The first time most therapists look at click prices, the numbers feel random. One search costs a couple of dollars. Another, which seems almost the same, costs ten times as much. Somebody in the account clicks "use recommended bid" to make the decision go away, and the budget is gone by Wednesday.
There's a pattern under those prices, and a practice that understands it can decide what each search is worth to it instead of letting Google decide. What follows is our order of work: a price for each search, three numbers that say whether that price is winning, and the month the pricing passes to Google.
Therapy Click Prices Run From a Few Dollars to $70, Depending on the Search
Look up a therapy search in Keyword Planner and you get a pair of top-of-page bid estimates, a low one and a high one. Across the therapy searches we pulled for this guide, US figures, the spread is wide:
- "Therapist that takes Aetna": $24.79 to $70.00
- "Online therapist": $16.15 to $48.42
- "Eating disorder therapist near me": $6.75 to $45.88
- "Telehealth therapy": $13.33 to $43.88
- "Therapist near me": $7.71 to $29.28
- "Anxiety therapist": $5.60 to $25.29
- "Therapist that takes Medicaid": $4.94 to $21.15
In our reading, three things push prices up. National online platforms compete hard for online and telehealth searches. Searches naming a commercial insurer draw advertisers who know those clients come with a predictable payment. And a few specialties, like eating disorders, have fewer providers and higher stakes. Searches that name a public program like Medicaid sit lower.
None of this means a practice should avoid the expensive searches. It means each search needs its own price, which is what manual bidding is for.
A Hand-Set Bid Is a Ceiling You Control Search by Search
In the exact-match campaign we start every therapy account with (we call it Isolation), bids are set by hand. Google describes manual bidding simply: "you can set a maximum price on the cost of someone clicking on your ads." That maximum is a ceiling, not a price. What you actually pay is often less, depending on the ads around yours.
Set a default bid for each ad group, then adjust individual keywords up or down as the data comes in. Your couples ad group might start at one bid, your anxiety group at another, and "therapist that takes Aetna" might need its own number entirely if you're in network.
One timing detail matters. Google knows nothing yet about how your ads perform on a keyword you added this week, and the quality grades from Chapter 4 need weeks of clicks to settle. In our experience, bidding a little stronger in the first weeks helps new keywords get shown and gather data, and the bids can come down as quality improves and the results show what each search is worth.
In those first weeks, check each ad group once a week, not every few hours. Click prices swing from day to day in a small account, and a bid changed on Tuesday's numbers is often a bid changed on noise. Monday mornings, the same day every week, keeps the changes small and the reasons clear.
What One New Client Is Worth Sets the Most You Can Pay for a Click
The client value from Chapter 3 now earns its keep. Three figures turn it into a ceiling for every click:
Most you can pay per click = cost per client you can afford × share of clicks that become inquiries × share of inquiries that become clients.
As an illustration: if you're willing to spend $300 in ads to win a client, one click in ten turns into a call or request, and half of those calls and requests become clients who attend a first session, the math is $300 × 10% × 50% = $15 a click. Above $15, every client costs more than you decided to pay. Below it, you have room.
Run that same math for each kind of search and the prices from the first section start to make sense for your practice in particular. Say an insurance plan pays your practice $85 a session. Even over a year of sessions, a click priced near the $70 top of that range on an insurer-named search has to convert very well to pay off. A client paying $150 or more in cash can carry a higher click price. Two practices bidding on the same search can sensibly make opposite choices.
Keep the inputs honest. Use attended first sessions, not form fills, as the "became a client" number, and listen to a sample of calls from your ads. A call that turns out to be a wrong number, a job applicant or someone wanting a medication you don't prescribe isn't an inquiry, and counting it makes every click look cheaper than it is.
That ceiling outlives manual bidding. Once broad match arrives with the Exploration campaign (Chapter 6), Google sets the bids, and your job shrinks to giving it a target cost per conversion, the target CPA. Where should the target start? Google's suggested starting point is your actual cost per conversion across the past 30 days. It wants a stretch holding 30 or more conversions before anyone grades the result, and it warns that an overly tight target can mean losing inquiries you would have won. In plain terms: copy whatever the exact-match campaign really paid. Most therapy practices get there in month two or three, when they're seeing roughly 30 quality conversions a month; a busy group practice can reach it faster.
Your Best Therapy Searches Should Win the Top Spot Most Days
A bid that never wins is just a number in a spreadsheet. To see whether yours are winning, open the keywords view and turn on three columns Google offers for exactly this.
The first, Search top impression share, answers a simple question about your couples therapy keyword or your trauma keyword: of all the times it could have appeared in the top group of ads, usually above the free results, how often did it? Search absolute top impression share is the stricter cousin: it only counts a win when yours was the first of those top ads. The third, Search lost top impression share (rank), is the diagnosis: the share of top-spot chances you missed because your ad's overall rank fell short, which points back at the bid, the ad, the landing page or all three.
Our own bar, not a Google rule: a practice's core specialties and best near-me searches should land in a top spot on roughly three of every four searches they're eligible for, and up to about nine of ten. Lower than that, and a client looking for exactly your kind of help often sees someone else first. Chasing near-perfect coverage on every keyword, on the other hand, gets expensive fast and rarely pays.
A practical way to apply the bar: sort the keywords view by cost, look at the ten searches spending the most, and read the top impression share for each. A search spending heavily while winning the top spot only a third of the time is a search you're paying to lose. It either earns a stronger bid and a sharper ad, or it gets paused so the money can go to a specialty you win more often. The searches at the bottom of the list matter less; a keyword with a handful of impressions a week won't say much either way for a month or two.
If a core search keeps falling short and the rank column is the culprit, nudge the bid and reread the ad and page against the search (Chapter 4). If a separate column, Search lost top impression share (budget), is the one climbing, the money is running out before the day does. That's a budget conversation, not a bidding one.
Auction Insights Tells You Who Is Ranking Above You, and Which Auctions to Quit
Behind every therapy search is a lineup of other advertisers, and Google will show you who's standing in it. Open auction insights on a keyword or a whole campaign and Google lines you up against the other advertisers in those same auctions. For a practice, half of its six columns do most of the work. Overlap rate says how often a rival group's ad appeared on the very searches yours did. Position above rate says how often that rival sat higher. Outranking share is your side of the ledger: the times you beat them, counting searches where you showed and they didn't.
The names that appear usually sort into three camps. Other local practices are your real peers; if one consistently lands above you on your own specialty, study its ad and landing page before you touch your bid. Large group practices bring bigger budgets but often broader messages, which a focused specialty page can beat. National online platforms can outspend almost anyone on searches like "online therapist," and a local practice usually shouldn't try.
Two practical limits. A keyword with under 10% impression share shows no insights, so very new or very small keywords may come up empty. And the report tells you who, not why: pair it with your own cost per first session before deciding anything.
The decision it supports most is walking away. If a search's clicks keep running past the ceiling from your client math, and the advertisers above you keep holding the top spot at prices you won't match, lower the bid or switch the keyword off, and put that money where a practice your size can win.
Next: Happy Therapy Clients Write About Feeling Safe and Being Heard
Bids decide whether your ad shows. The ad itself decides whether anyone clicks. In Chapter 8 the work shifts from price to words: what therapy clients say about the practices they love, and how to borrow that language for headlines.
For the client value behind every number in this chapter, see Chapter 3, and for when Exploration starts, Chapter 6. Every chapter is on the guide home.
When practices hire us for Google Ads management, bids are set from their own client math, keyword by keyword, and checked against impression share and auction insights every week.
