10/12/2026
Let's talk about online therapy. This is something I've been thinking about for quite a while, and I think it's worth discussing. This is written both for mental health therapists as well as those seeking therapy.
Before the pandemic, most therapy happened the old-fashioned way: two people sitting in a room together. Then 2020 happened, and overnight, those of us in private practice had to figure out how to provide therapy through a computer screen. For many of therapists, virtual therapy wasn't something we'd ever seriously considered. Suddenly, it was essential. And you know what? We discovered that it actually worked quite well for a lot of people.
Virtual therapy opened doors for people in rural communities, clients with transportation difficulties, busy parents, and those who simply feel more comfortable talking from their own homes. It allowed people to be seen during a break at work without the extra driving time. It also meant that a sick child, bad weather, or a particularly chaotic workday didn't necessarily require canceling an appointment. As life returned to normal, many clients were eager to get back to in-person sessions, while others discovered they preferred the convenience of telehealth. Most private practices and facilities adapted by offering both. Clients could choose in-person therapy, virtual appointments, or a combination of the two. It was a genuinely positive development for mental healthcare.
But while therapists were busy figuring out webcams, ringlights, and trying to convince their dogs to stop barking during sessions, some very large companies saw an opportunity. And that's where things got interesting: big business entered the therapy room.
During the pandemic, large online therapy platforms grew rapidly, attracting substantial investment. Some had been around for years, but the sudden demand for virtual services created an enormous opportunity. And venture capitalists love an enormous opportunity.
To be fair, these platforms offer some real advantages. They're convenient, heavily advertised, and often make finding a therapist feel easy. Some accept insurance, and they can provide therapists with a way to see clients without the expense and administrative headaches of running a private practice. I see the appeal for both the client and the therapist. There are also some excellent therapists working on these platforms. Some have their own practices and use online platforms to supplement their income. Others genuinely prefer working exclusively from home and do this full time.
My concern isn't with those therapists, or even with virtual therapy itself. It's with what happens when large corporations and investors become increasingly involved in decisions about mental healthcare.
Running a private practice has taught me that there's a delicate balance between operating a successful business and providing excellent clinical care. You have to keep the lights on, pay your therapists, deal with insurance companies and figure out how to bill, and somehow maintain your sanity through all the hoops we jump through. But clinical decisions should be driven by clients' needs, not investors' expectations.
Some large therapy platforms have financial relationships with insurance companies, including investment arrangements and contracts to provide services to their members. Those relationships aren't inherently problematic, but I think they deserve scrutiny. Insurance companies already have considerable influence over mental healthcare through reimbursement rates, provider networks, and coverage decisions. When insurers also invest in or contract extensively with the platforms connecting clients to therapists, it's reasonable to ask how those relationships affect clinical independence.
Who determines how much therapists are paid? How much control do therapists have over their schedules and treatment decisions? What happens when a client's needs don't fit neatly into a company's business model? These are questions we should be asking before handing over more of our mental healthcare system to corporations.
Another concern I have is how therapists are recruited, vetted, and supported. Large platforms aren't all alike. Some require background checks, license verification, and additional credentialing. Talkspace, for example, publicly lists these requirements for its therapists. But checking someone's credentials and understanding how they actually practice are two different things.
At my practice, we have regular staff meetings where therapists can discuss difficult cases, ask questions, share resources, and learn from one another while protecting client confidentiality. When I walk down the hall of our office, I see therapists every week consulting with one another. Sometimes one therapists works with the couple and another sees a child and they are able to discuss the best care of the family. Therapy can be incredibly rewarding, but it can also be complicated and emotionally demanding. Even experienced therapists benefit from having trusted colleagues to consult.
A therapist working independently through an online platform may have an excellent professional support system. Or they may be working almost entirely alone. The platform's model and the therapist's own professional relationships make a difference. I have practiced since 2006 and have seen several amazing therapists leave the profession due to the burn out of practicing alone with little support.
I've also worked with clients who came to me after disappointing experiences with large online platforms. Some of their stories have been genuinely concerning. That doesn't mean every therapist on those platforms provides poor care, but it reinforces my belief that credentials alone aren't enough. Therapists need opportunities for consultation, accountability, and professional growth. And sometimes we just need another therapist to tell us we're not alone.
Another concern about online platforms is privacy. When someone enters therapy, they're sharing some of the most personal details of their life. They deserve to know who has access to that information and how it's being used.
Unfortunately, concerns about the handling of sensitive information by online therapy companies aren't hypothetical. In 2023, the Federal Trade Commission finalized a settlement with BetterHelp over allegations that the company shared consumers' sensitive health information with advertising platforms, despite promising to protect that information. The settlement required BetterHelp to pay $7.8 million and prohibited it from sharing sensitive health data for advertising.
Think about that for a moment. People seeking help for depression, anxiety, trauma, or relationship difficulties shouldn’t have to wonder whether information they provide while looking for a therapist might end up being used for advertising.
This doesn't mean every online therapy platform mishandles information, or that private practices are immune to privacy violations. It does mean clients should be asking questions about how their information is stored, who can access it, and whether it's shared with third parties. Convenience should never come at the expense of confidentiality.
Here's something I wish more people knew: you probably don't need a giant national platform to receive virtual therapy. Many independent therapists and group practices offer the same convenience, often with the added benefit of having an office nearby if you decide you'd rather meet in person. You can find a therapist in your own community, establish a relationship with them, and have the flexibility to switch between virtual and in-person appointments when appropriate.
Local practices also contribute to their communities in ways that aren't always obvious. We build relationships with physicians, schools, community organizations, and other mental health professionals. When a client needs services we don't provide, we often know exactly whom to call. That's difficult to replicate through an algorithm.
I also want to encourage therapists who are considering working for one of these platforms to explore their alternatives. I understand the appeal. Starting a private practice can be intimidating. Between credentialing, billing, marketing, office expenses, and the seemingly endless paperwork, it's enough to make anyone question their career choices. I certainly didn't know what I was doing when I started. Sixteen years after starting my own practice, I've learned a tremendous amount, occasionally the hard way, and my practice is doing well. You don't have to figure everything out on your own. Practice coaches, experienced colleagues, professional organizations, and established group practices can all help you get started.
Joining a local group practice can be an especially good option for therapists who want the flexibility of private practice without taking on every administrative responsibility themselves. Of course, independent practice isn't the right fit for everyone. But I would love to see more therapists exploring ways to build sustainable careers while maintaining control over their clinical work.
Mental healthcare is fundamentally about relationships. It's about trust, clinical judgment, professional accountability, and the ability to provide individualized care. Those things aren't always easily measured on a corporate spreadsheet.
My encouragement to anyone looking for a therapist is simple: before signing up with a national platform, take a few minutes to explore the independent therapists and group practices in your community. You might find the same convenience, a therapist who is deeply connected to local resources, and the flexibility to receive care in the way that works best for you. If you are a client looking for anything related to therapy, reach out to me at [email protected]. There are some excellent resources that I am happy to connect you with.
And to my fellow therapists, don't underestimate the value of what we can build independently and together. I just believe that when it comes to mental healthcare, the people making the clinical decisions should be those of us who are trained to provide the care. Not the people holding an investment portfolio. If you have questions or want to discuss consulting, I am available and have other resources to point you to as well.
