Abstract
Purpose
Online directories play an important apomediary role in shaping how older adults find and compare potential providers. However, little is known about how this type of health information represents older adult needs and aging-related mental health expertise. This study examines how mental health professionals represent older adults and age-related care in their Psychology Today profiles.
Methods
We conducted a mixed-methods content analysis of 281 Psychology Today provider profiles across 8 U.S. cities. We used frequency counts and descriptive statistics to characterize provider attributes and areas of expertise. Using thematic analysis, we examined how providers describe their approach to serving older adults and aging-related mental health care. Quantitative findings informed and contextualized the qualitative analysis.
Results
We identified one overarching theme “Older Adults at the Limits of Apomediated Visibility” and four subthemes: “Absent Narratives of Aging,” “Token Mentions of Older Adults”, “Misaligned Descriptions of Expertise”, and “Generalist Framings Obscure Age-Specific Care”. These results suggest that apomediary signals of relevance may not consistently match substantive descriptions of provider expertise in older adult mental health care.
Conclusions
Findings reveal gaps between platform filters and profile narratives that may undermine the directory’s apomediary role, making “older adult” care appear searchable while obscuring the age-relevant information older adults need to make informed health decisions. Better alignment between structured search criteria and narrative self-representation would strengthen informed decision-making and advance equitable access to age-responsive mental health services.
Introduction
Apomediation in Online Health Information and Provider Directories
Digital health directories, such as Psychology Today’s Find a Therapist Tool, play an apomediary role in provider selection as they offer searchable narrative, areas of expertise, treatment modalities, and target populations.1-6 However, research shows that older adults face challenges in accessing and interpreting online health information, especially when content in not tailored to their health information literacy levels or specific needs.7-9 Therefore, the effectiveness of these platforms depends not only on usability, but also on the relevance and inclusiveness of the information presented. 10 Limited evidence exists to the extent that mental health provider platforms serve the health information needs of older adults.
Mental Health Needs of Older Adults
In addition, to social issues like isolation and loneliness,11,12 older adults also face distinct mental health challenges, including depression, cognitive impairment, bereavement/grief, and chronic illness. 13 The recent COVID-19 pandemic brought these issues to the forefront by exacerbating existing challenges and further straining access to essential services.14,15 Yet, older adults are significantly less likely to receive mental health care compared to their younger counterparts, often due to stigma, misdiagnosis, or structural barriers (i.e. lack of transportation, lack of geriatric specialist).16,17 The gap between need and utilization is particularly concerning as the U.S. population of older adults (adults aged 65+) is projected to double by 2060. 18
Representation in Provider Narratives
In digital health contexts, how providers describe themselves plays a critical role in shaping client perceptions of empathy, expertise, and therapeutic fit, 19 which ultimately affects care-seeking decisions. Provider profiles, often the first point of contact for prospective clients, function as a primary means of communicating areas of specialization. However, these signals are not always explicit which can contribute to the broader issues of ageism 20 and underrepresentation of older adults in digital health spaces. 21 While other studies have examined provider self-presentation on social media and health insurance network directory platforms,22-24 few have explored how aging and older adults are represented, or omitted, in mental health provider online directory profiles.
Research Questions
This study addresses this gap by investigating the representation of aging-related mental health needs in provider profiles and examining how older adults are framed within their profile narratives. To do this we pose two research questions (RQs): RQ1: To what extent do Psychology Today provider profiles represent older adult mental health care within an apomediated digital health information environment? RQ2: How is aging framed in provider profile narratives, and what do these framings reveal about social responsibility and equitable representation in digital mental health information?
Methods
Study Design
This mixed-methods study was designed to investigate how older adults and aging-related mental health care are represented in provider profile narratives on Psychology Today. A mixed-method study design was selected to address the study aim to investigate the representation of aging-related mental health in provider profiles as well as examining how older adults and their care is framed within provider narratives. The research integrated quantitative content analysis to assess the frequency and co-occurrence of aging-related terms across a broad sample of publicly available mental health provider profiles, and qualitative thematic analysis 25 to explore how providers frame their expertise and approach to older adult care within their profile narrative descriptions. Quantitative findings informed and contextualized the qualitative analysis by identifying patterns in provider characteristics, which were then explored in greater depth through thematic analysis.
Data Source and Sampling
Data were collected from publicly accessible mental health provider profiles on Psychology Today, a popular and publicly accessible online directory for locating mental health professionals in the United States. Psychology Today was selected as the primary data source for this study because it is one of the largest and most widely used professional directories for mental health practitioners in the United States. This platform provided standardized provider profiles which include structured health information such as areas of specialization and self-descriptions of therapeutic approach. This structured format enabled systematic data extraction suitable for both qualitative and quantitative analysis and ensured comparability across cases. Quantitative findings on the frequency of expertise areas were integrated with qualitative thematic analysis of mental health provider profile narratives to examine how reported specializations were represented and contextualized within self-described narratives.
To inform sampling, we first identified the fastest-growing cities for older adult populations based on findings from the U.S. Census Bureau. 26 We intentionally added three additional cities (Seattle, Washington; Baton Rouge, Louisiana; and Boston, Massachusetts) to enhance regional representation and reflect a broader spectrum of older adult communities. This final sample of 8 cities allowed for more inclusive analysis across diverse urban, suburban, and rural contexts.
Population Characteristics and Psychology Today Providers by City
2023 ACS 1 year Estimates Data Profiles.
Qualitative Analysis
We conducted thematic analysis 25 of the 281 provider profile narratives. This approach was selected for its flexibility to use both inductive and deductive approaches to examining the data. We employed deductive approaches to initial coding which was informed by preliminary phases of familiarizing ourselves with the data. Coding was conducted independently by two researchers. Consistent with thematic analysis practices, formal inter-rater reliability statistics were not calculated. Instead, analytic rigor was supported through iterative consensus-based discussions and comparison of coding decisions. This initial phase was followed by inductive refinement, which enabled the identification of patterns within in the data. Any discrepancies in coding and then development were resolved through ongoing discussion until consensus was reached.
Ethical Considerations
This study was based on publicly available and accessible data. The study protocol was reviewed and approved by the Louisiana State University Institutional Review Board (IRB) under IRB Protocol #25-0176. All provider data was de-identified and consent was not required.
Results
Descriptive Statistics
Distribution of providers varied by location, with the highest number in Austin, TX (n = 73), followed by Raleigh, NC (n = 47), Boston, MA (n = 41), and Seattle, WA (n = 37). Smaller cities such as Wilmington, NC, Baton Rouge, LA, Myrtle Beach, SC, and College Station, TX each had between 20 and 23 included providers. The average number of expertise areas listed per provider was 25.49 (SD=4.14, range=20.7-34.2). All providers included at least one area related to geriatric and senior mental health care. The top ten most co-occurring expertise areas across the entire sample included: (1) Geriatric and Senior, (2) Grief, (3) Coping Skills, (4) Stress, (5) Self-Esteem, (6) Mood Disorders, (7) Relationship Issues, (8) Life Transition, (9) Family Conflict, and (10) Women’s Issues.
Thematic Analysis
Through thematic analysis, we identified one overarching theme: “Older Adults at the Limits of Apomediated Visibility”. This theme captured a recurring disconnect between the platform’s structured signals of relevance to older adults and the limited, vague, or absent aging-related information in providers’ narrative self-description. Four subthemes characterized this pattern: absent narratives of aging, token mentions of older adults, misaligned descriptions of expertise, and generalist framings obscure age-specific care. See Figure 1 for thematic map. Thematic map
Subtheme: Absent Narratives of Aging
In this pattern, providers selected built-in filters indicating service to older adults, but their profile narratives contained no mention of aging, later life, or aging-related issues. As a result, the platform signaled relevance to older adults through its structured categories, while the narrative content offered no aging-related information to substantiate that relevance. These profiles appeared mismatched from the outset.
For example, one College Station provider described their practice focus in “Adolescent, Adult Personal, and Relational issues.” (COL141) Despite selecting filters for older adults, the provider’s narrative did not reference older adults, aging, or late-life concerns. Similarly, a Wilmington provider (WIL265) described their background as a “Licensed Clinical Social Worker who received my advanced clinical training working with adolescents, children and families at the [University] Child Study Center.” This pattern suggests that platform-level signals of relevance may not be matched by narrative information that helps users assess provider fit and make informed health information.
Subtheme: Token Mentions of Older Adults
We identified token mention in profiles where older adults were briefly referenced in provider narratives but not meaningfully described. In these profiles, older adults were typically listed alongside multiple age groups or populations served, with little elaboration on aging-related concerns, expertise, or approach to care. As a result, older adults were acknowledged, but only minimally.
One provider (COL152) described experience “working with individuals across all stages of life—children, teenagers, adults, and seniors.” In this example, older adults are mentioned as part of a comprehensive age range “all stages of life”, rather than a distinct focus of care rendering them invisible in practice, signaling inclusion without meaningful engagement. The reference to “seniors” functioned as a brief marker of inclusion, but the profile offered no additional detail about experience with aging-related issues or later-life care.
This pattern appeared more often in profiles that emphasized breadth of service across age groups. While older adults were not entirely absent from these narratives, their inclusion remained brief and underdeveloped, contributing to visibility without substantive description.
Subtheme: Misaligned Descriptions of Expertise
The third pattern involved misaligned descriptions of expertise, in which providers selected older adult-related filters, but used their narratives to emphasize populations or specialties that diverged substantively from older adult mental health care. Unlike absent narratives, in which aging-related content was simply missing, these profiles directed attention toward other areas of practice, creating a clearer mismatch between filter-based categorization and narrative emphasis.
One Seattle provider (SEA232) described their “work with WNBA athletes and high-profile clients in both the Movie and Music Industries.” Although the provider had selected older adult-related filters, the narrative focuses on athletes and high-profile media industry clients without mention of older adults. Rather than leaving older adult care unspecified, the profile emphasized a therapeutic focus oriented toward distinctly different populations.
Misaligned descriptions appeared throughout the dataset, with providers selecting older adult filters while describing client populations or specializations that diverged substantially from geriatric mental health. This pattern was observed across provider types and geographic locations, reflecting a recurrent disconnect between platform categorization and narrative emphasis.
Subtheme: Generalist Framings of Expertise
A fourth pattern involved generalist framing, in which providers explicitly identified older adults or seniors as part of their client population but described their services in broad, non-specific terms. Unlike token mentions which referenced older adults only briefly, these profiles did acknowledge older adults more directly. However, the narrative language remained general enough that it did not clearly convey aging-related expertise, concerns or therapeutic focus.
For example, one Boston provider wrote: “I offer individual telehealth therapy, through a user-friendly, HIPAA compliant platform to adults and seniors. I have more than 19 years of experience collaborating with clients to successfully address a variety of behavioral, relationship and challenging life issues…” (BOS103). This narrative acknowledges “adults and seniors” as target populations but presents services in a generalized way, using therapeutic language that could apply to any age group.
Generalist framing appeared less frequently in the dataset, but it represents a distinct form of weak specificity. In these profiles, older adults were acknowledged, but the narrative remained too broad to clearly communicate age-specific relevance.
Discussion
To our knowledge, this is the first systematic analysis of Psychology Today provider profiles focused on representation of older adults and aging-related mental health care. Prior research has examined healthcare provider’s digital presence across different digital platforms such as structured medical platforms, social media environments, and provider directories. Yet, little research has focused on how aging-related care is represented within digital mental health directories. Our findings contribute to this literature by examining provider profiles not merely as image management nor marketing tools, but as apomediary information spaces where particular populations, needs, and forms of expertise can be made more or less visible. Other research on online mental health platforms has examined how providers strategically curate their profiles to attract clients. For example, a study of a Chinese online psychiatric consultation system found that providers use informational content, emotional expression, profile images, and patient reviews as impression management tools. 22 Similarly, research on healthcare providers’ social media presence demonstrates that clinicians curate both professional and personal identities online. 23 Our findings showing that while online provider profiles are curated forms of digital self-representation, that curation can intentionally or unintentionally misrepresent certain populations. For older adults, the issue is not only whether providers appear credible or approachable, but whether their profiles communicate age-relevant expertise in ways that older adults can recognize as relevant and meaningful.
Our study also extends research on provider directories, including studies of directories associated with insurance carriers. 24 Insurance-based directories typically organize information around plan participation, provider availability, location, expertise or specialty, and network status. Psychology Today profiles offer more narrative and self-representational content which affords providers greater opportunity to explain their approach, expertise, and client population. Our findings broaden existing concerns about directory quality. The problem is not only whether provider information is accurate or up to date, but whether it substantively represents the needs of the populations the directory claims it serves. In this study, older adults were visible at the level of platform classification but were often less visible in provider narratives. This finding complicates assumptions that search filters alone are sufficient indicators of access. Our findings suggest that digital access to mental health care requires more than technical searchability.
Our findings are relevant to broader research documenting the underuse of mental health services among older adults despite increasing need and elevated risk.11,13 Prior studies have shown that depression, loneliness, chronic illness, grief, cognitive impairment, and caregiving stress are significant concerns in later life,11-13 yet older adults’ mental health need often remain underdiagnosed or untreated due to stigma, symptom misinterpretation, limited access, and structural barriers.16,17 Our findings highlight an additional digital information dimension to this problem. If provider profiles do not clearly communicate age-relevant expertise, older adults may face an additional barrier at the point of information seeking, even before they contact a provider.
Additionally, our study also resonates with research on ageism and the reorientation of aging and older adults in health and digital environments. Older adults and aging are often framed through a deficit lens where their needs may be treated as peripheral rather than central within a health system.20,21,27 In the present study, ageism did not appear through overtly negative language, but through a subtler pattern of limited specificity. This suggests a continued form of representational invisibility where older adults are included as a searchable group but are not consistently addressed as a distinct population with specific lived experiences and care needs. However, our findings also point to opportunities for improvement. Profiles that used client-centered or balanced framing more often connected provider expertise to recognizable aging-related concerns. These profiles demonstrate how provider directories can advance meaningful access as an apomediary tool. By making aging-related concerns explicit, providers can help older adults and their caregivers better assess provider fit, reduce uncertainty, and make better informed health decisions.
Provider directories should be evaluated not only as technical access tools, but as apomediary tools that shape recognition, interpretation, and health decision-making. Our findings highlight the population-level consequences of digital profile content and that directory adequacy involves more than accuracy and availability. For older adults, meaningful representation requires age-responsive care that is not only searchable, but relevant, recognizable, and credible within the apomediary tools that guide mental health care decision making.
Implications and Recommendations
Our findings have implications for mental health providers, platform designers, and researchers. When mental health issues are presented without age-relevant framing, profiles may fail to signal to older adults or their caregivers that the provider offers the type of inclusive care they are seeking. This gap between health information presented and representation needed for older adults to recognize provider fit may contribute to continued underutilization of mental health services.2,9,17,28 For health care providers who represent their expertise and practice through online directories, these findings suggest that these tools should be treated not only as marketing, but thoughtfully approached as digital health communication tools. Tools that require ethical responsibilities to clearly convey age-relevant expertise and care approaches that accurately describe services fit for older adults. For platform designers, we recommend working not only with health care providers to understand broad expertise and areas of specialization that may go unrepresented, but also to work with older adults and advocates to carefully curate a user experience through filters, search terms, and other platform structures that align with their health information needs and wants through community-engaged participatory research. 29
Additionally, although this study was conducted in a U.S. context, the findings may have applicability or relevance to low- and middle-income countries, with important contextual considerations. Differences in digital infrastructure, access to technology, and population-level digital health literacy shape how individuals engage with and interpret digital health information. Future research is needed to better understand how these factors may influence the extent to which the barriers identified in this study are present or experienced in other countries and contexts.
Limitations
This study should be considered in light of some limitations. First, the analysis reflects a single point in time, and provider profiles may change over time. Second, because the study focused only on Psychology Today profiles, the findings may not extend to other directories or provider websites. Additionally, Psychology Today presents a specific sample of mental health care workers in the United States which may not generalize, but may have applicability, to other countries where digital health literacy challenges may differ. Finally, it is possible that provider profiles may not fully reflect the actual clinical competence or experience in geriatric health care. At the same time, the findings underscore the social responsibilities of digital self-representation in apomediated health information environments. When aging-related filters are not matched by clear narrative content, provider profiles may limit health literacy by making care visible without making it interpretable. Future research should examine how older adult mental health care is represented across digital platforms, how representations change over time, and how older adults engage with apomediated sources in the process of health decision-making.
Conclusion
This study highlights a critical gap between the appearance of age-related expertise and the representation of older adult care in Psychology Today provider profiles. Inconsistencies between structured search criteria, self-selected expertise areas, and provider profile narratives may limit older adults’ ability to identify appropriate mental health services. Addressing this gap is critical for supporting health literacy, strengthening transparency in provider self-representation, and promoting more equitable access to age-affirming care in apomediated digital mental health environments.
Footnotes
Ethical Considerations
The study protocol was reviewed and approved by the Louisiana State University Institutional Review Board (IRB) under IRB Protocol #25-0176. This study was based on publicly available and accessible data. All provider data was de-identified and consent was not required.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
This study was based on publicly available and accessible data.