Google Ads for Therapists: Why Your Ads Are Losing Money (and How to Fill Your Caseload)
If you are a therapist running Google Ads, you’ve likely felt the frustration: You see the "Impressions" increasing, but your phone isn’t ringing and you don’t have a solid caseload for your practice.
Or worse, what I have seen happen with my clients is that they are getting calls but the people calling are asking for therapy services you don’t provide or insurance you don't take.
In 2026, the therapy market on Google Ads is more competitive than ever with big box therapy brands taking all the traffic. Read more about this in my post: The "Big Therapy" Problem: Why Ohio Practitioners are Being Priced Out of Their Own Communities
If you’re still using basic settings or relying on generic AI advice, you’re not running ads — you’re subsidizing Google’s record profits.
One piece of advice I give every coaching client: the bidding algorithm doesn’t care how skilled you are as a therapist — it only cares about your data and signals.
If you want to read more about what signals are in Google Ads you should explore all the posts related to data quality and signals: Google Ads Signals & Value Hub
To stop the money loss in Google Ads, we have to look at the "Diagnostic Math" of your account and we need to take a detailed look. I do this every single day with my clients when I am working with them in active Google Ads coaching sessions.
Here are the three reasons your ads are failing—and the strategic shift required to fix them.
After working in PPC for 17 years, what you’re experiencing isn’t a marketing problem but it’s a misdiagnosed Google Ads system problem, the good news is that it’s fixable.
1. The "Broad Match" Trap for Private Practice
Diagnostic Pattern: Intent Drift
Most therapists target keywords like "Therapist near me" or "Counseling." On the surface, this makes sense. But behind the scenes, Google’s "Broad Match" is showing your ads to people searching for "Free mental health clinics" or "How to become a therapist." I see this in nearly every therapist account I audit.
One thing I see left out of almost all “expert Google Ads” content is that keywords can be broad in match type and broad in intent. We need to pick wisely and I walk through this diagnostic decision with all my clients on coaching calls.
The Problem: You’re paying for what I call "curiosity clicks," not "client intent."
My Warning: If you don't have a rigid Exclusion Architecture and Strategic Framework (negative Keywords and deliberate expansion), you are likely wasting 30-40% of your daily budget on searches that will never lead to a private pay client.
The Fix in PPC Coaching: In coaching, I diagnose whether your account is signaling high intent or broadcasting too broadly — and then we correct the targeting architecture. Instead of broad, generic terms, I restructure your targeting so Google understands the specific clinical fit you want to attract. This repels the wrong clicks before they cost you $45.00. In 2026 we also cannot put in “private pay trauma therapist in” keywords. We have to do this in a bucket way or all the “long tail” keywords will be labeled “low search volume”. If this is confusing this is exactly why your ads aren’t working, this is something I have spent 17 years learning to do.
PPC Coaching Note: “Diagnostic Math” is the structured way I evaluate therapist ad accounts — patterns, signals, intent pathways, and the gaps that quietly drain your budget.
2. The "Psychology Today" Messaging Mistake
Diagnostic Pattern: Mismatched State of Change
Many therapists copy their directory profile text directly into their Google Ads. But a Google searcher is in a different "State of Change" than a directory browser. This is one of the most common failure patterns in therapy PPC.
The Problem: Your ad copy is "Educational" when it needs to be "Decisional." This is a problem I struggle with in my own business as a paid search expert. I myself am the most comfortable when I am educating and teaching but I have learned in my own business that humans don’t buy education, they buy solutions to their pain. And for therapists this is extremely important because the profession is a deeply needed form of care for humans in need.
My Advice and Warning: Using generic terms like "Compassionate Care" makes you invisible to people who need you. In a sea of automated RSAs (Responsive Search Ads), your messaging must act as a filter. If you don't mention your specialty and your "fit" in the headline, you’re signaling openness to the wrong search intent.
My Fix: Use copy that talks to your ideal patient, but not in a marketing way that is unaligned to your ethics. There is a very important line you never want to cross. Your ad should clearly state who you help (e.g., "High-Functioning Anxiety Specialist") and who you don't. This protects your CTR and your ethics and your ad spend.
3. The "Friction-Heavy" Landing Page
Diagnostic Pattern: Conversion Path Blockage
I have seen so many therapist coaching clients who struggle here. Read more about the root of this problem in my post: Why Your “All-in-One” Agency is Wasting Your Google Ads Budget: The Ohio Therapist’s Guide to Real Math & ROI
You’ve paid for the click. The potential client is on your site. But if they have to hunt for your "Contact" button or read a 2,000-word bio before seeing your availability, they will leave. The solution to this has been for the agency side of marketers to make a “sales landing page” which is not right for therapists.
You need your landing page to reduce friction but to maintain your ethics and avoid selling. You as a therapist should never ever be selling, but you should be offering solutions and guiding. I have found when I am working with therapists and I explain this concept they are the most successful when they think of their landing page in the same way they think of their professional practice. It is the first line of communication for someone in a crisis.
The Problem: Your landing page is a "virtual office" instead of a "conversion path."
My Warning: 2026 AI-driven search behavior is impatient. If your page takes 3 seconds to load or your "Book a Call" button is buried at the bottom, your Cost-Per-Lead will double overnight. So you need a landing page that is fast but doesn’t look like it is made for a quick sale. It has to align with your ethics and standard of care.
My 2026 Strategy: Your landing page needs a "Signal-to-Noise" audit. We remove the details and focus on one goal: Getting that person to schedule an intake in a way that is comforting and caring to the caseload and goals for your practice.
Stop Guessing. Start Growing Your Private Practice
You didn't go to school to become a PPC manager. Every hour you spend "tinkering" with your daily budget spend or trying to understand "Maximize Conversions" is an hour you aren't seeing clients. Our communities desperately need trained clinicians. This is the exact issue I correct in Protective PPC™ audits.
The data from your PPC account doesn't lie. If your keywords are "tightening" but your caseload isn't full, you don't have a traffic problem—you have a Strategy and Intent Gap.
I specialize in helping Ohio therapists (and practices nationwide) move from "Ad Spend Chaos" to "Consistent Caseloads” and we do this with a high focus on ethics and care for the community that needs to be connected to trained therapists.
If your account feels unpredictable or expensive, that’s not a reflection of your clinical skill — it’s a diagnostic indicator that the system is misaligned with how therapy practices actually operate.
