secure client messaging. People looking for a therapist can filter by geographical region, specialty and insurances accepted, as well as things like gender, therapy type, age, ethnicity, languages spoken, sexuality and faith. This is intended to make therapist-client matches better and faster.
But therapists continued to tell us they are seeing a dropoff in referrals they get from the service. Many pointed out that the referral market has many sources — where once Psychology Today was the predominant force — and is thus increasingly fragmented. All spoke on condition of anonymity, saying that they thought that being outspoken could draw unfavorable attention. (Read our first post here. If you have things to share, reach me by email at jeanne@clearhealthcosts.com or encrypted Signal 914-450-9499.)
To 40, from 357
A 30-something licensed marital and family therapist (L.M.F.T.) practicing in California sent an email in which she showed screenshots of her profile’s performance. The numbers: 2020, 94 contacts; 2021, 357 contacts; 2022, 161 contacts; 2023, 72 contacts; 2024, 85 contacts; 2025, 40 contacts. The profile snapshot also shows the total number of views of her profile — called “results views” — dropping. She wrote: “The results view goes from 32k in 2020 to 2,600 in 2025 which is a significant decline. I have also noticed an increase in spam calls [from service providers] that is 90% of the referrals I get from psychology today these days.”
A psychiatrist wrote to thank us for the post and added: “I just started my practice in 2023, just before the downturn — and I thought it was just me. I don’t know what to do next exactly, but I’m so glad to read it, recommended by a friend, and know I’m not alone!”
A PhD psychologist from California wrote: “My practice is primarily for neuropsychological assessments. … I have been in practice for 28 years. I have noticed a deep decline in referrals from Psychology Today and a much higher number of people who found me in ChatGPT. It’s a new world….”
A California marriage and family therapist wrote: “I’ve noticed a decline in my Psych Today referrals even as a specialist in high demand. It’s been so steep I honestly forgot about my subscription until I saw the email” from a colleague mentioning our post.
Zero, or one or two
Another California L.M.F.T. wrote: “Got as many as five contacts per month August 2022 until late 2024. Have gotten zero clients since then. Have tried several options to revive referrals.”
A third California L.M.F.T. wrote that she gets one or two referrals a month, which does constitute a drop, and added: “But the majority of my referrals — luckily — comes from colleagues and existing clients, followed by Google searches (I have a Google My Business profile).”
A California PsyD said he is a group practice owner. In addition to his own practice, he has a couple of supervisees and a works with a fellow licensed psychologist who has a few supervisees of his own. He has used Psychology Today for six years, he said. Our post really resonated with him, he said: In 2023, “I really started to notice a dip in traffic and the amount of outreach i was getting.”
He asked around, and some people said “it’s just fine” but “most other folks I was talking to were telling me the same thing” about a dropoff.
His numbers from his profile: 2020, 120 views; 2021, 130 views; 2022, 128; 2023, 59; 2024, 53; and 2025, 28.
Platform profiles ascendant
“The other thing that really alerted me to something going on,” he said, was that he was looking for a therapist for himself on Psychology Today, and during his search it felt like three-quarters of the profiles that he clicked on would say “managed by Rula” or another platform.
Other therapists told us before something similar: They know that the mental health platforms that have sprung up with venture or private equity funding — Alma, Grow, Headway, Octave, Rula and others — often manage profiles for their therapists. Some hypothesize that Psychology Today has business arrangements with the platforms, and that those arrangements have some way of advantaging platform therapists — placing their profiles higher in the listings than non-platform ones.
Psychology Today told us specifically that they do not give an advantage to platform therapists’ profiles. (Read our first post here. If you have things to share, reach me by email at jeanne@clearhealthcosts.com or encrypted Signal 914-450-9499.)
Seeking to cancel
An L.M.F.T. practicing on the West Coast and virtually wrote to us that she had sought to cancel her membership, and Psychology Today responded by asking her to renew. She said she had then written to Psychology Today inquiring if third-party companies like the platforms are working with Psychology Today to get profiles of their therapists boosted higher over those of therapists not working with those companies.
Psychology Today responded to her in writing: “While there is some chatter in various forums, I assure you that we do not prioritize profiles based on who pays for the profile and do not have partnerships with ‘Venture Capital firms’. While larger networks may generate more buzz, they typically represent only a small portion of the overall directory. Clients tend to be discerning, and we make sure to clearly distinguish network profiles for transparency.”
This may be a form response; in her query, she did not mention “venture capital firms,” but rather “third party companies.”
She wrote later: “I am so grateful that I am not trying to start a career as a therapist today with so many copycat ‘virtual’ organizations and AI ‘therapist’ platforms. I think with covid forcing all of us to become virtual therapists, a huge market potential opened up that allowed for venture firms to capitalize on the ‘virtual platform.’
“This has really done our profession a deep disservice. I really feel for young LMFT’s just getting their careers started with so much competition that is not based on quality care.”
Psychology Today response
In response to a question to Psychology Today asking if they can explain why some see drops and others don’t, for our previous post, a Psychology Today spokesperson wrote, on condition of anonymity:
“There have always been differences in how many contacts individual therapists receive. Profiles that are complete, client-focused, transparent, and professionally presented — including strong photos and video — tend to perform well. That has always been consistent.”
Can Psychology Today tell us any reason for such a drop? Most of these therapists are longtime customers and are surprised.
“We periodically update our algorithms to improve the consumer experience and provide more balanced choice, rather than concentrating traffic in one direction,” the spokesperson wrote. “However, there has been no overall decline in directory visits and no material change in total contacts. Individual fluctuations do occur, but they do not reflect a system-wide shift.”
Sussex Publishers is the company that has published Psychology Today magazine since it acquired the magazine in 1991. Sussex Directories, which runs the find-a-therapist directory, is a technology company, the spokesperson said, creator of the directory interface and of other directories available in the U.S. and in other countries. The two companies have common ownership; according to its terms of use page. Sussex Directories is based in George Town, Grand Cayman, in the Cayman Islands. One advantage to being based in the Caymans is tax avoidance.
Role of platforms
I asked Psychology Today to explain its relationships with platforms like Grow, Rula, Alma, Octave and so on.
The spokesperson’s answer: “Psychology Today’s directory is designed to present consumers with the full range of their therapy options and allow them to choose what works for them. The networks you mention offer therapy — often online and frequently covered by insurance — and for many people they are an important part of the landscape. For that reason, they are included in the directory.”
I asked: “I see that they have arrangements with you whereby they can manage a therapist’s profile. How does that work?”
The spokesperson’s answer: “We provide the same directory tools to individual practitioners and to organizations that support therapists. Networks may manage profiles on behalf of therapists, but each profile is created one at a time and is subject to the same standards and rules as any individual listing. Maintaining the integrity and fairness of the directory is essential, and all participants operate under the same terms.
“To be clear: everyone pays exactly the same price for a profile. There are no exceptions, no preferential rates, and no ‘inside deals.’ The price for a listing in Psychology Today has remained unchanged since 2004. We view the directory as a shared network: as more therapists join, the network becomes more valuable for everyone, and keeping the cost stable is part of our commitment to that principle. Psychology Today has been in business since 1967, and our approach has always been to act ethically and support the people who rely on us.
I asked: “Do those platforms receive advantageous placement for their therapists’ profiles because of their contracts with you? Are their profiles listed above non-platform profiles?”
The answer: “No. Network affiliation does not influence ranking or placement. All profiles follow the same visibility criteria. We do identify which therapists are in-network so consumers understand the type of services being offered and how they are accessed, but that information has no impact on ranking.
“It’s also worth noting that even after COVID and the growth of video-based therapy and AI tools, consumers still tend to prefer local, in-person therapists when available and affordable. Cost and insurance coverage play a critical role in those decisions, which is exactly where your mission at ClearHealthCosts aligns with ours: helping people navigate their options with greater transparency. It’s a daily challenge. We’ve been doing it for the last 20 years and expect to be doing it for the next.”
Competing listings
Of course, there are other competing listings and directories that may be siphoning off referral traffic from Psychology Today. For example, the online BetterHelp therapy provider has a seemingly inexhaustible advertising budgeet; one of the therapists we talked to said many of the podcasts he listens to have Betterhelp ads.
Many insurance companies have listings of therapists participating in their networks. But there has been a great deal of information about how those lists are “ghost networks” — when a potential patient tries to use the insurer’s listing of participating therapists, it turns out that many phone numbers are unreachable or out of date, or the therapists do not participate. See coverage here and here and here. A patient who encounters a ghost network might make calls to multiple providers seeking care, and not find anyone who has a working phone number, is in network and is accepting patients.
And if they work, the participating providers often don’t get the referral.
Insurance app
A Midwestern L.C.S.W. wrote: “Here’s a missing piece: United Healthcare has an app to directly link and easily schedule appointments with available behavioral health providers. They struggled with implementation in 2024 and were sending multiple referrals from the wrong states (I’m only licensed in Illinois). 2025 they changed the algorithm to send referrals to the soonest available in-state therapist. Since I have many immediate openings, I was getting dozens of referrals every month.
“Then suddenly last year they changed to algorithm again and now I get maybe one or two referral[s] per quarter. I have lots of available slots, open appointments every week. The lack of clients is forcing me into early retirement. I suspect all those referral[s] now go through platforms they are joint-invested in like Better Help.
“Also while United is competing with me, manipulating markets, and controlling referrals, they are squeezing me out of market share and business. Then they are simultaneously trying to recruit me to join them as an Optum provider paying half the hourly rate. Cigna has partnered with Headway or some other, who are recruiting me to work for them. I’m already a Cigna provider. why won’t they partner with me? That’s called vertical integration. This is why there are no longer any independent doctors. There’s massive amount of market manipulation, pay-to-play schemes, and monopoly collusion going on.”
From plenty to zilch
A 50-something associate marital and family therapist from the West Coast said she has been practicing for only a year. “In fact Psychology Today was my lead source in the first few months, say February-March roughly of last year,” she said.
“And then it stopped. I don’t have a track record, so I don’t know if it is normal.” She started hearing from people in her consultation group and online groups that they were having similar issues too.
“People say ‘freshen it up — if you make changes you’ll come back up to the top of the list. So I did, and got a couple more people come in. But then nothing. Then i freshened it up again — and nothing.” Combined with other marketing, she said, she’s not sure this is effective — though it’s not that expensive.
She said she’s been reflecting on marketing, as a new therapist, and trying to do more connecting with people — via support groups in her area of practice, volunteering and attending offline activities and events where she can meet potential clients, or developing a network for referrals from people who know her.
On LinkedIn, Kirstie Tuffs, who is a Licensed Independent Clinical Social Worker, wrote in a post: “Over the past 12–18 months, however, a growing number of experienced clinicians, many with long waitlists and no changes to fees, availability, or profiles, report a sharp and sustained drop in referrals from Psychology Today.
“👉 This is not a seasonal fluctuation.
“👉 This is not limited to one region.
“👉 And it cannot be easily explained by ‘profile optimization.'”
Of course, there are other sources of referrals besides Psychology Today — but that site has had supremacy in marketing for so long, billing itself as the “# 1 source of online referrals” that it has taken on the aura of the 800-pound gorilla. (Read our first post here. If you have things to share, reach me by email at jeanne@clearhealthcosts.com or encrypted Signal 914-450-9499.)
‘Sponsored results’
And of course “sponsored results” that come up higher on the Google search for “UnitedHealthcare find a therapist” might give precedence to one or several of the platforms — in my search on Jan. 13, Grow and Headway topped that search. (See screenshot.) The sponsored results are specifically the result of the sponsor paying for top placement.
But sponsored results and “Google Search” results are, well, different, and different for each searcher.
An incognito browser search put Rula at the top. (See screenshot)
Insurance companies have their own referral sources, including apps or on-site referral engines — “find an in-network therapist” functions like this from UnitedHealthcare. So a United enrollee might never venture onto Psychology Today.
There are also other networks, including Telemynd. This suggests that Psychology Today is losing market dominance in many ways.
“This new partnership allows Telemynd to provide mental health services to a network of over 82 million individuals,” according to an Oct. 24, 2023, news release about Telemynd partnering with UnitedHealth. “Other partnerships include Aetna, Horizon Blue Cross Blue Shield of New Jersey, Tricare and the Department of Veterans Affairs.”
Telemynd, launched in 2000 as a predictive analytics company aimed at improving the delivery of mental health services, says it connects patients with mental health services through its national network of licensed therapists and psychiatrists.
Owning profiles
Meanwhile, in a related development, the virtual care platform Octave is requiring applicants for at least one job to “give Octave consent to create separate profiles on external directories (including Psychology Today) to share with Octave clients.” In 2024, Octave closed a $52 million Series C round led by Cigna Ventures, the venture wing of Cigna.
The platforms, like Octave, Alma, Grow and Rula, have been offering to take over profiles of therapists practicing under their umbrella. As noted above, some people observing the problem speculated that this practice included some arrangement between the platform and Psychology Today to give precedence to platform therapists’ profiles. (Psychology Today says no.) In any case, the Octave therapist applicant is asked by the platform to give consent to create separate profiles on Psychology Today — and other directories — as a condition of employment.
Evernorth Behavioral Care, a wholly owned subsidiary of the big insurer Cigna, works closely with the Cigna Ventures-backed Octave, which calls itself “an innovator in outcomes-focused behavioral health care.” Octave claims on its site: “Most Octave patients pay just $28 per session with insurance. Octave offers evidence-based therapy with expert therapists, backed by outcome tracking and personalized care.” (Read our first post here. If you have things to share, reach me by email at jeanne@clearhealthcosts.com or encrypted Signal 914-450-9499.)
