Almost every Google Maps guide written for small businesses says the same thing: ask every happy customer for a review, and watch your listing climb. A dentist can hand patients a card on the way out. A plumber can text a link after the job.
A therapist mostly can't. The professional codes that govern counselors, psychologists, social workers and marriage and family therapists all limit soliciting testimonials from current clients, and the listings show it. So a therapy practice has to build its Maps presence on the parts of the listing it fully controls, and be careful even with the reviews it already has. Below: what the review gap looks like in Louisville, what the codes allow, how the map spots are actually won, the review replies that have cost practices money, and how the listing feeds the Search ads.
Nearly Half of Louisville's Therapy Listings Have Fewer Than 10 Google Reviews. For Therapy, That's Normal.
For the research behind this guide we ran 18 Google Maps searches across the Louisville market and kept the 122 listings that were therapy or counseling practices. The review counts are low:
- Median: 10 Google reviews per listing
- 60 of 122 listings have fewer than 10
- 101 of 122 have fewer than 25
- 7 have none at all
Listings named for a single clinician, usually solo practices, have a median of 2.5 reviews. The five biggest listings, large groups and a national practice's offices, hold 2,729 of the 4,327 reviews we counted, or 63%.
For comparison, the same method on primary care in Kansas City, from the research for our doctors guide, found a median of 39.5 reviews per listing. Those listings weren't filtered by category, so the comparison is rough, but the gap is large enough to matter: a therapy practice with a dozen reviews isn't behind its peers. It is its peers.
That matters for how you read your own listing. If a practice compares itself to the dentist down the street, it will chase a review count the profession doesn't produce. Compare against other therapy practices in your market instead, and put the effort into the parts of the listing you control.
Therapy Ethics Codes Turn the Usual Review Advice Upside Down
Chapter 8 walked through the codes for ad copy. They apply here with more force, because, in our reading, asking a client for a Google review is about as close to soliciting a testimonial as it gets.
- APA (psychologists): psychologists "do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence."
- ACA (counselors): counselors who use testimonials don't solicit them from current clients, former clients or others vulnerable to undue influence.
- NASW (social workers): no soliciting testimonial endorsements from current clients, including asking consent to reuse something a client already said.
- AAMFT (marriage and family therapists): no soliciting testimonials or endorsements from current clients or others vulnerable to undue influence.
Therapists feel the squeeze. One asked on Reddit: "How does one get ethical google reviews? I was under impression you can never ask." For many licensees, that's close to right. Federal rules add another layer for everyone: the FTC's consumer reviews rule treats paying or rewarding people for reviews with a particular sentiment as unfair or deceptive.
What's left is narrower than the usual advice, and it's worth checking with your licensing board before relying on any of it:
- Don't ask current clients (and, for counselors under the ACA code, former clients). Not at the last session, not in a follow-up email, not with a card at the front desk.
- Don't reward anyone for a review. No discounts or gifts, for clients or anyone else.
- Let the listing earn what it earns. Clients who want to review a practice can find it. The listing's job is to be complete and accurate for the people deciding whether to call.
Local Group Practices Took 50 of 69 Map Spots on Our Louisville Therapy Searches
We ran 24 therapy searches in Louisville, from "therapist near me" to "couples therapy louisville," and recorded who showed up in the three-listing map pack. A map pack appeared on 23 of the 24 searches. Of the 69 spots, local group practices took 50. Solo practices took 4.
In that map pack, one name kept coming back: Kentucky Counseling Center held a spot on 17 of our 24 therapy searches, and its listing carried 661 reviews, one of the largest counts in the market. It was also one of the two most active local advertisers we found in Google's Ads Transparency Center. In our experience, size helps on Maps the same way it helps in Search: more locations, more clinicians, more searches covered.
A smaller practice can't copy the size, but it can control the basics, starting with categories. Google asks businesses to pick categories that complete the sentence "This business IS a," to use as few as possible, and to choose the most specific ones that still describe the core business. Across the 122 Louisville listings, the main categories in use were:
- Mental health service: 36
- Counselor: 32
- Psychotherapist: 12
- Psychologist: 12
- Marriage or relationship counselor: 11
- Mental health clinic: 8
- Family counselor: 8
- Child psychologist: 2
- EMDR psychotherapist: 1
In our reading of Google's guidance, a practice built around couples work is better described as a marriage or relationship counselor than as a general mental health service, and a psychologist-led practice should say so. Google even offers an EMDR psychotherapist category, which only one listing in our sample used. The rest of the listing matters as much: accurate hours, the services list matched to the specialty pages from Chapter 4, real photos of the office, and, our advice, a website link that goes to the home page or the main specialty page rather than a booking widget, so a nervous visitor can read before committing to a time.
Replying to a Bad Review Can Tell the World Someone Was Your Client
The reviews a practice does get bring a different risk. For a practice HIPAA covers, a reply that confirms the reviewer was a client, or describes their treatment, can be a violation.
HHS has enforced this. In 2023 it settled with Manasa Health Center, a New Jersey practice providing adult and child psychiatric services, over a complaint that the practice "impermissibly disclosed the protected health information of a patient when the entity posted a response to the patient's negative online review." Manasa paid $30,000 and agreed to a corrective action plan. A California dental practice, New Vision Dental, paid $23,000 over responses to patient reviews that disclosed protected health information.
Therapy practices in our sample reply a lot. Owners replied to 381 of the 679 reviews we read, including 70 of the 134 rated one to three stars. Only 11 of the 75 owner replies to low-star reviews we pulled used privacy or confidentiality language.
The safe reply confirms nothing. It doesn't say the person was seen, doesn't mention a session, a clinician or a diagnosis, and moves the conversation offline:
- Risky: "We're sorry your sessions with Dr. Lee didn't help your anxiety. We did reschedule you twice."
- Safe: "We take every concern seriously. Privacy laws keep us from discussing whether anyone has been seen here. Our office manager would welcome your call."
The safe version also reads better to the next person deciding whether to call. It shows a practice that protects privacy, which is exactly what a nervous first-time client is looking for.
Write the reply policy down before you need it. Decide who in the practice replies, what the standard wording is, and that no reply ever mentions a clinician, an appointment or a reason for care, even when the reviewer has already shared those details themselves. In our reading, a reviewer sharing their own details doesn't give the practice permission to confirm them. Both settlements were over what the practice disclosed in its replies.
Someone Typing "Therapist Near Me" Wants a Cross Street, Not a Tagline
The Business Profile isn't only a Maps listing. Linked to Google Ads as a location asset, it puts the practice's address, a map and the distance to the office into the Search ads themselves. Google's help page says location assets can show "the store address, a map to the store location, or the approximate travel distance," and the ads can appear on Google Maps, including the Maps app.
For a therapy practice that sees clients in person, that's the answer to the first question many searchers have: how far is it? Link the Business Profile in the account's assets, check that the address and phone number match the website, and keep the hours current, because a location asset for a listing marked closed won't show.
Two therapy-specific limits apply. First, Google restricts reporting on local actions, the calls and direction requests from a listing after an ad, for sensitive locations, and its help page names counseling centers (Chapter 1). Don't build the account's measurement on those numbers. Second, there's no Local Services Ads category for therapists, counselors or psychologists in the US, so the pay-per-lead option other local businesses use isn't available. For a therapy practice, the Business Profile plus location assets is the local ad setup.
Next: AI Max Comes Last, Because It Can Put a Therapy Ad on a Crisis Search
The listing and the Search account now work together. Chapter 13 covers the last automation setting in the guide: AI Max, which can match ads to searches no one chose, crisis searches included, and why it comes last.
For the click ID that measurement relies on instead of local actions, see Chapter 1; for the ethics codes and ad copy, Chapter 8; and for location settings tied to your license, Chapter 9. Every chapter is on the guide home.
When practices hire us for Google Ads management, we link and check the Business Profile before the first ad runs, and we write review replies that protect the client first.
