More and more therapists are coming to us with questions and observations about declining Psychology Today client referrals, saying that their traffic is down significantly and hypothesizing about the reasons.
These conversations are a result of our earlier posts noting that Psychology Today’s directory, long a top source of referral traffic for therapists, had dropped significantly, and considering possibilities for the reasons.
The issue is important because therapists have long believed that Psychology Today is, as it advertises itself, the No. 1 source for online referrals. If it’s not working any more, or not working as well as it did, — as many therapists have told us — then clients are not finding the therapists they may want to see, and therapists are not getting the clients they want to see. (Read our first post here and our second post here. If you have things to share, reach me by email at jeanne@clearhealthcosts.com or encrypted Signal 914-450-9499.)
Psychology Today answered our questions for our first post, saying that nothing has changed on their end in the listings. They did not respond to a request for comment on the matters raised in this post. We will update if they comment.
Platforms fill listings
Dr. Maelisa McCaffrey, a licensed clinical psychologist who counsels practitioners on documentation at QAPrep, said she had observed that, as per our earlier post, the mental health platforms — Alma, Rula, Octave, Grow and others — are filling up the Psychology Today therapist listings with profiles of their affiliated therapists. The platforms offer to manage a therapist’s Psychology Today profile and to pay for it. This can be exclusive, as in Alma owns and manages the therapists’s only profile, or there can be an Alma-managed profile in addition to the therapist’s own profile.
“The platforms are adding more profiles to PT (many times for therapists who already have an individual profile) so now therapists are essentially competing with themselves,” she wrote in an email. “As you noted, they put a positive spin on this by highlighting that they use different locations to target clients in different areas. However, that means nothing to the individual therapist when the person who answers the phone is a platform and they use that referral to simply fill their next spot. I see no indication that if someone calls a number managed by Rula, for example, that Rula would then guide them to the therapist on the profile. My sense is that Rula will refer them to the next therapist on their list (or their own algorithm will guide placement).
“I’ve heard from many therapists that after they cancel their membership with the platform, their PT profile managed by said platform is still up on PT for months. So they are competing with their own profile but the referrals are going to the platform. And the platform gets a huge benefit by keeping these active and simply owning a large share of the profiles on PT.
“I know therapists who have contacted PT and they are not helpful with this (meaning the ‘managed by’ profile stays up for months after the complaint), so it seems they have some incentive to ignore this obviously predatory behavior by the platforms.”
A Psychology Today profile costs $29.95 a month, promising unparalleled search engine optimization, filters for easy matching of therapist with client, an online free teletherapy platform, a protected phone number and more. Would-be clients can sort by location, insurance, gender, specialization, remote or in-person, faith and a number of other criteria, so matching the proper client with the proper therapist option should be easy.
‘People who don’t live here’
After our first two posts, I was inundated with emails and calls from people who had things to say. Most of them did not want me to use their names, saying they didn’t want publicity — either with clients or with Psychology Today. “My confidentiality is important to me,” one said. But some did say it is fine for me to use their names with their experiences. Here’s what people told me.
Sharon Harper, a licensed clinical social worker who practices in Williamsburg, Va., said a survey of the Zip code listings in her area points to the problem of platform and similar network profiles flooding the zone.
There are three Zip codes near her, she said: 23188, 23187 and 23185.
“Two of the three zip codes had hundreds and hundreds of names of people who don’t live here,” she said in a Zoom interview.
“Right now in the 23188 area code, with 20 therapists per page, there were 140 therapists. In 23185, they had 280 therapists.” She pointed out that many were from Lifestance or Thriveworks, which are nationwide networks for counseling — different from the venture-funded platforms like Alma, Grow and Rula, but similar in that they compete as groups for part of the mental health care market, pushing profiles of individual practitioners down in visibility. The therapist’s status on a listing as a nationwide network member, rather than a local practitioner in an individual or small-group practice, is hard to see without clicking through, she said, which many would-be clients may not do.
“Out of the first 10 profiles, 5 were with major companies,” she said. “By Page 4, there was a guy in Utah, so we have people from other states. Real therapists here in Williamsburg are competing against 320 therapists, and by page 4, we are talking to people from out of state.
“Real therapists like me can’t be found.”
(I did the same search in 23188, and the guy from Utah was on Page 6; when i did an incognito search, Page 4 had someone from Philadelphia and someone from Newport News, Va. and another from the same place.)
‘Something’s happening’
Referring back to our previous coverage, in which Psychology Today said they do not have agreements to advantage platform profiles, Harper said: “They might not have a specific agreement, but something’s happening.”
In the third Williamsburg zip code, 23187, she said, “there were less than 10 therapists on that page. It’s right next to me. But the companies haven’t found that Zip code yet.” When I did that search, there were 6 therapists in that Zip code and others listed as “nearby.”
In a later email, she added: “When I looked again at my zip code on PT this morning, the very first person appeared to be a Williamsburg zip code but when I opened their profile, they were actually located in Colorado. This made me think about what it might be like for a client, overwhelmed and reaching out for help, maybe for the first time, wading through pages with hundreds of therapists, only to find the first call is to someone who isn’t even local. Imagine. And it isn’t clear to users — the additional address was at the bottom, and they’ve already clicked on the person. How many give up after that? Maybe that also affects the PT outcomes. Makes sense that PT can still claim the number of people visiting, but therapists are not getting the conversions.”
One result of this is likely to be that a person looking for a therapist might easily see profiles for platform and national network therapists more than individual therapists. Platform therapists tend to be newly qualified: The platforms attract people who find the process of insurance credentialing difficult, and who are looking for quick cash-flow. An established solo-practice therapist with existing insurance credentialing intact, who may have a practice that is delivering cash-flow, is less likely to join a platform.
It is entirely possible that some of this is a result of changes in the industry. As the pandemic set in, therapy became Zoom-ified — a previously in-person therapy session moved online as a growing norm. Around the same time, the platforms — Alma, Grow, Rula etc. — and the larger group practices — Lifestance, Thrive — took on a larger share of the market, often hiring as 1099 or similar employees newly trained and less experienced therapists, thus taking a bigger market share from an ecosystem that had previously been largely dominated by individual practitioners in their offices. Platforms buying Psychology Today profiles will obviously diminish the visibility of individuals.
Another news development raised further concerns about the platforms like Alma, Grow, Rula, Octave and others. Alma was acquired by Spring Health, an employee assistance platform. This fulfills the business pattern predicted for the platforms: Set up, acquire lots of users and revenue, and sell to the fastest, highest bidder. Private equity and venture capital, of course, are not here to make mental health treatment great: They are here to make money. That’s not necessarily bad — it’s just a statement of fact, since that’s what investment does in a capitalist economy. The problems come when things like good mental health, therapist wellbeing, client privacy, data of both therapist and client, and other elements of the system fall into the hands of venture capital and private equity, where they may be used to make more money instead of making more mental health. Private equity involvement in fields like hospice, substance abuse and so on are similarly challenged, but if private equity is involved in making widgets, the downside is a worse widget, not worse mental health.
Referrals are zero
A second therapist, a clinician in the Midwest, speaking on condition of anonymity, wrote: “My referrals from Psychology Today were anywhere from 5 to 10 a year. For the last two years referrals from Psychology Today are zero. The last few calls that have come in over the last 2 years are all spam and sales for other professional businesses. Some brand new clinicians in my area, have been hired at online for profit companies/agencies. Several early career clinicians, with very little clinical training and experience, are hired, while charge $150 to $175 a session. Generally, out of pocket rate in the mid-west for early or mid-level clinical career is $100-$125 a session at best. Generally seasoned experienced clinicians, meaning 25 to 40 years or more of full-time clinical experience with extensive training, in the mid-west area generally charge $125 to $200. This nationwide host-provider/company is hiring early career clinicians, clinicians with 15 to 25 new clients scheduled to see them before they even met for training, within a week before the employment start date.
“Clearly something very fishy is going on if a clinician with 30 years or more of full-time clinical experience, trained in several approaches, well known in the local community, receives 0 contacts in over two years from Psychology Today, while several unknown new clinicians with little training and experience are filled with 30 clients in two weeks post hired not yet on insurance panels. Also, the newly hired clinician does no marketing. They just show up and meet the clients either remotely or at a community shared office.”
A third therapist, William Schroeder, owner of Just Mind Counseling in Austin, Tex., wrote in an email: “We operate a group therapy practice in Austin, TX with approximately 50 clinicians. Psychology Today is no longer a reliable lead source for many counseling practices, largely due to how VC- and PE-backed platforms are now leveraging it.” In a Zoom interview, he expanded on the topic. In addition to his group practice, he is also in a a mastermind group with 80-plus practices.
Schroeder noted that most P.T. therapists believe that some kind of change in their profiles, no matter how small, will boost their visibility. From his observations, he said, he surmises that the platforms and other big multi-state group practices are using some kind of agentic or mechanized means of making small updates across all profiles to achieve a higher ranking on Psychology Today. (Others told us they thought P.T. has agreements with the platforms to advantage those profiles, but P.T. told us that is not true.)
One result, Schroeder said, is that a person searching for a therapist is likely to be served more profiles from platform or multistate group practice therapists — who quite often are newer therapists, choosing platform and remote work as a contractor to get their practice started up with the advantages of fast credentialing and cash-flow. That will lead those clients to less experienced therapists — it being true that the smaller, one-person or local group practices do not have the same visibility. Schroeder has written about his view of the state of the industry on Medium.
‘Not genuine’
Another therapist, on condition of anonymity, wrote: “Since the profile doesn’t connect with a therapist but goes to the intake like, Rula/Grow/etc, therapist profiles will have every single insurance checked so they show up. And likely with the multiple profiles and the number of therapists they have, they cover every specialty and special population. Even though the searching client doesn’t realize they’re not necessarily getting that person. …
“So basically it’s so unethical and these companies are acting like they’re connecting clients with therapists but it’s not genuine. And here’s the kicker, they cull their networks once enough people are on board and only send referrals to therapists who will take the cheapest rate. So you find a specialist therapist on PT but call a Rula admin and they act like they’re that practice but likely say that therapist is full but we have someone else.”
Another therapist, a licensed clinical social worker who is licensed in Texas and New York State, but moved to New York State in June of 2024 and now practices exclusively virtually, wrote about weaker Psychology Today traffic: “I have been wondering. I am licensed in Texas and New York State. I moved to NY state in June of 2024. However, I kept my Texas listing … and use different avenues in the northeast. Over the last few years my part time client list has dwindled a bit. Because of health issues, I have not paid a lot of attention.
“However, in the past six to eight months, I have been actively working to bring my client up. I realized that I have not received a single recommendation from P/T in all of that time. In the past, I usually got at least a half dozen hits from people looking at profile and often would receive two to three contacts a month. … It is a little pricey when I am not getting anything at all for the monthly fee.”
Another therapist, who moved from Philadelphia to Phoenix last year, sent this chart of contacts and referrals from Psychology Today.
There are also a number of posts on social media with similar results, including this person citing low referral numbers and asking, “That’s like a whole 6% of my active clients- probably less of you count the people that meet made it to the first appointment. Does anyone have thoughts or opinions on the worth of keeping it or is it just kinda luck that I’m found in the sea of profiles?”
The Hemingway Report, an industry publication, has a post about Psychology Today reproducing a chart of P.T. traffic from the search engine marketing firm Semrush showing a drop in traffic.
Psychology Today endorsements
Another factor in traffic may be the “endorsement” function on Psychology Today. If therapists in a group are cross-endorsing each other, that seems to give a lift to their profiles, or at least add to the authority of their profiles. It thus seems to lessen the visibility of non-group or individual therapists.
Cindy Lineberger, a licensed clinical social worker from Hickory, N.C., wrote in an email: “Large agencies and multi-location group practices create visibility loops that are not obvious to consumers.” She noted that the platforms and other agencies can manage individual profiles, and that the P.T. filter doesn’t allow the option of choosing an agency or a private practice, “and thus gives the impression that each listing is a private practitioner even if it’s listed as their name or their business name.”
Smaller group practices do something similar by listing a practice profile that looks like a private practice, while also listing each clinician individually. Group names are often omitted; only a street address appears. Each profile is assigned a unique Psychology Today number, but these commonly route back to the same office. Because disclosure of group affiliation isn’t required, consumers would not know they’re seeing multiple profiles from the same agency.
“Endorsements amplify this effect,” she wrote. “Clinicians within the same agency regularly endorse one another, creating dense internal linking with no guardrails. In professional Facebook groups, it’s openly discussed that clicking profiles, requesting directions, or calling numbers improves visibility — something agencies can do internally and repeatedly, but solo practitioners cannot.”
One example she cited is local to Hickory, N.C., where she practices. A number of the individual therapists’ endorsements — most, it seems — are from fellow members of the practice, as identified on their profiles, or people whose office addresses match the office address. Most do not identify themselves as group member practitioners.
“My biggest beef is that it not only hurts honest clinicians like myself who play by ethical guardrails but it hurts consumers who believe they are seeing one thing but it’s not what they believe,” she wrote. “They don’t know the endorsements are employees, owners, or others who have a financial interest or affiliation. They see social proof and in today’s quick pace influencer world that matters. Great clinicians who don’t have endorsements are often bypassed b/c the number of endorsements play a big role in the profiles getting viewed. Like google are you going to trust a business with zero or 1 review or more even if mixed.”
(We are not naming the practice, since this does not appear to be illegal. Also, the endorsement pattern is repeated in other cities with other group practices, so singling out this one seems inappropriate.)
She said she had canceled her Psychology Today profile.
Spam and scams
Schroeder also said he and other therapists have noticed a substantial number of spam or scam calls coming in through their Psychology Today profiles — including one where the caller tried to convince him calling on his P.T. phone number that he had missed a subpoena to appear in court and that there was a warrant for his arrest. Schroeder said he thinks there should be a way for Psychology Today to squelch this kind of activity. He also said he has heard from other therapists who have lost considerable amounts of money in such scams.
Others said they get frequent spam calls on the P.T. number for office space, website updates, practice tools and so on — more of this type of call than from actual clients seeking treatment.
One therapist wrote: “I do get a lot of spam but I can’t confirm it is from them. The number I have on PT is now my virtual assistant’s, not mine.”
This spam complaint is a fairly common complaint in the online world. At some point, your membership in a group or forum begins to serve as a way to deliver your phone or email to service providers who want to tell you how great their stuff is — client outreach, revenue cycle management, etc. — meaning your information is used and scraped and often sold to others. Or, said differently, you are the product.
When AI delivers referrals
Interestingly, AI tools like ChatGPT are delivering more and more referrals, according to anecdotal reports from therapists reaching out to us. We’re not clear on how that works, but at least one industry observer has seen the trend and predicts it is about to explode.
In a prediction in a future report, Hemingway Reports predicted:
“ChatGPT, Claude, and other general-purpose AI assistants emerge as a major referral source for mental healthcare.
“Everyone is using an LLM. And they’re talking to them about their mental health.
“Jackie Ourman, Therapist and Founder of the Social Connection Collective articulated it well: “People are already using general AI tools for emotional support and companionship, and in 2026 that behavior is likely to grow dramatically. Large language models are becoming a place people turn when they feel overwhelmed, lonely, or unsure how to handle the normal challenges of real human relationships.”
“But the makers of these LLMs don’t want to hold mental health risk.
“OpenAI’s recent announcements make that very clear. They are already facing several large lawsuits for the mental health risk they allegedly create. So, they are developing pathways to refer people to professional help. In 2026 millions of people will use these tools to chat about their mental health, and the tools will partner with third parties to refer them out to support. We are already seeing evidence of this through OpenAI’s partnership with Throughline [a crisis line]. This dynamic will make general-purpose LLMs a significant referral source for therapy and other mental health services.”
(Hemingway also predicted: “The growth in therapy volume will slow in 2026, due to economic and cultural headwinds” and “One-size-fits-all mental health platforms will lose market share to companies built for specific populations.” The entire “13 Predictions for the mental health market in 2026” is worth a read.)
More big groups
When more big groups have a presence, either inside of your health insurance company or in the Psychology Today listings, that takes traffic away from the small individual providers who formed the backbone of the therapy industry for so long.
“Vertical integration” is the phrase used to describe things like UnitedHealth acquiring Refresh Mental Health in 2022. Refresh had a network of 300 locations across 37 states, offering services including psychiatry and substance abuse treatment. When United bought Refresh, that meant that the 300 locations were serving United. So a patient might enter Refresh-United, be seen by a Refresh-United provider, and have the bill paid by Refresh-United, without ever seeing anyone else.
(Read our first post here and our second post here. If you have things to share, reach me by email at jeanne@clearhealthcosts.com or encrypted Signal 914-450-9499.)
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Related:
Therapists say Psychology Today referrals have dried up, and express concern
Therapist forums buzzing over drop in Psychology Today referrals
Therapists have misgivings on the platforms: Alma, Headway etc. and the business of therapy
UnitedHealth-Optum pay cut makes clinicians reassess value of tech mental health platforms
