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Are therapy referrals down? 3 possible explanations (with solutions)

September 16, 2025 by Ben Caldwell

A pen hovers over business charts. / Photo via Lukas via Pexels / Used under licenseAre fewer people seeking out therapy? Good nationwide data is hard to come by, but we have some signals. Online therapy provider BetterHelp reports a dwindling subscriber base, down about 20% from its peak two years ago, even as they continue to spend millions of dollars on advertising. And anecdotally, we’re hearing lots of individual therapists report that they’re struggling to bring in new clients over the last few months. 

If your practice has been struggling with fewer therapy referrals, here are three possible reasons for it – and solutions for each.

1. Psychology Today clutter

The Psychology Today therapist directory has long been used by therapists to describe their services and attract new clients. Some therapists who rely heavily on the PT directory have seemed particularly impacted over the last few months.

One possible explanation: Some of the large companies that contract with therapists to manage certain elements of their practices have been making it part of their service agreement that they can create PT profiles for their therapists. If the therapist already has one, they offer to take it over. 

The result, again from what we’re hearing anecdotally, has been a large wave of new or updated PT profiles. Those profiles may aim to keep prospective clients in the therapy company’s network even if the specific therapist in the profile doesn’t have availability.

If you feel like your profile is getting drowned out, what to do? PT doesn’t detail exactly how their algorithm works, but others have figured out a few things about it, and about user behavior, over time. We would summarize their guidance as 1) update your profile regularly, 2) have a clear and specific marketing message, and 3) make your profile unique. Putting a dog in your photo, for example, might actually increase response rates – but it might not work if lots of other therapists are doing it.

2. Artificial intelligence

Yes, people are turning to AI for mental health support. Who can blame them? There aren’t enough licensed mental health providers, and AI support is cheap and readily available. AI systems also will not judge users – that’s a big part of their appeal – and tend to validate everything a user says, which can be both appealing and problematic.

We’re not evangelists for AI around here, but we’re not doomsayers either. It’s a new technology that needs guardrails, and therapists will adapt to its availability in a wide variety of ways. If you’re concerned about AI taking a chunk out of your practice, I previously detailed ways you can make yourself indispensable.

3. The larger economy

The relationship between the larger economy and the public’s utilization of psychotherapy is complicated. You might expect that therapy usage goes up when the economy goes down, considering the stressors people experience. But there’s at least some evidence to suggest that the opposite is true, as people may put off necessary care because of the cost.

Of course, you can’t do much about macroeconomic factors. But therapists have found lots of ways to make their practices thrive even in tough economies. You may want to consider accepting insurance, which tends to provide a steady stream of referrals, albeit at lower per-session rates. You may want to review and update your marketing channels, or even revisit your fee structure.

The key takeaway

You might feel helpless in the face of all three of these forces. They’re all beyond your individual control. Therapists seeing fewer therapy referrals this year may feel anxious, or worse. It doesn’t mean that your practice is broken, or that you can’t grow and thrive. It may simply be time to adapt.

You can’t control the world around you, or the various forces that impact how and where clients seek out mental and emotional support. But you can change what you offer, how you package it, and who you offer it to at any time. 

It can be an unsettling time to be a therapist in private practice. That also means you have new opportunities to show prospective clients the value and healing you bring.

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  • Exam Prep
    • California LMFT Clinical Exam Prep
    • California LMFT Law & Ethics Exam Prep
    • California LPCC Law & Ethics Exam Prep
    • California LCSW Law & Ethics Exam Prep
  • CE Courses
    • California Law and Ethics 6-Hour for LMFTs, LPCCs, & LCSWs
    • California Law and Ethics for BBS Associates (AMFTs, APCCs, & ASWs) – 2025
    • Telehealth for California LMFTs, LPCCs, and LCSWs
    • Supervision of California BBS Associates
    • Supervision for Clinical Effectiveness
  • Books
    • Basics of California Law for LMFTs, LPCCs, and LCSWs (11th ed)
    • Preparing for the 2025 California MFT Law & Ethics Exam
    • Preparing for the 2025 California Clinical Social Work Law & Ethics Exam
    • Saving Psychotherapy
  • Resources
    • Think Like the Testâ„¢ Podcast
    • Exam Prep Articles
  • Blog
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