The Framework Therapists Use to Decide Between Directories and SEO

Before comparing cost or patient volume, it helps to understand what each channel is doing mechanically — because they operate on completely different logic.

Directory Listings (Psychology Today, GoodTherapy, TherapyDen)

When you create a profile on Psychology Today, you are renting space inside someone else's website. Psychology Today has built strong domain authority over many years, which is why its listings rank well on Google for searches like "therapist in [city]" or "anxiety therapist near me." Your profile benefits from that authority as long as your subscription is active.

The moment you cancel, your profile is removed. You own nothing. There is no residual value from the years of subscription fees you paid.

SEO (Search Engine Optimization for Your Own Website)

SEO works by making your practice's own website the thing that ranks on Google. When someone searches for "trauma therapist in Denver" or "CBT therapist accepting new patients," the goal is for your site — not a directory listing you're renting — to appear in those results.

This takes longer to build (typically 4-6 months to see meaningful movement, depending on your market's competitiveness and your site's starting authority). But once your pages rank, they continue attracting patients without ongoing per-click or per-listing fees.

The Core Difference

Directories are rented visibility. SEO is owned visibility. That distinction drives every other comparison in this article — cost structure, patient quality, scalability, and risk.

This framing also explains why the right answer is rarely one or the other. It depends on how long you've been practicing, how competitive your local market is, and how much runway you have before your calendar needs to be full.

The visible cost of a Psychology Today listing is modest — around $30-40/month as of this writing. But most therapists building a full referral funnel don't stop at one directory. They add GoodTherapy, TherapyDen, Zocdoc, Headway, or specialty directories for their niche. Directory costs stack quickly.

A therapist running profiles on three to four directories simultaneously can spend $150-300/month — $1,800-$3,600 per year — on listings they don't own and can't transfer.

SEO Investment Range

A foundational SEO engagement for a solo or small group therapy practice typically runs $750-$1,500/month depending on market competition, the scope of content needed, and whether technical website issues require remediation. That range is higher per month than a single directory listing, but the economic logic is different:

• SEO builds cumulative authority — month 12 is worth more than month 1, even at the same spend.
• A ranked website serves every specialty page, every location page, and every service you offer — simultaneously.
• You are not locked to a platform's pricing decisions or algorithm changes that affect directory visibility.

The Break-Even Question

The more useful question isn't "which is cheaper per month" but "what does one additional patient per month cost me from each channel?"

In our experience working with therapy practices, therapists who track referral sources often find directory cost-per-patient climbs as their specialty becomes more competitive locally — because more therapists join the same directories. SEO cost-per-patient tends to fall over time as rankings compound. The crossover point varies by market and firm size, but it typically arrives within the first 12-18 months of an active SEO campaign.

For a deeper look at SEO pricing for therapy practices, see our Therapist SEO resource hub.

The right allocation depends on where you are in practice development. Here are four common scenarios and how each channel performs.

Scenario 1: New Practice, Empty Calendar

If you opened your practice in the last 6-12 months, you need patients now — not in six months. A Psychology Today profile is the right first move. It can produce inquiries within days of going live, and the per-month cost is low enough to run while you build your website's SEO foundation in parallel.

Recommended split: Start directories immediately, begin foundational SEO work in the first 3 months, plan to reduce directory spend as organic leads emerge.

Scenario 2: Established Practice, Referral-Dependent

If your calendar is full through professional referrals but you have no digital presence, you have a concentration risk problem. SEO is the priority here — building an asset that generates independent patient flow. Directories are optional.

Recommended split: Invest primarily in SEO; one directory profile for passive visibility is sufficient.

Scenario 3: Competitive Urban Market

In a large city with many therapists, directory pages often rank for broad searches, but SEO allows you to own specialty-specific searches where competition is thinner. A therapist optimizing for "EMDR therapist for veterans in Chicago" faces far less SEO competition than one targeting just "therapist Chicago."

Recommended split: Run one or two directories for broad visibility; invest in SEO targeting your specialty and neighborhood-level keywords.

Scenario 4: Group Practice Scaling to Multiple Locations

Directories do not scale — you pay per clinician and per location. SEO scales well. A group practice website can rank for multiple specialties, multiple therapists, and multiple service areas from a single domain investment.

Recommended split: SEO is the primary channel; directories serve as supplemental coverage for individual clinicians who want their own visibility.

Volume of inquiries matters less than the quality of those inquiries — whether the person searching is the right fit for your specialty, can pay your rate, and is ready to start.

Directory Traffic: Browse Behavior

Many people browsing Psychology Today are comparison shopping. They view multiple profiles, often sort by insurance or sliding scale availability, and may contact several therapists simultaneously. This is not a criticism of the platform — it reflects normal consumer behavior when a service is unfamiliar.

The implication is that your conversion rate from directory inquiry to booked session may be lower than it appears, especially if you are out-of-network or charge premium rates.

Organic Search Traffic: Intent-Driven Behavior

Someone who finds your website by searching "perinatal OCD therapist accepting new patients in Austin" has already self-selected significantly. They know their diagnosis, know what treatment approach they want, and are searching for someone available. In our experience working with therapy practices, organic search visitors convert to booked consultations at a meaningfully higher rate than directory browsers — particularly for specialties with a defined patient population.

This matters for practice sustainability. If your caseload is built on patients who sought you out specifically, you tend to see lower dropout rates, better fit, and stronger referral word-of-mouth compared to patients who picked your name from a list.

The Nuance

Directories still attract real patients with real needs. The quality gap is most pronounced for specialty practices — therapists who treat specific diagnoses, populations, or using specific modalities. Generalist therapy practices may find directory and organic traffic more comparable in quality.

Therapists considering this shift raise predictable concerns. Here are the ones that come up most often, answered honestly.

"My Psychology Today profile is already working. Why change anything?"

You shouldn't change anything — you should add. A working directory profile is not a reason to avoid SEO; it's evidence that digital channels can bring you patients. The question is whether you want to remain dependent on a platform you don't own indefinitely. If Psychology Today raised its price 40% tomorrow or changed how profiles are ranked, your pipeline would be directly affected.

"SEO takes too long. I need patients now."

That's accurate — and it's why the two-channel approach is standard in the early phase of a practice. Directories are faster. SEO is more durable. You run both until SEO is producing enough independently that reducing directory spend makes financial sense. Most therapists reach that crossover point within 12-18 months of starting an active SEO campaign, though timing varies by market competition and starting authority.

"I'm not technical. SEO sounds complicated."

The technical parts — website structure, page speed, schema markup — are handled by whoever manages your SEO. What you contribute is clinical expertise: explaining your approach, your specialties, and the populations you serve. That content is what Google uses to understand your relevance. You do not need to understand how search algorithms work to benefit from them.

"What if Google changes its algorithm?"

Algorithm changes are real and affect all websites. But directories are equally subject to Google's algorithm — Psychology Today's listings rank because of SEO. If anything, owning your own site gives you more control than renting space on someone else's. Your domain authority, your content, and your backlink profile are assets you keep regardless of what any directory decides to do.

Rather than declaring a winner, here is a decision framework based on three variables that are specific to your practice.

Variable 1: How full is your calendar right now?

• Under 60% full: Prioritize the fastest channel to fill capacity — directories, plus local SEO for near-term wins like Google Business Profile optimization.
• 60-90% full: You have runway to build SEO without financial pressure. This is the ideal time to start.
• At capacity or waitlisted: SEO is purely a growth and future-proofing investment — building the asset before you need it urgently.

Variable 2: How long do you plan to maintain this practice?

If you are in the first 1-2 years of practice, directories are efficient. If you intend to practice for 10+ more years, the economic case for building owned search visibility is strong — the asset compounds over that time horizon, while directory fees do not.

Variable 3: How specific is your specialty?

The more defined your specialty and target patient population, the more SEO outperforms directories. Directory searches default to location and insurance filters. Google searches can be filtered by diagnosis, modality, population, and neighborhood — which is exactly where specialty-focused therapists win with SEO.

The Practical Starting Point

For most therapists reading this, the right move is: keep the directory profile(s) that are currently producing results, stop adding new ones, and begin building your website's SEO foundation in parallel. As organic traffic grows, you will have data to decide whether each directory subscription is earning its cost.

If you want to invest in SEO that gives your practice lasting visibility, see how we approach this for therapy practices: therapist SEO services.