The Evaluation Framework That Separates Qualified Therapist SEO Agencies from Generic Vendors

This guide is written for licensed therapists, counselors, psychologists, and group practice owners who are actively evaluating SEO providers — not just researching the concept of SEO in general.

If you're still weighing whether SEO makes sense for your practice, the therapist SEO hub is a better starting point. Come back here once you've decided to move forward and want a structured way to vet candidates.

This framework applies whether you're:

• A solo practitioner replacing an agency that produced no measurable results
• A group practice owner hiring your first SEO vendor
• A practice manager evaluating multiple proposals side by side
• A therapist who was burned by a generalist agency and wants to understand what mental health-specific SEO actually requires

One clarification before we go further: this guide discusses marketing evaluation criteria, not clinical or legal advice. When assessing HIPAA compliance or state licensing board advertising rules, verify specifics with a qualified healthcare attorney or your licensing board directly. What follows is educational content about vendor selection, not a legal framework for compliance.

Most therapists evaluate agencies on two dimensions: price and promises. That framework reliably produces poor outcomes. A more useful model evaluates vendors across four dimensions:

1. Healthcare-Specific Competency

General SEO skills transfer partially to mental health practices — technical optimization, keyword research, and link building are universal disciplines. But the strategic layer is different. A therapist's website operates under HIPAA constraints, APA Ethics Code Standards 5.01–5.06 governing advertising, FTC endorsement guidelines affecting how testimonials appear, and state licensing board rules that vary by jurisdiction.

An agency without working knowledge of these constraints will publish content, solicit reviews, or build landing pages that create compliance exposure — often without realizing it. Ask directly: How does your team handle content that involves patient outcomes or testimonials? A qualified answer involves a clear policy, not a blank stare.

2. Local Search Depth

The majority of therapy clients search locally — city name, neighborhood, or proximity. An agency that leads with national traffic metrics is solving the wrong problem. You need a vendor who understands Google Business Profile optimization, map pack rankings, local citation consistency, and how review volume and recency affect local visibility. These are specific, auditable skills.

3. Reporting Clarity

You should be able to look at your monthly report and answer: Are more people finding me? Are they contacting me? What changed this month and why? If the answer requires a 45-minute explanation from the agency every time, the reporting is designed to obscure rather than inform.

4. Content Process Discipline

Content published under your name — blog posts, specialty pages, FAQ sections — is your professional communication. Any agency that publishes without your review, or treats your approval as a bottleneck to minimize, is not a fit for a licensed mental health professional. Confirm the review and approval workflow before the contract is signed.

Use these criteria as a structured scorecard when comparing agencies side by side. Each criterion has a clear signal for what a qualified answer looks like.

Portfolio of Mental Health Clients

Ask whether they've worked with licensed mental health professionals — therapists, psychologists, or psychiatrists — not just healthcare broadly. Dental SEO and therapy SEO share almost nothing beyond the word healthcare. Look for examples of ranking improvements for therapy-specific searches, not general wellness content.

HIPAA and APA Ethics Awareness

You don't need an agency that's a HIPAA compliance officer. You do need one that understands they are operating in a regulated space and knows which actions require your review. Ask how they handle review responses, whether they've encountered APA advertising ethics guidelines before, and what their policy is on publishing any claim involving patient outcomes. Correct answers demonstrate awareness; evasive answers demonstrate risk.

Transparent Keyword Strategy

Before signing, you should receive a clear explanation of which search terms they're targeting, why those terms were chosen, and what the realistic traffic opportunity looks like in your specific market. Vague answers like "we'll target the best keywords for your practice" are not a strategy — they're a placeholder.

Link Building Methods

Ask directly: How do you build backlinks for therapy practices? Qualified agencies use methods like local directory citations, digital PR, and content-based link earning. Be cautious of any agency that describes link purchasing, private blog networks, or bulk directory submissions as their primary approach — these tactics carry risk that outlasts the contract.

Contract Terms and Exit Conditions

Review the contract length, notice period for cancellation, and what happens to the work product if you leave. Assets built for your practice — your Google Business Profile optimizations, your website content, your local citations — should remain yours. Any contract that's ambiguous on this point deserves a direct question before you sign.

Some vendor behaviors are disqualifying on their own. No amount of low pricing or smooth presentation offsets these signals.

• designed to first-page or position-one rankings. Google's own guidelines state that no one can guarantee rankings. An agency making this promise either doesn't understand how search works or is willing to misrepresent outcomes to close a deal. Neither is acceptable.
• No content review process. If the agency publishes blog posts, specialty pages, or FAQ content to your site without your review and approval, you are signing away control over your professional voice and compliance posture. This is not a workflow disagreement — it is a fundamental incompatibility with licensed mental health practice marketing.
• Testimonial pages or patient outcome claims without compliance context. The FTC requires disclosure when testimonials represent atypical results. APA Ethics Code Standards 5.01–5.06 restrict certain advertising claims for psychologists. State licensing boards may impose additional restrictions. An agency proposing these tactics without raising compliance considerations is operating outside their lane.
• Inability to explain what they're measuring. If a vendor can't show you a sample report and walk you through exactly what each metric represents and why it matters for patient acquisition, that's not a reporting preference — it's a gap in accountability.
• Pressure tactics or limited-time pricing. Legitimate agencies don't close deals with countdown timers. If a proposal comes with urgency framing designed to prevent you from evaluating alternatives, treat it as a signal about how the relationship will be managed.
• Lock-in contracts longer than 12 months with no performance benchmarks. Long contracts without defined performance milestones transfer risk entirely to the client. A qualified agency should be willing to define what success looks like and stand behind it with reasonable exit provisions.

These questions are designed to surface competency gaps and assess working knowledge — not trick vendors, but distinguish those with genuine mental health SEO experience from those learning on your practice.

1. "Walk me through how you've handled HIPAA constraints in a previous therapy practice campaign." A qualified answer is specific: it describes an actual constraint they navigated, not a general statement about taking compliance seriously.
2. "What's your content review process, and how long does approval typically take?" The answer should describe a defined workflow, not an improvised one. You're looking for evidence that content approval is a standard step, not an exception for nervous clients.
3. "Which local ranking factors matter most for a therapy practice, and how do you prioritize them?" Look for specifics: Google Business Profile completeness, review recency and volume, NAP citation consistency, proximity signals, and on-page local relevance. Vague answers indicate surface-level local SEO knowledge.
4. "What does your monthly report look like, and can I see an example?" Ask for a redacted sample from a current client. If they can't or won't provide one, the reporting process either doesn't exist in a useful form or isn't something they're confident in.
5. "How do you handle Google Business Profile review responses for therapy practices?" The correct answer acknowledges HIPAA constraints — specifically, that confirming someone is a patient in a public response creates privacy exposure. Any agency that hasn't thought through this has a knowledge gap in a high-visibility, high-risk area.
6. "What happens to my website content and local citations if I end the contract?" You should receive a clear, immediate answer. Hesitation or ambiguous language in this response warrants direct follow-up before you sign anything.

Therapists evaluating agencies often encounter — or have — a set of recurring objections. Most of them are worth examining directly rather than avoiding.

"My last agency didn't deliver and I'm not sure SEO works for therapy practices."

This is one of the most common situations we hear about. In our experience working with therapy practices, underperformance from a previous agency usually traces to one of three issues: the agency targeted national or informational keywords with no local intent, the content strategy didn't reflect how actual therapy clients search, or reporting was structured around vanity metrics rather than patient inquiries. These are solvable problems — but they require an agency that understands the therapy-specific search landscape, not a generalist applying a generic content calendar.

"I don't have time to review content."

A structured review process with clear deadlines and concise summaries should take less time than you're imagining — typically a 10–15 minute review per piece for most practices. If an agency is asking for more than that, or structuring their workflow to make review feel burdensome, the workflow is designed wrong. Protect your review rights regardless; the compliance and professional reputation stakes are too high to delegate entirely.

"I'm already getting referrals — do I need this?"

Referral-dependent practices are exposed to concentration risk: one colleague retires, one hospital changes its referral policy, and a significant portion of new patient flow disappears. SEO builds a parallel acquisition channel that works whether or not your referral network is active. It's not a replacement for relationships — it's a hedge against their variability.

If you want to see how our approach to therapy practice SEO is structured, explore our approach to therapy practice SEO — including how we handle compliance, content review, and local search for mental health professionals.