Ask a therapist to list the searches a new client might type, and the list usually stops after a dozen: "therapist near me," "counseling," "couples therapy," "anxiety therapist," the town name. Those are real and worth buying. But people looking for therapy are often more specific than that. They type the method a friend recommended, the problem they've read about, the insurance card in their wallet and the hour they're free.
This chapter is about the gap between the searches you can list and the ones clients actually type, and the order in which a therapy account goes after each.
The Top 25 Therapy Searches Carry 60% of the Volume. The Other 2,924 Carry the Rest.
We pulled US search data from Google's Keyword Planner for searches where someone is looking for a therapist, counselor or specific kind of therapy, and grouped close variants together. That left 2,949 distinct searches.
The biggest ones are no surprise: "therapist near me" at 368,000 searches a month, "therapist" at 301,000, "couples therapy" at 246,000, "marriage counseling" at 201,000. The top 10 together carry 42.7% of all that provider-search volume. The top 25 carry 60.2%.
The other 2,924 searches carry the remaining 40%, about 1.59 million searches a month. Individually they're small. "Gottman therapist near me" gets 590 searches a month. "Erp therapy near me," for a specific treatment for OCD, gets 2,400. Together they're a market most practices never see, because nobody writes them on a whiteboard.
That split is the whole strategy in one picture. The head, the 25 or so searches you can predict, is where a new account starts. The tail, the thousands you can't predict, is where a growing account finds room to grow.
Exact Match Keeps Your Budget on the Therapy Searches That Already Book Clients
A new account goes after the head first, and it does it with exact match. That's what we call the Isolation campaign: a short list of known, high-intent searches, each bid set by hand, each search terms report read closely. Chapters 2 and 4 built its structure, and Chapter 5 filled it with keywords picked by hand.
The reason to start narrow isn't caution for its own sake. A brand-new account has no history of who booked, and Google's bidding algorithms have little to study until it does. Tying every dollar to a handful of exact searches buys that history cheaply: the first calls, the first requests, the first sessions on the calendar. Those early conversions are what everything after this depends on.
Starting narrow also keeps the first month's reports readable. When only twenty or thirty searches can trigger an ad, a bad week is easy to diagnose: it was this keyword, this ad, this page.
Isolation also teaches you something no keyword tool can: which of your specialties actually book. Maybe couples searches fill the calendar and anxiety searches mostly bring requests for medication you don't prescribe. That's worth knowing before you hand the account more freedom.
Therapy Clients Name the Method They Want: EMDR, DBT, IFS, ERP, Gottman
A lot of these searches come from people who've done their reading. Therapy has named methods, and clients search for them by name once they've heard one might help:
- "EMDR therapy near me": 60,500 searches a month, bid range $2.80 to $14.55
- "DBT near me": 8,100, bid range $4.66 to $22.46
- "IFS therapist near me": 3,600
- "ERP therapy near me": 2,400, high-end bids around $21
- "Gottman therapist near me": 590
Someone searching for a method is often further along than someone searching "therapist." They know what they want, and they're checking whether you offer it. The flip side is just as important: these searches only pay off for practices with clinicians trained in that method. An ad for EMDR that leads to "we don't offer that, but we can help in other ways" wastes the click and the client's hope.
So if your clinicians are trained in a method, give it a page (Chapter 4) and a small set of keywords. If they aren't, leave it alone. The tail is full of searches you can't fill, and half the work of targeting is saying no to them.
The same goes for the other ways clients narrow a search. Insurance is one: in our US data, searches that name an insurer or Medicaid add up to roughly 76,000 a month across 589 phrasings, a rough upper bound since the count catches a few off-topic rows. Time is another, in searches for evening or weekend availability. Format is a third, in searches for online therapy or in-person sessions. Each of these is a real client with a real constraint, and each is too specific and too varied to list completely. That's the tail in practice.
Google Says Broad Match Needs Smart Bidding. We Wait for About 30 Conversions a Month Before Using It.
You can't list 2,924 searches by hand. That's what broad match is for. Per Google, a broad keyword reaches related searches too, including some that don't share your keyword's exact meaning. For example (our illustration), a "trauma therapist" keyword might surface for someone typing "counselor for ptsd after car accident." A broad match keyword for "trauma therapist" can show for searches you never thought to write down.
There's a catch, and Google states it bluntly: "It's critical to use Smart Bidding with broad match." Smart Bidding prices each search on the spot from signals about how likely that person is to become a conversion. Without a track record of conversions, those signals point nowhere in particular. With little history, it has little to go on. Google's own guidance for target CPA, the cost per conversion you ask it to aim for, recommends judging performance over the last 30 days with at least 30 conversions.
That's where our rule comes from. So we wait. When the exact-match campaign (Isolation, in our vocabulary) is producing roughly 30 quality conversions a month, a second campaign joins it. We call it Exploration. It starts life as a duplicate of the exact-match campaign, trimmed to the three to five keywords that have already put clients on the calendar. Those keywords switch to broad match so Google can wander past the list. Bidding switches too, to Maximize conversions with a target CPA, the cost per conversion you ask Google to aim for. Set that first target close to what the exact-match campaign actually pays today. Aim lower than reality and, by Google's own account, the campaign can skip clicks that would have turned into clients. A cheap target on paper can mean fewer first sessions in practice.
For most practices, that point arrives around months two or three. A larger group practice with more traffic and more clinicians to fill can get there sooner. It's the conversion count, not the calendar, that decides.
Broad Match Will Find Crisis Lines, Careers and Platform Names. The Search Terms Report Catches Them.
Broad match reaches further, and in therapy, further includes searches no practice should pay for. The negative list from Chapter 5 matters more now than it ever did under exact match.
Three kinds of searches turn up again and again:
- Crisis lines. Four crisis phrasings alone draw 72,800 searches a month in the US. A broad match keyword built around "therapist" or "counseling" can wander toward them. These are the first searches to catch and the most important to block.
- Careers. "How to become a therapist," "therapist salary," "counseling degree." Students and job seekers type the same words your clients do.
- Platform and directory names. BetterHelp, Psychology Today, Headway, Grow Therapy. People searching a brand want that brand.
Inside every campaign sits a log of what people literally typed before your ad showed. Open that list, the search terms report, every morning for Exploration's first month. Every search that doesn't belong goes on the negative list. Every search that books a client is a candidate for its own exact match keyword back in Isolation.
Once the junk thins out, a weekly read is usually enough, though the habit shouldn't lapse. New phrasings appear, and irrelevant searches can quietly eat into the budget.
Turning On Broad Match Doesn't Mean Turning Off Exact Match
Exploration doesn't replace Isolation. Both keep running, and the share of budget each one gets moves with the results.
Early on, Isolation carries most of the budget and Exploration tests the tail. As Exploration proves it can find clients at an acceptable cost, more budget can move its way. Some practices eventually scale Isolation back to a handful of keywords. Others keep it as a safety net for their most valuable searches, and turn it back up when a key search starts slipping in position.
There's no fixed ratio; the right split depends on your own numbers.
What decides it is the same thing that decided everything so far: what the conversion data says. If Exploration's cost per first session climbs while Isolation's stays steady, pull back. If Exploration keeps finding clients you'd never have listed, let it run.
Next: Insurance-Named Therapy Searches Run Up to $70 a Click
Every one of these campaigns needs bids, and in therapy some searches are far more expensive than others. Chapter 7 deals with what to pay. It walks through hand-set bids for each exact keyword, the impression-share and auction reports that tell you whether you're winning the top spots, and the first target cost per conversion when broad match begins.
Missed the structure this all sits in? Chapter 4 covers specialty ad groups and Chapter 5 covers building and sorting the keyword list. Every chapter is on the guide home.
When practices hire us for Google Ads management, Exploration doesn't start on a schedule. It starts the week the account has earned it.
