Most therapists hire a marketing agency the same way most people buy a mattress: once a decade, with no idea what a fair deal looks like, from a salesperson who does this every day. The agency has run this call a thousand times. You’ve run it once. That’s the imbalance, and the only way to fix it is to walk in with the right questions to ask a marketing agency before you sign anything.
I’m Patrick Antinozzi. I’ve run RapidWebLaunch for 13 years, and I now run The Therapist SEO Company, so yes, I’m one of the people you’d be interviewing. That’s exactly why I can tell you which questions make agency owners squirm. Below are the 10 I’d ask if I were a practice owner spending my own money, and for each one, why it matters, what a good answer sounds like, and what a bad answer sounds like. Bring the list to your next sales call. The good agencies will respect you for it.
1. If I cancel, what do I keep?
This is the single most important question on the list, and almost nobody asks it.
Why it matters: Many agencies build your website on a proprietary platform, register your domain under their account, or write content they contractually own. Everything looks fine until you try to leave, and then your site, your content, and every ranking they earned vanish with the agency. In SEO terms, that’s 1 to 2 years of progress gone. The industry has a name for it: the website hostage situation.
A good answer: “You keep everything. The domain is registered in your name, the site can move to any host, every page and blog post is yours, and you have admin access to your Google Business Profile, Analytics, and Search Console. We’ll put that in the contract.” That’s how we handle it with our therapist web design service, and it’s the only honest way to do it.
A bad answer: “The site runs on our platform, but most clients never leave.” Or any answer that requires a follow-up email to “check with the team.” If ownership were clean, they’d know instantly.
2. What are your contract terms?
Why it matters: SEO genuinely takes 4 to 6 months to move, and agencies use that truth to justify 12-month contracts. But a long contract moves all the risk onto you. If the work is bad, you find out around month 3, then pay for 9 more months of it. The agency’s incentive to perform evaporates the day you sign.
A good answer: “Month to month. If we stop earning your business, you leave.” Month-to-month terms are the strongest trust signal in this industry, because the agency has to re-win you every 30 days. It’s why our pricing is one flat $1,500/month plan with no contract and no setup fees.
A bad answer: “We require 12 months because SEO takes time.” SEO does take time. That’s an argument for patience, not for removing your only leverage. Also watch for “month to month” paired with a 90-day cancellation notice, which is just a quarterly contract wearing a costume.
3. What does exclusivity mean to you?
Why it matters: If an agency works with three anxiety therapists in your city, it is ranking your competitors against you with the same playbook, and someone has to lose. Some agencies quietly serve everyone. Some promise “exclusivity” that only covers your exact specialty, so they’ll happily sign the group practice across town as long as it lists “couples counseling” first.
A good answer: “One practice per service area, period. If we work with you in your city, we turn away your competitors.” That’s our policy, and it should be non-negotiable for any local business.
A bad answer: “We keep client work confidential” (that’s not exclusivity, that’s secrecy), or “we make sure there’s no direct overlap” (undefined and unenforceable). Ask them to name the rule and put it in writing.
4. How will you report results, and what number do you consider success?
Why it matters: Rankings and impressions are how agencies look busy. Client inquiries are how you pay rent. A new therapy client is worth roughly $2,000 or more in lifetime value (about $150 per session across 15 or more sessions), so the only report that matters connects the work to calls, form fills, and booked consultations.
A good answer: “We track calls and contact-form submissions, tie them to their source, and report them monthly alongside rankings. Success is new client inquiries.” Our client Dakota Trauma Therapy in Bismarck ranks #1 for “bismarck therapists” with 21 local searches in the top 10, and the reason that matters is what it produces: inquiries. You can see the numbers in the Dakota Trauma Therapy case study.
A bad answer: A sample report with 14 pages of impressions, “visibility scores,” and keyword movement charts, and zero mention of phone calls. If inquiries aren’t on page one of the report, they aren’t the goal.
5. What will you NOT do for my practice?
Why it matters: This is the fastest honesty test I know. Every legitimate strategy has trade-offs and limits. An agency that claims to do everything (SEO, ads, social, email, branding, video) for $1,500 a month is doing all of it badly or most of it not at all.
A good answer: A specific list. Ours: we don’t run social media, we don’t do pay-per-lead, we don’t guarantee rankings, and we don’t take on practices whose market we can’t realistically win. An agency that names its limits has thought about where its results actually come from.
A bad answer: “We’re a full-service agency, we handle it all.” Or worse, hesitation followed by “what were you hoping for?” That’s a menu being written in real time to match your wallet.
6. Have you worked with therapists, and what’s different about marketing a practice?
Why it matters: Therapy is not roofing, and it’s not dentistry either. Therapists are bound by APA, ACA, and NASW ethics codes and by HIPAA. The single clearest test: an agency that treats you like a restaurant will cheerfully suggest you “collect Google reviews from happy clients.” For a therapist, soliciting reviews or testimonials from current clients is an ethics violation. An agency that doesn’t know that on day one will either get you in trouble or waste months proposing tactics you have to veto.
A good answer: They bring it up before you do. “We know you can’t solicit client testimonials, so we build reputation through your content, your credentials, your directory presence, and how you respond to reviews that appear organically, all within your ethics code.” They should also understand client privacy in analytics and ad tracking, and that the people you serve are clients, not customers to be retargeted.
A bad answer: “Marketing is marketing, the fundamentals are the same.” The fundamentals are the same. The rules are not.
7. Who actually does the work?
Why it matters: The person on the sales call is often the last senior person you’ll ever speak to. At many agencies, your account gets handed to a junior account manager who relays your requests to an offshore fulfillment mill. That’s how you end up with blog posts about “mental wellness solutions” that no therapist would ever publish.
A good answer: Named humans. “I write the content, this person builds the site, here’s who answers your emails.” Small niche firms usually win here by default; the person selling you is the person doing the work.
A bad answer: “We have a dedicated team of specialists.” Ask a follow-up: “Can I see a piece of content your team wrote for another therapy practice?” If they can’t produce one, the team doesn’t specialize in anything.
8. What results should I expect, and on what timeline?
Why it matters: This question filters out the two worst kinds of agencies at once: the ones that overpromise and the ones that hide behind vagueness. Google’s own documentation warns against firms that guarantee rankings, because nobody controls Google’s results.
A good answer: Honest ranges. “Expect 4 to 6 months before rankings move meaningfully, 6 to 12 months to lead a competitive market, and here’s what we’d check at each milestone to confirm we’re on track.” They should also be willing to tell you if your market is too competitive for the budget, before taking your money.
A bad answer: “Page one in 30 days, guaranteed.” End the call. Also bad: “SEO is a long-term investment” with no milestones at all, which is how bad agencies collect 12 months of fees before you notice nothing happened.
Here’s a quick reference you can screenshot for the call:
| Question | Good answer sounds like | Bad answer sounds like |
|---|---|---|
| What do I keep if I cancel? | ”Everything, in writing" | "It’s on our platform” |
| Contract terms? | ”Month to month" | "12 months minimum” |
| Exclusivity? | ”One practice per area" | "No direct overlap” |
| How do you report? | ”Calls and inquiries" | "Impressions and visibility” |
| What won’t you do? | A specific list | ”We do it all” |
| Therapist ethics? | Raises testimonials issue first | ”Marketing is marketing” |
| Who does the work? | Named humans | ”A dedicated team” |
| Timeline? | “4 to 6 months, milestones" | "Guaranteed page one” |
9. How did you pick the keywords you’d target for me?
Why it matters: Lazy agencies target whatever sounds impressive (“therapist near me,” “online therapy”) without checking whether those searches happen in your city or match what you actually treat. The right targets depend on your specialties, your service area, and real local search volume, and the difference between “trauma therapist bismarck” and “emdr therapy near me” can be the difference between ranking and invisibility.
A good answer: They show you data for your city and your specialties before you sign, and they explain the trade-offs: which keywords bring clients ready to book versus researchers, which are winnable in 6 months versus 2 years. You can pressure-test any agency’s keyword pitch yourself with our free therapy keyword tool, which shows real search volumes for therapy terms in your area. If their target list doesn’t survive contact with the data, that tells you something.
A bad answer: A generic list that could apply to any therapist in any city, or “we’ll do keyword research after onboarding.” The research is how they should have priced and scoped the engagement in the first place.
10. Why should I hire you instead of doing this myself?
Why it matters: Not because you’re looking for a sales pitch. Because the answer reveals whether they respect you. Plenty of therapists successfully handle their own Google Business Profile and write their own site copy, and an honest agency will say so.
A good answer: Specific and a little humble. “You could do this yourself. What you’re buying is 15 hours a month you don’t have, plus pattern knowledge from doing this across many practices: what a converting therapy site looks like, which directories matter, how to structure a specialty page. If you have the time and interest, start yourself and call us when you’d rather see clients.” An agency confident in its value doesn’t need to make DIY sound impossible.
A bad answer: Fear. “SEO is way too technical, one wrong move and Google penalizes you.” That’s mostly false and entirely manipulative. Google penalties come from spam tactics, not from a therapist writing an honest page about EMDR.
What to do with the answers
You don’t need an agency to ace all 10. You need clean answers on the non-negotiables (ownership, contract terms, ethics awareness) and honest answers everywhere else. Two or more bad answers from the table above and I’d keep looking, no matter how good the case studies are.
And weigh the answers against the math. At our pricing of $1,500 per month, month to month, with a client lifetime value around $2,000, the whole engagement pays for itself at roughly one new client a month. Any agency you talk to should be able to walk you through that same break-even logic for their own fees. If they can’t, they haven’t thought about your side of the deal.
If you want to hear how we answer these 10 questions ourselves, email us at hello@thetherapistseocompany.com and we will answer in writing. Or start with our free Practice Visibility Report: a one-minute look at your site with no contract and no pressure.
Frequently asked questions
- What questions should I ask before hiring a marketing agency?
- Start with ownership (who keeps the website, domain, and content if you cancel), contract terms (month to month or locked in), and reporting (do they count client inquiries or just rankings). Then ask what they will not do, how they handle ethics rules for therapists, whether they work with your competitors, and who actually does the work. The answers to those seven tell you more than any portfolio.
- How do I know if a marketing agency is legitimate?
- Legitimate agencies offer month-to-month terms or short commitments, put ownership of your website and content in writing, explain their methods in plain English, and set a realistic timeline of 4 to 6 months for SEO results. Red flags include guaranteed rankings, secret proprietary methods, pressure to sign a 12-month contract on the first call, and reports built entirely on impressions and traffic.
- Should a therapist hire a general marketing agency or a niche one?
- A niche agency almost always gets you further faster. General agencies spend the first few months learning your industry at your expense, and they routinely suggest tactics that violate therapist ethics codes, like soliciting client testimonials. An agency that already works with therapists starts with keyword data, content patterns, and compliance knowledge in place from day one.
- How much should a therapy practice pay a marketing agency?
- Most solo and small group practices pay between $500 and $2,500 per month for SEO and marketing. We charge one flat rate of $1,500 per month, month to month, with no setup fees. Since a new therapy client is worth roughly $2,000 or more in lifetime value, the plan pays for itself at about one new client per month.
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