A therapist in Louisville can see the Indiana shoreline from the riverfront. A client in Jeffersonville, ten minutes across the bridge, can be sitting in that therapist's office by lunch. But if the same client asks for a video session from their own couch, the answer for many Kentucky counselors is no.
That gap between where a practice can advertise and where it can legally treat someone is the heart of setting up a therapy campaign. Google's defaults know nothing about licenses. They're built to find as many clicks as possible, in as many places as possible. Below are the switches we flip before a counseling campaign spends a dollar, beginning with the one that can put a clinician crosswise with the licensing board.
A Video Session Happens Where the Client Is Sitting, Not Where the Therapist Is
The licensing boards and compacts we checked agree on one point: what counts is where the client is physically located during the session. Ohio's counseling board puts it plainly: "All licensees and registrants providing services via teletherapy to persons physically present in Ohio shall be licensed in Ohio." The Counseling Compact's own FAQ says counselors "must have a license or a privilege to practice in the state where the client is located." Florida tells its licensees to contact the board "in the jurisdiction where the patient is located" before seeing anyone outside the state.
That matters for advertising because telehealth is now standard. Of the 12 Louisville-area practice websites we read for this guide, 10 offer video sessions, using platforms like Doxy.me and Zoom. A video session doesn't care about distance, so a telehealth ad can reach far past the office. The license doesn't stretch with it.
There's one separate rule worth knowing if your practice includes a psychiatrist or nurse practitioner who prescribes. Google restricts ads for online prescribing, and telehealth providers that prescribe need LegitScript certification to advertise it. As we read Google's policy, talk therapy over video, with no prescribing, isn't covered by it.
One in Five Louisville-Area Searches for a Nearby Therapist Comes From Indiana
Louisville makes the license problem concrete, because its metro area sits in two states. We pulled Keyword Planner volumes for "therapist near me" across the Louisville market and its counties:
- The whole Louisville market: about 1,900 searches a month
- Jefferson County, Kentucky, home of Louisville itself: about 880
- Clark County, Indiana (Jeffersonville, Clarksville): about 260
- Floyd County, Indiana (New Albany): about 140
Those two Indiana counties alone account for about 400 of the 1,900 monthly searches, roughly one in five, and the market takes in eight smaller Indiana counties beyond them, so the true Indiana share is a little higher. County figures from Keyword Planner are rounded, so treat the share as a close estimate, not an exact count.
Here's why the share matters. The licensing compacts that let a clinician work across state lines don't treat the two states the same way yet:
- Counselors. The Counseling Compact went live in Indiana but not in Kentucky; as of October 2026 it's live in 11 states, Indiana among them. Kentucky has joined but isn't live, so a counselor licensed only in Kentucky can't use the compact to see a client sitting in Indiana yet.
- Psychologists. Both Kentucky and Indiana are in PSYPACT, the compact for psychologists, which allows telepsychology across member states once the psychologist holds the compact's authorization.
- Social workers. Kentucky has enacted the Social Work Licensure Compact, but the compact isn't issuing multistate licenses yet; its data system is expected in spring 2027.
- Marriage and family therapists. There's no licensure compact for MFTs at all.
None of this stops an Indiana resident from driving to a Kentucky office. The session then happens in Kentucky. It only limits video sessions delivered into Indiana. Two of the Louisville practices we reviewed advertise telehealth "across the states of Indiana and Kentucky" or similar. That only works if every clinician seeing Indiana clients holds an Indiana license or, for psychologists, PSYPACT authorization. A practice that doesn't should say so in its ad and on its page: "telehealth for Kentucky residents" is a short line that saves a lot of awkward intake calls.
Google's Default Location Setting Shows Your Louisville Therapy Ad in States You Can't Serve by Video
Every campaign has a location target and, under it, a quieter choice about who counts as being in that location. Google offers two options. "Presence or Interest" is what a new campaign starts with. On top of the people actually in Louisville, it counts anyone, anywhere, who has shown an interest in the city. "Presence" counts people in or regularly in the area; a commuter from across the bridge counts.
For a vacation rental or a real estate agent courting out-of-town buyers, Google's preference for the wider net is reasonable. But its own help page carves out an exception: businesses in sensitive categories that come with strict targeting rules are told to consider Presence instead. Therapy fits that description twice over. Mental health is a sensitive ad category, and the license limits who can become a client.
With the default left on, a Louisville counseling ad can show to someone in Cincinnati or Nashville who searched for therapists in Louisville, was recently there, or has been reading about the city. Some of those people will travel. Those who aren't planning to travel are looking for telehealth, and a Kentucky-only counselor can't see them by video.
How we set it for a therapy practice:
- Telehealth practices: target the states where every clinician you advertise is licensed or compact-authorized, with Presence. For a Kentucky-only group, that's Kentucky. Presence still includes Indiana commuters who are regularly in Kentucky, which is why the "telehealth for Kentucky residents" line belongs in the ad and on the page either way.
- In-person-only practices: target a radius or the counties within a realistic drive of the office, with Presence. Across a river, that radius can include Indiana, because the session happens in Kentucky.
- Practices licensed in both states: keep them in one campaign if the services and pages are the same, or split them if the Indiana page has to say something different.
New Search Campaigns Arrive With AI Max and Search Partners Already Switched On
Location is the first of several switches a counseling practice should flip before launch. A new Search campaign comes with several settings already turned on, and we turn most of them off before launch.
AI Max. Every Search campaign a practice creates today starts with AI Max active, per Google's own setup page. Two parts of it matter for therapy. Text customization lets Google write ad text from your site, which can produce claims your ethics code wouldn't let you make (Chapter 8). Final URL expansion hands the landing page choice to Google, so a click meant for your trauma page can end up somewhere else on the site. Google says it only picks pages relevant to the search, but in a practice that also offers medication management, relevant can still mean a psychiatry page you'd never send a "couples counseling" search to. AI Max also needs conversion-based Smart Bidding to work well, and an account bidding by hand (Chapter 7) doesn't have that yet. So we leave AI Max off at launch and come back to it in Chapter 13.
Search partners. Google's help page confirms a fresh Search campaign opts into its partner network automatically, which means the ad can show on non-Google sites and on YouTube. In our experience those clicks are harder to judge and often lower quality. We uncheck the box at launch and test partners later, separately, if the account needs reach.
Display Network. One more checkbox in that same Networks panel lets a counseling Search campaign spill onto Google's Display Network of websites and apps. A therapy Search campaign exists to answer searches, so we leave Display out, and we check the account's channel settings too, since Google has started managing these networks there as well. Reaching people before they search is a different campaign type, covered in Chapter 11.
Auto-tagging stays on. This one we keep. Auto-tagging attaches Google's click identifier to every ad click, and that ID is what lets the practice send a booked first session back to Google without sharing anything about the client (Chapter 1). Check that it's on before the first click arrives.
Language. Starting in September 2026, Google began removing the language setting from Search campaigns; ads are matched to searchers by the language of the ad itself. So a counselor who sees clients in Spanish needs ads written in Spanish, pointing to a page in Spanish. There's no switch to flip.
A Practice's Own Name Belongs in a Separate, Cheaper Campaign
Some people search for the practice by name: they heard it from a doctor, saw it on a friend's insurance list, or already called once. In Chapter 2 the name of one large Kentucky group with Louisville offices drew about 1,300 searches a month in this market on its own.
In the accounts we manage, those searches convert far better and cost far less than anything else, because the person already chose you. Mixed into a specialty campaign, they make the whole campaign look cheaper and more successful than it really is, and Smart Bidding later learns from that inflated picture. So we put practice-name searches in their own small campaign with their own budget. The specialty campaigns then show what they really cost to win a new client from a stranger's search, which is the number Chapter 7's bids depend on.
The other benefit is protection. Directories and national platforms can bid on local practice names too. A brand campaign makes sure that when someone types your name, your own ad is there, pointing to your own site instead of a directory profile.
Next: Performance Max Waits Until Search Ads Have Booked Real Therapy Clients
With licensed locations set and the defaults switched off, the Search campaigns are ready to run. Chapter 10 covers what comes after they've produced real results: Performance Max, why it can't use a therapy practice's client list, and why it should wait until the Search account has a steady record of booked first sessions.
For how the click ID carries a booked session back to Google, see Chapter 1, and for the specialty pages each campaign points to, Chapter 4. Every chapter is on the guide home.
When practices hire us for Google Ads management, we set every campaign's locations from the clinicians' actual licenses before launch, and we check them again whenever someone joins or leaves the team.
