You are renting your caseload
A directory profile fills chairs, and it also decides who sees you, in what order, next to which competitors. Raise your fee, add a specialty, open a second office, and the directory does not care. It is selling the same searcher to every clinician in your zip code.
The practices that get off that treadmill do it by owning the searches the directories handle badly. Not 'therapist near me', which the directories will always win, but 'EMDR therapist' plus a city, 'adult ADHD testing' plus a city, 'perinatal therapist who takes Cigna'. Those queries have less volume and far more intent, and one page can own each of them.
Keep the directory listing. Stop letting it be the whole plan.
The standard reputation playbook is off limits here
Every marketing agency's first move is a review engine. For psychologists, APA Ethical Standard 5.05 prohibits soliciting testimonials from current therapy clients or others vulnerable to undue influence, and state boards enforce their own versions. An agency that installs a review-request automation in your practice is creating a licensing problem for you.
Responding to reviews is its own trap. Thanking someone for being a client confirms treatment, which is a HIPAA disclosure. The only safe public response acknowledges nothing about whether the person was ever seen.
What replaces reviews is referral infrastructure and proof that is not a client's voice: clinician credentials, training and certification in the modality, published writing, community presence, and speed of response. That takes longer to build and it does not get taken away by a board complaint.