As I worked to grow my practice across states, I was also watching the business of online therapy change.
The Promise of Done-For-You Services
A new generation of companies entered the mental health field, offering to handle many of the things that made private practice difficult: insurance credentialing, billing, scheduling, records, telehealth technology, and help finding clients. Some offered training and professional communities.
These type of done-for-you service are designed to be appealing. They offer simplicity and a way to find clients for therapists who are busy running a business alongside their job of providing clinical care. We handle marketing, insurance contracts, billing, compliance, and technology, often with little business training or support.
A service offering to simplify those responsibilities can make running a private practice feel more manageable. I joined some of these platforms myself, but over time, I started looking more closely at what came with that convenience.
Privacy Concerns and Enforcement Actions
Within the terms of service and privacy policies, companies described their relationships with vendors and how they collected and shared data. I heard growing concerns in therapist communities about documentation requests, changing reimbursement arrangements, and a lack of transparency. Some providers described how little control they had when a platform changed its policies.
Public enforcement actions reinforced some of the concerns providers were raising. In 2023, the Federal Trade Commission announced a proposed order requiring BetterHelp to pay $7.8 million to settle allegations that it had revealed sensitive consumer information with advertising platforms despite its privacy promises. The order also restricted future data sharing. While the case does not reflect every online mental health company’s practices, it shows why providers and clients need to understand how a platform uses their information as part of its business.
Investor Influence and Corporate Intermediaries
I also began looking more carefully at who was financing the rapid expansion of digital mental health companies. Public investment announcements have shown insurer-affiliated venture funds participating in funding rounds for mental health platforms and provider networks. For example, Optum Ventures and Cigna Ventures participated in funding for Alma, a membership-based network for mental health providers.
An investment relationship alone doesn’t tell us how a company treats therapists or clients, but these ties did make me wary of whose interests they prioritized.
These companies have helped some clinicians accept insurance, reduce administrative work, and reach new clients. Relying on these services to manage so much of a practice gives that company considerable influence over how a therapist works, and can create a dependence that is difficult to break. When the platform makes changes to a payment rate or business policy it can have immediate effects on both the therapist and their clients.
At the same time, well-funded companies can spend heavily on advertising and search-engine visibility. Independent practices and small group practices are then competing for attention with companies that have vastly greater financial and technological resources. As a result, many providers feel that the only way to become visible online is to attach their practice to a corporate intermediary.
As clinicians shifted toward large therapy platforms, I saw a shift away from independent professional networks and I worry about what that could mean for the profession itself.
The Importance of Relational Networks
Therapists have always depended on professional relationships. We consult with one another. We learn who has expertise in a particular area. We exchange referrals, recommend training, help newer clinicians, and support colleagues through the realities of practice.
Those networks are not merely marketing channels. They are part of how knowledge, trust, mentorship, and professional culture move through the field.
A 2025 Psychotherapy Action Network survey of 667 mental health professionals found that respondents continued to rely heavily on relational referral networks. The same study documented concerns about transparency, privacy, clinical autonomy, reimbursement, and the influence of corporate practice-management companies. Because the organization approaches the topic from an advocacy perspective, its findings should be read within that context, but they reflect concerns that are being discussed widely among independent clinicians.
What can disappear when one platform becomes the whole ecosystem
Many platforms have become the place where providers receive training, find consultation, access business resources, purchase tools, and interact with colleagues. Those resources can be useful, but when they are all concentrated inside one corporate system, independent providers who have developed excellent supervision, consultation, continuing education, business support, or clinical materials may become harder to discover.
The provider-built ecosystem begins to narrow. Instead of learning directly from one another, hiring one another, referring to one another, and supporting businesses created by people with direct experience in the field, clinicians may increasingly access every resource through the same few intermediaries.
Strengthening Provider Autonomy
I do not believe the answer is to reject technology or to pretend independent therapists should manage every responsibility alone.
Technology can make private practice more sustainable. Providers do need better tools. They need administrative support, marketing guidance, community, and easier ways to be found.
But those tools should strengthen independent practices rather than make clinicians increasingly dependent on companies whose priorities may change as investors, insurers, or growth targets exert pressure.
The goal is not to avoid platforms. It is to imagine a platform built to support provider autonomy, professional relationships, and independent practice. It is to create something that offers providers the networking and support they need, building on the strengths that already exist within the professional community.
That was the vision that led to Therapy Expanded.
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Next: Why We Built Therapy Expanded: A Different Kind of Professional Network