Quick Answer
The most common reason in 2026 is a visibility gap, not a quality gap. Three structural shifts reduced client flow for most therapists: Psychology Today referrals dropped 77 to 94 percent, clients shifted to Google and AI search engines like ChatGPT, and platform companies increased competition. Therapists with full caseloads use 3 to 4 channels, not just one.
It is not just you
This is the most important thing to say upfront: if your practice is slow, it is almost certainly not about your clinical skills.
Across the profession, therapists are reporting the same experience. The inquiries slowed. The phone stopped ringing. The referrals that used to come in steadily just... stopped.
"It's been crickets for the last 3 months."
Therapist, r/privatepractice
"I went from 10 inquiries a month to maybe 2. I thought it was just me."
Therapist, professional forum (2025)
"Something changed and I can't figure out what."
Therapist, Reddit (2025)
You did not suddenly become a worse therapist. The landscape around you changed. The channels that used to deliver clients are delivering fewer of them. The ways clients find therapists are different than they were even two years ago. And the advice most therapists received in grad school about building a practice has not been updated to reflect that reality.
Here is what actually happened.
What changed (and when)
Three shifts happened between 2023 and 2025. Each one would have made it harder to fill a caseload. Together, they rewrote the rules.
Psychology Today referrals collapsed
Therapists report 77 to 94 percent drops in PT inquiries. Platform companies like Rula and Alma now manage thousands of profiles, crowding out independent practitioners. More therapists are listed, but fewer clients are starting their search on PT.
Clients started asking AI for recommendations
ChatGPT grew to 800 million weekly users. People ask it "find me a therapist for anxiety in Denver" and it recommends 3 to 4 specific providers by name. Most therapists are invisible to these tools because AI reads websites, not directory profiles.
Google changed how it shows therapy results
65% of Google searches now end without a click, thanks to AI Overviews and the local map pack. "Therapist near me" still gets 550,000 monthly searches, but Google increasingly answers the question directly without sending people to a website or directory. Your Google Business Profile now matters more than your website in many cases.
None of this is your fault. You did not go to grad school to learn SEO. The landscape changed faster than the profession could adapt. But understanding what changed is the first step to doing something about it.
The strategies that stopped working
These are the things most therapists were taught (or figured out on their own) about building a practice. They are not wrong. They are just no longer sufficient.
"Set up a Psychology Today profile and wait"
This used to work. PT referrals are now down 77 to 94%. The profile is still worth having, but waiting for the phone to ring from PT alone will leave your practice empty.
"Tell friends and colleagues you have openings"
Word-of-mouth referrals are valuable when they come. But they do not scale, and you cannot control when they arrive. A practice that depends entirely on who you know will have unpredictable income.
"Post educational content on Instagram"
Instagram builds brand awareness, not caseloads. Therapy clients search with intent ("I need a therapist now"). They do not scroll Instagram looking for one. The hours you spend creating carousel posts could do more on your website.
"Be patient, it takes time"
Patience without a strategy is just hoping. If you have been waiting 6 to 12 months with no active strategy beyond a PT profile and occasional word-of-mouth, waiting longer will not change the result. The landscape shifted. Waiting for it to shift back is not a plan.
"Just do good clinical work and clients will come"
Good clinical work keeps clients. It does not find them. The best therapist in your city can have an empty practice if nobody knows they exist. Visibility and quality are separate problems. You can be excellent at both.
"I didn't go to grad school to learn marketing."
The most common sentiment in therapist communities right now. Fair enough. But the landscape changed, and the therapists who acknowledge that are the ones with fuller caseloads.
How clients actually search for a therapist in 2026
Understanding the client's journey is the key to figuring out where your visibility gap is. Here is what a typical client search looks like now:
A typical client search in 2026
Client recognizes they need help (trigger event)
They Google "therapist near me" or "anxiety therapist [city]"
They see Google Maps results and AI Overview (no click needed)
Some ask ChatGPT: "recommend a therapist for [issue] near [location]"
They check the therapist's website (if one exists)
They read Google reviews
They reach out to 1-3 therapists who seem like a good fit
Notice what is missing from this journey: browsing Psychology Today. That used to be step 2. For many clients, it is no longer part of the process at all.
If you are invisible at steps 2, 3, 4, or 5, the client will never find you. It does not matter how good your clinical work is if you do not show up where clients are looking.
Where are you invisible?
For most therapists who are struggling to get clients, the answer is one or more of:
No Google Business Profile (invisible in Google Maps results)
No website (or a thin one) (invisible to Google organic and AI tools)
No Google reviews (invisible or low-trust in local results)
No structured content (invisible to AI search engines like ChatGPT)
Quick self-assessment: where is your visibility gap?
Answer these five questions honestly. Each "no" is a gap where potential clients cannot find you.
Do you have a Google Business Profile that is fully completed?
Without this, you are invisible in "therapist near me" searches (550K+ monthly)
Do you have a website with at least 5 pages (About, specialties, FAQ, contact)?
AI tools need content to recommend you. A one-page site gives them nothing to work with.
Do you have 5 or more Google reviews?
Google reviews affect both search rankings and AI recommendations. 5 is the minimum for credibility.
Are you listed on 3+ directories (PT, TherapyDen, insurance portals)?
Multiple directory listings increase the chances AI tools mention you (41% weight on list mentions).
Does your website have FAQ sections with clear questions and answers?
This is how AI tools extract and cite information. No FAQ = no AI recommendations.
If you answered "no" to 3 or more: Your visibility gap is likely the primary reason your practice is quiet. The good news is that every one of these gaps is fixable, and most of them can be addressed in a weekend.
Free: 2026 Practice Visibility Checklist
The 15-point checklist we use to audit therapy practice visibility. Goes deeper than the self-assessment above, covering Google, AI search, directories, and local SEO.
Free download. No spam. Unsubscribe anytime.
What to do about it (starting this weekend)
You do not need to become a marketer. You do not need to spend thousands of dollars. These are the highest-impact actions ranked by effort and return.
Start here (free, high impact)
Google yourself and ask ChatGPT about yourself
Open incognito mode. Search "[your specialty] therapist [your city]." Then ask ChatGPT: "Recommend a therapist for [your specialty] in [your city]." This shows you exactly what potential clients see (or do not see).
15 minutes
Claim and complete your Google Business Profile
This is the single highest-impact free action. Fill out every field: name, address, phone, hours, specialties, insurance, and a detailed description in your own words. Add photos.
30 to 60 minutes
Ask 5 clients for Google reviews
Google reviews matter more than PT reviews for search rankings and AI recommendations. At an appropriate point: "If you found our work together helpful, a Google review helps other people find us."
Ongoing, aim for 1 per month
Next level (some time investment)
Build a real website with specialty pages
Not a one-pager. Dedicated pages for each specialty, an about page in your own voice, FAQ sections answering common questions, and a contact page with full information. This is what Google and AI tools need to recommend you.
1 to 2 days (or hire it out)
List on TherapyDen and your insurance portals
Multiple directory listings increase your chances of being found by both search engines and AI tools. TherapyDen is free for a basic profile and growing as a PT alternative. If you accept insurance, make sure your portal profiles are complete.
30 minutes per directory
Make your website AI-readable
Write FAQ sections with clear questions and direct answers. Keep your name, address, and phone consistent across all listings. Write 500+ words on each page. This is not technical. It is writing clearly so AI tools can understand and recommend you.
2 to 4 hours
These steps compound. A Google Business Profile with reviews, a real website, and consistent directory listings create a visibility flywheel. Each channel makes the others more effective. After the initial setup, maintenance is minimal. This is not about becoming a marketing person. It is about being findable.
When to invest in professional help
The DIY approach works for many therapists. But there are situations where professional help is worth the investment.
DIY is fine if:
You have 5+ hours to invest upfront
You are comfortable with basic website tools
Your market is not extremely competitive
You can write content in your own voice
Consider help if:
You have been trying for 6+ months with no results
You are in a competitive urban market
Technology overwhelms you
Your time is better spent seeing clients
The ROI math
The average therapy client generates $3,000 to $8,000 in annual revenue. Professional SEO for therapists typically runs $300 to $800 per month. If it brings even 2 new clients monthly, the return is 8x to 20x.
The key is finding someone who understands therapy practices specifically. A generic marketing agency will not understand confidentiality concerns, clinical language, or the nuances of how therapy clients make decisions. Look for someone who works exclusively with therapists or healthcare providers.
A note on marketing agency claims: Be skeptical of anyone who guarantees specific results, uses jargon without explanation, or wants to lock you into a long contract. Good SEO takes 3 to 6 months to show results. Anyone promising page-one rankings in 30 days is not being honest.
Frequently asked questions
Why am I not getting therapy clients?
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The most common reason in 2026 is a visibility gap, not a quality gap. Three structural shifts reduced client flow: Psychology Today referrals dropped 77 to 94 percent, clients shifted to Google and AI search, and platform companies increased competition. If you rely on a single channel, your visibility has likely decreased.
How long does it take to fill a therapy caseload?
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Most therapists take 6 to 18 months, depending on location, specialty, insurance acceptance, and marketing effort. Therapists who actively manage their online presence across multiple channels fill faster than those relying on a single one.
Why is my practice slow?
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How clients find therapists has changed significantly since 2023. If your online presence is limited to a PT profile, you are invisible to Google Maps, AI tools, and anyone who does not browse that specific directory. The clients are still searching. They just search differently now.
Why am I not getting referrals anymore?
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Psychology Today referrals dropped 77 to 94 percent. Word-of-mouth still works but does not scale. The therapists getting consistent referrals now have a visible online presence: website, Google Business Profile, Google reviews, and content that AI tools can recommend.
What are therapists with full caseloads doing differently?
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They use 3 to 4 channels: a well-structured website with specialty pages, an optimized Google Business Profile with 10+ reviews, presence on multiple directories, and content AI tools can read. They treat visibility as ongoing, not a one-time setup.
Should I spend money on marketing?
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Many high-impact actions are free: Google Business Profile, reviews, directory listings. If you invest, SEO ($300 to $800 per month) compounds over time. The average therapy client generates $3,000 to $8,000 per year, so even 2 to 3 new monthly clients more than covers the investment.
Is it normal to struggle to get therapy clients?
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Yes, especially now. The landscape changed significantly in 2023 to 2025. Strategies that worked before are less effective. Most therapists were not trained in practice building. Struggling to get clients is not a reflection of your clinical skills.
How do I get my first therapy clients?
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Start with free, high-impact actions: claim your Google Business Profile, list on 2 to 3 directories, join local provider networks, and let colleagues know you are accepting clients. Build a website with at least 5 pages covering specialties, about, FAQ, contact, and insurance info.
Do I need a website if I have Psychology Today?
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Yes. AI tools like ChatGPT read your website, not your PT profile. A website appears in Google search, Google Maps, and AI recommendations. A PT profile without a website makes you invisible to the majority of channels clients use in 2026.
Why do some therapists have full caseloads?
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The main differentiator is online visibility, not clinical quality. A therapist with a basic website and 10 Google reviews is more visible than one with 20 years of experience and no website. Insurance acceptance, specialty focus, and multi-channel presence all contribute.
Related guides
Guide
Psychology Today Stopped Working
The data behind the PT decline and what to do instead
Guide
How Clients Find Therapists in 2026
The data behind the shift in how clients discover providers
Research
ChatGPT Therapist Recommendations in 10 Cities
What AI recommends and why
Guide
How Clients Find Your Practice
Practical steps to show up where clients are searching