Google Ads for therapists: budgets, keywords and the money pits
What a therapy click really costs, the campaign build that works for private practice, the keywords that drain a budget, and how to judge results in 30 days.
Google Ads is the only channel where you can buy demand that already exists. Someone typing "couples counseling Denver" at 11 p.m. is not being persuaded to want therapy. They are choosing between the practices in front of them. That is why the clicks are expensive and why the channel still works for practices with an open calendar and a real fee.
Set expectations at the start. In most US metros, therapy and counseling keywords run $12 to $45 per click. A booked consultation costs $80 to $250. If your fee is $160 and the average client attends fifteen sessions, a client is worth $2,400, so $200 to acquire one is a good trade and $600 is still profitable. If you are on a panel reimbursing $85, the arithmetic tightens and the channel only works if your intake conversion is strong. The fees guide has the full calculation.
What to run, in order
Start with one Search campaign. Not Performance Max, not Display, not Smart campaigns. One Search campaign, manual control, so you can see every search term you pay for.
Structure it as three ad groups by intent, not by keyword volume:
Ad group one is your specialty plus city. "couples counseling austin", "emdr therapist austin", "postpartum therapist austin". These are the cheapest good clicks you will buy because they are specific and the competition is thinner. Fifteen to thirty keywords in phrase and exact match.
Ad group two is the general local term. "therapist near me", "counseling austin", "therapy austin". Higher volume, higher cost, lower intent quality. Exact and phrase only. Cap this group at forty percent of budget.
Ad group three, only if you are private pay, is the payment-qualified term. "private pay therapist", "out of network therapist [city]", "therapist that doesn't take insurance". Tiny volume, excellent fit.
Set the campaign to a single target location, either your city with a five to fifteen mile radius or your metro. Set location options to "presence" so you are not paying for people researching your city from another state.
The keywords that burn money
Broad match is the biggest single waste in this category. Left on broad, "therapy" pulls physical therapy, massage therapy, speech therapy, occupational therapy and every use of the word in the language. Our own dataset shows how blurred this category is: the listing categories people choose for themselves mix counselors and psychologists with massage and physical therapists, and Google's matching is no better at telling them apart than a spreadsheet is.
Build a negative keyword list before you turn the campaign on, not after. Start with: physical, massage, occupational, speech, PT, rehab, spa, school, degree, program, jobs, salary, career, courses, free, hotline, crisis, near me jobs, ceu, license, supervision, worksheet, quotes, meaning, definition. Add "psychiatrist" and "medication" unless you prescribe.
Then read the search terms report every Monday for the first eight weeks. Ten minutes a week. Every term that is not a person looking to book gets added as a negative. A campaign that starts at forty percent wasted spend usually gets to ten within a month of this.
The three settings that quietly cost the most
Search Partners and Display Expansion are on by default in some builds. Turn both off. They spend your money on placements that convert far worse for local health services.
Ad schedule matters more here than in most categories. Run ads when you or your intake person can actually answer. A click at 2 a.m. that goes to voicemail costs the same as one at 2 p.m. that gets answered. If you can only answer 9 to 6 on weekdays, either run only then, or make sure missed-call text-back covers the rest, which the follow-up guide walks through.
Bidding: start on Maximize Clicks with a hard CPC cap of about $25 for the first three weeks to gather data, then switch to Maximize Conversions once you have fifteen to thirty tracked conversions. Switching too early is the most common reason a small account stalls, because the algorithm has nothing to learn from.
Conversion tracking, or you are guessing
Track three things or do not run the campaign. Calls from ads, using Google's call reporting so a call over 60 seconds counts. Calls from your website, using the same forwarding number. Form submissions on the contact page.
Two cautions specific to this field. Do not put anything a person writes about their symptoms into a tracking parameter or a conversion label. And keep any tool that touches intake detail on the right side of your own privacy obligations. A name and a phone number in a form is normal business data; a free-text box describing a mental health condition, sitting inside an ad platform's tag, is a problem you do not need. Keep the ad form to name, phone, email and preferred time, and take the clinical detail on the call.
The landing page decides whether any of this works
Sending ad traffic to your home page wastes a third of it. Build one page per ad group. A couples counseling ad goes to a couples counseling page that names the fee, the format, the length, the availability and the next step, with a phone number as a tap-to-call button at the top and a two-field form. No slider, no stock photo, no "welcome to our practice".
The four questions the page must answer above the fold: do you treat this, what does it cost, do you take my insurance, and when can I be seen. Practices that answer all four convert ad clicks at eight to fifteen percent. Practices that answer none convert at two.
Budget and how to judge it
For a solo practice, $800 to $1,500 a month is a real test. Below $500 you will not gather enough data in thirty days to learn anything, and the account will sit in a permanent learning state. Above $3,000, a solo calendar usually fills before the budget does.
Judge on cost per booked consultation and on show rate, not on clicks or impressions. Thirty days in, you want to see the search terms report clean, cost per call under $150, and at least half of booked consultations showing up. If cost per call is fine but nobody shows, the problem is the intake call and the deposit policy, not Google.
Compare all of it against where you sit in the benchmark report before you conclude the channel is broken.
Frequently asked
Should I run Performance Max? Not as a first campaign and rarely as a second. PMax hides placements and search terms, which for a category this easily confused with physical and massage therapy means paying for traffic you cannot see or exclude. Get a clean Search campaign profitable first.
Do I need to bid on my own practice name? If a competitor or a directory is bidding on it, yes, and it will cost a few dollars a day because your quality score on your own name is high. Otherwise it is optional.
What about the crisis-related searches? Exclude them. Terms like "suicide hotline" or "crisis" are not clients you can serve through a booking form, they should reach 988, and Google restricts advertising against much of that language anyway.
If you want a campaign built, negatived and monitored, Google Ads management is one of the services in the free 14-day trial. Text or call (385) 832-6175.