Dec 2020 Google Algorithm Change: How Did Therapists Fare?

Between December 3rd and the 18th Google rolled out its 2020 Core Algorithm Update. It’s part of the regular tuning Google does to their algorithm to improve search. This last one was a big one.

It shook a number of industry players from their coveted spots on the rankings. Amazon and Psychology Today slipped off of Page 1, while sites like eBay and Verywell Health replaced them.

In general, SEOs have been a bit confused about the update. There’s no obvious catch-all factor that accounts for the dramatic shifts in rankings seen across all industries.

But, what I’m interested in is how the update affected therapists, and while there’s more analysis to be done there are some clear patterns that are emerging.

How did the 2020 Core Update affect therapists?

I routinely track 5500 therapist’s rankings. And, I got lucky this week when a therapist directory owner shared 900 more rankings with me. So, I’ve had the benefit of studying a data set of 6400 rankings in the private practice therapy field.

I’m not done with my analysis (anyone have some spare 48-hour days?) and I have a feeling we’ll realize more impacts as the weeks roll on, but I do want to share a few of the big shifts that I’ve seen thus far.

TLDR: For folks with well-structured sites and relevant and thorough copy, things are VERY GOOD!

(NOTE: I’ve checked these results across several cities but I can’t check everything. If you see something different in your area, please let me know so we can dig deeper!)

Here are the details I’ve seen thus far:

1. Psychology Today no longer monopolizes search results:

First off, whereas PsychologyToday used to own the top three spots on Google for nearly every search term therapists want, local therapists are now ranking above PsychologyToday.

In my most recent search, “anxiety therapy,” the Psychology Today directory page was buried at position 10. According to Sistrix, an SEO software company, lost -20.3% visibility overall in the UK and that appears to be the case for the United States as well.

This is a big switch. A healthy change.

Not only is this good for therapists and counselors who were previously crowded out by Psychology Today, but it means that potential clients can match directly with the people who can help them—rather than jumping from Google to a directory listing.

This should also serve as a warning. Therapists and counselors who think they can match with clients exclusively through a directory like Psychology Today will be invisible next to therapists with websites.

2. Google is treating some informational terms differently, and showing local results:

Whereas searches for terms like “anxiety” and “trauma” (without being followed by “therapy” or “counseling”) used to only return high powered national sites, these searches now sometimes show a local 3-Pack of therapists in the mix.
A Google search of "anxiety therapy" that returns a local three-pack widget of therapists.
This image shows a search in Google for the term “anxiety”. It displays the local 3-Pack, which is a widget that shows searchers local businesses in their area that match their keyword.
This is a bit of an odd experiment. As, during the course of this writing, terms like “trauma” would sometimes return a 3-Pack and sometimes not.
A Google search of "anxiety" that returns an informational widget with a definition of the term "anxiety".
The image shows a search for the term anxiety, which returns an informational widget rather than the local 3-Pack widget.

Rather than matching a term, like “trauma”, with therapists and counselors who specialize in “trauma therapy: in the 3-Pack, Google sometimes delivers exact-match keyword results. Which is why my latest search shows a Herbal Medicine Store with trauma in its name in the 3-Pack.

The algorithm is not interpreting “trauma” in a narrow sense—as a psychological healthcare term—but in a wide sense that scoops up local businesses loosely associated with the term.

I don’t expect this change to last. My guess is the algorithm will be refined as time goes on to match user intent, but it still doesn’t know what to make of a simple search like “trauma”.

3. Searches for terms like “anxiety therapy” are still showing a local 3-Pack of therapists, but also show national sites along with organic listings of local therapists.

What this change may signify is Google’s increasing emphasis on the local 3-Pack listing.

It may indicate that, nationally speaking, most local searches begin and end with the 3-Pack listing, and then conclude that people who ignore the 3-Pack are looking for general (non-local) information. They’re not looking for a therapist, they’re looking for anxiety therapy research from NIMH or a definition of “anxiety disorders” from Mayo Clinic.

Still, this is a working hypothesis. Local listings are still showing, albeit mixed with national results.

It may be telling us more about how people use Google rather than how Google wants to train people to search. If this is true then it means therapists need to ensure that their Google My Business listing is proper.

4. When we add the city name (“anxiety therapy “), we see the local 3-Pack followed by more local organic therapist rankings and directories.

While Psychology Today has been bumped from many search terms the directory still owns the first few results for some local searches such as “anxiety therapy boulder”.


Google is associating large directory websites with specifically local keywords, e.g. keywords with the city name attached. The reasoning might go, if the search is local then create access to local directories.

Other directories are also showing, such as Good Therapy, Yelp, and Theravive.

Searchers must be clicking the Psychology Today directory when the local 3-Pack doesn’t give them the results they want—for now. This reinforces that notion that Google is connecting potential clients with therapists primarily through the 3-Pack.

5. Irrelevant pages that ranked for certain searches have largely been removed.

For instance, if your home page used to rank for “anxiety treatment” or your child counseling page used to rank for “counseling” this is most likely no longer the case.

Google has tightened up around relevance.

The search engine wants to deliver results that match searcher’s queries. Irrelevant pages are a distraction. This is a good sign for therapists with a sound strategy, as their pages are organized to rank for specific keywords.

This may also show that Google is getting smarter about keyword cannibalism between posts and pages that are about similar topics.

6. In general, thin content pages fell in the rankings. Long copy, which already did well before, is winning more and more.

Websites that put in the time to create value-laden content rank higher than lazy, thin content.

This is true for every core update. Thin, hastily slapped together pages always lose with each tuning of the algorithm. Google has even explicitly stated that good content will rank.

The algorithms ultimate goal is to understand what makes one page more valuable than another. While it’s not quite there yet it’s clear that this Core Update is trying to take a big step forward.

Don’t get lazy!

7. It’s taken over 30 days for the update’s consequences to be felt.

Something strange happened after the core update.

While Google’s rollout was supposedly finished on December 18th, we saw a drop in rankings for many of our clients on January 10th. Those rankings then bounced back to around their original position on February 11th. A 30 day experiment?

An image of an analysis on Serpfox, an SEO tool, which shows a therapist's rankings for the term "anxiety therapy" between the months of December and February.
The above image is of an analysis done on Serpfox for the term “anxiety therapy” on a particular therapist’s website. The chart shows the recorded rankings for the term between the months of December and February. We see a sharp drop in rankings and then a later rebound in February.
It’s odd. The U-shaped curve occurs for websites that ranked well, had a sound structure and were well-maintained. It’s difficult to determine what variable caused the drop.
An analysis on Serpfox, an SEO tool, that shows the keyword ranking for the term "anxiety therapy" between the months of December and February.
The image is of an analysis done on Serpfox for the term “anxiety therapy” on a particular therapist’s website. The graph shows a sharp drop in rankings that quickly rebounded and then stabilized in January. The more recent rankings show a steady increase.

Overall though the general trend has been an increase in rankings, despite the odd fluctuations we see above.

There must have been quite a bit of fine tuning in the month of January.

Or, more likely, the Core Update’s consequences took time to be fully realized.

These updates are not a flip of a switch. There are hundreds of billions of websites indexed on Google and it takes time for the new update to sort through and rank each site accordingly.

8. I’ve seen fluctuations in anorexia and bulimia therapy terms as well as binge eating and eating disorders counseling terms.

For some clients terms like “anorexia counseling” follow a similar U-shaped curve as described above. They saw a significant drop in rankings around January and have since recovered during the month of February, 2021. These are therapists whose pages ranked on Page 1 or 2.

As soon as we go beyond Page 1 or 2 there are wild fluctuations for terms including “anorexia” and “bulimia”.

It seems that therapists with a strong presence are being rewarded, while those who failed to secure high rankings before the Core Update are still being sorted.

Terms related to “binge eating” and “eating disorders” are a bit more varied. Unless they’re attached to terms like “ therapy,” or “counseling” therapists seem to be struggling to rank high, settling somewhere beyond Page 1.

It’s difficult to tell where many of these terms will land. Perhaps Google is awarding the more medical-type terms to treatment centers rather than to private practice therapists.

9. I’m seeing quite a bit of volatility around addiction terms, but I can’t yet see a clear pattern.

Addiction terms have experienced quite a bit of volatility.
An analysis on Serpfox, an SEO tool, that shows the rankings for the term "family coaching for addiction" between December and February 2021.
The image shows a search done on SerpFox, a SEO research tool, for the term “family coaching for addiction”, on a particular therapist’s website. The rankings have fluctuated between Position 12 and Position 50 between the months of December and February.

What we see here is the update trying to understand where to rank this client’s website for “family coaching for addiction,” as a local term.

Whether or not these fluctuations will continue remains to be seen.

An analysis on Serpfox, an SEO tool, that shows rankings for addiction-related terms steadily increasing between the months of December and February 2021.
This image shows a therapist ranking for addiction related terms and has seen a steady increase in their rankings since the December Core Update.
Of course, those who already ranked well, whether because they had limited competition or excellent pages, have been rewarded with further rankings.

The final takeaway from Google’s Core Update

In general, this update seems to be another sign that Google is trying to improve how it understands searcher’s intent, and how it categorizes particular web pages to match the intent.

The algorithm is asking questions like…

  • Is this search local or national?
  • Does this local business match the intent of the keyword?
  • Should we deliver a large platform such as Psychology Today or a local therapist for this keyword.
  • What do people want?

Therapists who have adopted a smart SEO strategy and continue to maintain their sites seem to be doing well after the update, and will continue to do so. With Core Web Vitals becoming a ranking signal in May 2021 it’s now more important than ever to have your site up to snuff.

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