Happy, Healthy, & Wealthy Therapists | Ep 36: Big Tech in Mental Health: The Honest Pros and Cons

Released: 06/11/2026

Show Notes:

In this episode, Amanda tackles one of the most divisive topics in private practice: venture-backed mental health platforms like BetterHelp, Talkspace, Headway, Alma, and Grow Therapy. Pushing back on the all-or-nothing takes, she breaks down the legitimate criticisms (low pay rates, shifting reimbursement structures, and competitive pressure on private pay practices) while being honest about her own privilege in building a premium fee practice. Amanda shares her experience credentialing with Alma early on, why it served a strategic purpose, and how she’s navigating her sponsorship relationship with them transparently amid recent Aetna reimbursement changes. She closes with a call for therapists to stop demonizing each other’s choices and remember that burnout and inaccessible care are systemic issues bigger than any one company.

3 Key Takeaways:

1. The criticism of VC backed mental health platforms is often valid (low rates, shifting reimbursements, market pressure on private pay fees), but painting every company with the same brush misses real differences between them.
2. Not every therapist has the financial runway to go all in on private pay, and choosing a credentialing platform or insurance panel as a strategic tool isn’t a failure or a betrayal of the profession.
3. Amanda shares her own experience using Alma as a short term bridge to build confidence and caseload before transitioning fully to private pay, while being transparent about her sponsorship and encouraging listeners to do their own research before joining any platform.

Connect with Amanda:

• Follow on Instagram: @amandakbcoaching
• Check out the Amanda KB Coaching website

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Sponsors:

• This episode is sponsored by Alma – learn more here
• This episode is sponsored by Jane – use code: AMANDA2MO for a 2-month grace period

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Just a quick heads up, everything I share in this podcast is for informational and educational purposes only. It’s not legal advice, financial advice, or tax advice. Every practice and every state has its own rules. So if you’re wondering how something applies to your situation, make sure to check in with an attorney, accountant, or another qualified professional who can give you guidance based on your specific circumstances.

Transcript:

Amanda (00:00)
Hey, hey, welcome back to the podcast. Today we are going into a topic I have opinions about, but maybe not the opinions you’d expect from me. We’re talking about big tech in mental health, the venture capital backed platforms, the therapy apps, the credentialing networks, all of it. And I want to have a genuinely honest conversation about this because I think the discourse right now is really.

Binary. I’ve been not seeing so much of it because I know a lot of it is happening on Facebook, and I personally try to keep off of Facebook, but I know that it is happening and I know what’s going on out there these days. So generally the themes that I hear or have seen are it’s either these companies are, you know, saving mental health care by making, you know, mental health care so accessible, by giving it to people where they’re like underserved or whatever, or

These companies are single-handedly destroying private practice. And I think both of these takes miss a lot of nuance in the conversation. So today I want to give you my take on the real pros and cons. Talk about who these platforms actually serve and who they don’t, and be honest about my own position in this conversation because I think that matters too. So let’s get into it. So first, let’s just acknowledge why this topic.

Is so charged right now. Over the last several years, we’ve seen a massive influx of venture capital money into mental health care. Companies like BetterHelp, Talkspace, Headway, Alma, Grow Therapy, the list goes on and on and on. And the pitch is always some version of we’re gonna make mental health care more accessible, easier to navigate, and less administratively painful for providers. And the response from a lot of private practice therapists.

Especially those of us who have worked really hard to build an independent premium practice has been, you know, skeptical at best and hostile at worst. And I get it, I really do, because some of these companies have done genuinely harmful things, whether that’s to the therapist or to the clients who are on them. There have been platforms that have paid therapists poverty wages.

Platforms that have treated clients as users and taken data from them, and they’re treating therapists as contractors with essentially no recourse, no benefits. There have been platforms that have created a race to the bottom on session fees that are actively undercutting what therapists could charge and make in private practice. And that is real and that is documented. And the anger that I have, ⁓ and so many other therapists have, is perfectly valid.

But here’s where I want to push back a little on us in the private practice space. Because I think we sometimes take that very legitimate anger and paint every single company with the same brush. And when we do that, I think we’re actually ending up doing a disservice to the therapists who are in a very different set of circumstances than some of us. So in this episode, I’m going to try to.

Untangle this a little bit. This is something I’ve been thinking a lot about. It’s something I’m trying to be very intentional about how I speak on this in this episode. And you know what? In some of my anxiety and talking about it, I might, I might mess up, right? And I don’t have all the full picture, but I’m gonna share what I know as I know it right now. So let’s start with the legitimate criticisms because I don’t want to gloss over those. Problem number one, the business model misalignment.

A lot of these companies are funded by venture capital. And venture capital, by design, is looking for a return. That means at some point the company either has to go public, get acquired, or generate significant profit. And when you’re in the business of mental health care, the pressure to scale and generate returns can create some really uncomfortable trade-offs. And we’ve seen this play out with platforms that have reduced therapist pay rates.

Platforms that have changed their reimbursement structures without much notice, if any at all. Platforms that have been acquired and then completely shifted their model in ways that left therapists kind of scrambling. I mean, I don’t know about you, but I’ve heard some legitimate horror stories around things that have changed and have left clients, ⁓ the client in the sense of the client seeking therapy, have left them feeling unsupported or

Depending on how drastic the financial change is, it might lead some people to some therapist to completely leave the platforms. And if they’re doing that, then right, they have to think about the client care. And some people might be significantly impacted by the financial ⁓ standpoint, but from an ethical standpoint, not yet leave the model. And so nobody’s winning in this case. Yes, the client gets to keep their therapist, but now the therapist’s actively suffering in some ways, especially if they’re really, really relying on that money. So

This is problem number two, the rate issue. And this is honestly probably one of the biggest ones. Some of these platforms, and I’m not gonna name names because honestly it changes all the time, and I do not want to give outdated information, but some of these platforms are paying therapists rates that are genuinely insulting. Like we’re talking $30, $40, maybe $50 a session. And when I was ⁓ in

I guess I don’t know if it’s in network with an EAP when I was paneled with an EAP. And I know this is a little bit of a different conversation, but like even rates of $100 an hour, like they felt kind of exciting from the aspect of like, well, at least I’m making a good amount of money. I’m making more than minimum wage. But those are far and few and in between. And I know a lot of these companies don’t have structures where they give you consistent pay rates. A lot of the things are like,

merit based and how many features are you taking advantage of and are you getting your clients to fill out paperwork that they’re then using for some kind of data. So huge problem in the sense of the rate that they’re asking for and what they’re asking in exchange for that rate. And when we’re talking 30 to 50 bucks for a licensed clinician with years of education and training and student loan debt, like that’s that’s not good. It’s not doable. It’s not sustainable.

And these companies are marketing this to clients as affordable therapy, which, yeah, in the sense of like being accessible, that does happen, right? Like I know a while ago, before I could afford my own therapy because my insurance benefits sucked, I browsed things like BetterHelp. I don’t remember the specific name of the one that I was looking at, but like from a financial standpoint, it made sense. It was like a hundred to two hundred dollars a month for XYZ benefits, and I’m like,

Well, shoot, there are people charging that much for one single therapy session. So, like maybe I should consider it. But, you know, accessibility matters, but not when the cost of that accessibility is being offloaded entirely onto the therapist, right? Because I have heard so many therapists who are with these platforms either as their primary job or maybe as like a quarter to a third of their income. And to hear the number of clients that they have to see.

and what they’re sacrificing in terms of their met their own mental health or the kind of like risk that it puts their license in to be accessible in so many different ways, like via text and stuff like that. Like that that’s not actually accessibility. That’s usually just dangerous to the therapist and their license and dangerous to the clients in terms of they don’t actually get to see what true support can look like from the sense of a therapist working.

In a regulated state, right? Now I’m talking about like regulations, we’re talking about like nervous system regulations. So problem number three, these platforms they are in some ways competitors, right? I want to be honest about this too, because I think we all know it, right? Like it shows up, these companies show up at the top of Google searches, they’re showing up in ads everywhere. When a large platform with

Massive marketing budgets and VC money is showing up in the same Google searches as your private practice and offering a lower price point, that does affect the market. It affects client expectations around what therapy quote unquote should cost. It affects how hard therapists have to work to justify their fees, let alone their premium fees. And that is real competitive pressure, right? That is okay to name that. Okay, so those are.

Very real problems. And again, super valid. And I’m not here to dismiss any of that. But here’s where I want to get into some territory that I think makes people in private practice, you know, a little too a lot uncomfortable. But as much as we see the rhetoric, and as much as I am a part of that rhetoric of building your private pay practice, building the practice that works for you, making a great living, not burning out, all of that stuff that.

is genuinely something I stand behind and believe and want for every therapist out there. Not every therapist is in the same position. Like I just said, I talk a lot on this podcast and in my social media platforms about building premium private pay practices, about charging what you’re worth and what you want and what number excites you, about therapy intensives and SEO and creating the kind of practice that funds the life you actually want.

And I believe in all of that deeply. But I also have to be honest with myself about something, which is this. I am speaking from a place of privilege with all these messages that I give. I am at a point in my career where I have an established reputation. I have an audience. I have a marketing system that works for me. And I have enough financial stability that I can afford to be choosy. I’m not currently a paying member of any of these platforms.

including Alma, who does sponsor this podcast. And I recognize that being removed from that reality means I have to be careful in terms of how I talk about it. Because the truth is that not everyone has the luxury of just go private pay and trust the process and it’ll all work out. Not everyone has the luxury of just go credential yourself, figure it out yourself. whether it’s because they don’t have the capacity to go through all that paperwork, whether they don’t have

The financial ability to wait for however long it takes to get credentialed with any of these panels. There’s so many different reasons why it is not just that easy to either credential yourself or just go private pay. If you are a newly licensed therapist who just signed a lease on an office, who has student loans due next month, who doesn’t have six months of savings to float while their SEO kicks in and their referral network warms up, the advice of believe in yourself and

Go all in on private pay, like it’s just not helpful. That can genuinely be harmful to someone, especially considering today’s economy. And I think sometimes in our energy to really protect the private practice model, which I do think is worth protecting, we are accidentally shaming therapists who are making totally reasonable decisions for their actual circumstances.

Like maybe someone joins one of these platforms because they need income now, not someday, not I’d love to make 10k months in six months. Like they need money now. Maybe someone who works for one of these companies because they genuinely don’t want to market themselves. They don’t want to run a business. They went to school to be a therapist, not an entrepreneur, and they’re completely okay with a lower rate in exchange for not having to think about any of the business stuff. All of that is

A super valid choice, like full stop. If that works for them, yes, you can still argue the whole side of how these companies may not be the most ethical depending on their practices for the clients. And right, if this is the thing that works for the therapist and it doesn’t harm the therapist, there is something to be said for that. I think there’s a huge difference in terms of what is ultimately driving all of our decisions. Like when I was working at

The college counseling center I at before I left for private practice, I thought it was so weird that someone who was in private practice left to come join our staff. And we asked her questions about it. And she’s like, honestly, I just I hated marking, marketing myself. I hated the feast or famine of private practice. I wanted community, but I didn’t want to join a group practice. She wanted a W-2 situation. I think we in private practice.

Have this habit of idealizing and putting private practice on a pedestal. Like it’s what everyone should want, and especially a private pay practice, and especially a premium fee private pay practice. Like we have such this idea of what it should be because it works for us, right? But it doesn’t mean it works for everyone else. It doesn’t mean that that’s everyone else’s goals. And so if someone chooses to get on one of these platforms.

We have to stop demonizing that. That is not a symbol of weakness for that. It is not a failure of their ambition of, they could just work hard enough. It’s someone making a decision that works for their life and their values and their circumstances. I think the private practice community, myself included sometimes, can get a little self-righteous about this. Like if you’re not building a private pay premium practice, you’re somehow settling. But again, that’s just not a fair framework.

To put on people, right? What works for us doesn’t work for everyone else, and that’s okay. So the platform I have the most personal experience with is Alma, and I wanna be some I wanna be upfront about something before I go any further than that. As you have probably heard, if you’ve listened to multiple of these episodes, Alma is an ongoing sponsor of mine. They sponsor this podcast, my email list, my social channels. This specific episode isn’t like a special paid placement from them, but

I do have a financial relationship with them. And I think you deserve to know that before I start talking about them. And I’m sharing this because I want to be genuinely transparent with you. And also because I think it makes my point stronger, not weaker. I’m not going to recommend something to this audience just because someone is paying me to. That is not how I operate. There’s been a lot of people who have reached out to me about becoming a sponsor and I have turned them down for various reasons.

Alma specifically is a company I have real personal history with that predates any sponsorship conversation that we had. And I know that there is a lot going on. I’m filming this episode on June 1st, 2026. I know there’s a lot going on about that currently with some reimbursement changes. I’m gonna talk about that in a second. But I want to tell you at least what my experience was when I was with them in this was the summer through winter of 2022.

So I left my private or I left my student counseling job in June 2022. And I, you know, was chasing the thing that everyone said I should chase, which was a private pay practice, right? Maybe do some super bills, but definitely don’t do in network. That is so hard to do. And for work trying to build my practice while working a 45, 50 hour a week job.

while paying a mortgage, while having to afford life and pay my student loans and credit card bills and stuff like that. I just didn’t have the mental capacity. I didn’t have the financial ability to think about, well, what would it look like if I credentialed myself and filled out this 50-page application and waited with the best paying insurance panel? What I heard in Oregon was where I was living at the time. They were like, yeah, it might take like six months.

To get credentialed with this company. I was like, I don’t want to wait six months. I need clients now. And I had maybe somewhere between three and five private pay clients on my caseload that were ranging between like $85 to maybe at that point $125 an hour, which again, fantastic. I was super excited about, but also wasn’t enough. It wasn’t where I wanted to be. I was setting my rate lower because I wanted clients. So

I had a friend of a friend reach out to me who was in private practice and she was like, here’s this company, Alma, that I use. ⁓ here’s what I love about it, here’s what I recommend really, you know, why I recommend giving it a try. And so I did. I ultimately signed up with them. They completely took over my credentialing process. And again, for someone who was super overwhelmed by simultaneously trying to figure out how to market myself and set up my systems and understand my niche and website and show up for my clients.

Not having to also navigate credentialing on my own was genuinely significant. Right. I know obviously you have to pay a monthly or an annual fee to be a part of their platform, but it was more financially accessible for me to do that than to pay someone to do it for me. And how do I know even who to trust of how to pay someone to do that for me? So signing up with Alma back then gave me a foothold. Being an in-network therapist with even one insurance panel.

meant I could respond to those in search of a therapist posts in Facebook groups and listserves. I could say, I take that insurance. And that sounds small, but it really wasn’t. Those early clients gave me confidence in my clinical work, in my marketing, in myself as someone who could actually build something. But it was not my plan forever to be in network. And this was something I did also very, very strategically.

I signed up with Alma because I knew I had heard horror stories of people trying to de-panel with insurances that they were independently credentialing with, and it taking forever, or having some weird loopholes, or just still trying to maintain some kind of control over you. And what I had heard from that friend of a friend was: yeah, if you ever want to get off Alma, it’s just as simple as like you toggle some stuff off and you tell them, stop promoting me and you know, decredential me with these. And so

I got maybe, I think in total, like four-ish people, ⁓ not even reached out through the OMA platform, but I think I had four people who started with me because of being in network with one of their panels. But then my private pay practice was really kicking off. I had maybe like anywhere between 15 to 22 clients a week at that point. And so I was feeling pretty confident that, all right, being in network with this one panel.

Did what it did for me. It helped float a little bit of my financials. It helped me get more confident to raise my rate. It helped buy me some time so that I could go all in on private pay. And when I was ready to go all in, depaneling through Alma was easy, which again, if you’ve heard the horror stories of trying to depanel when you’ve credentialed individually, that is a huge deal. Now, do I think Alma is perfect? No.

Do I think you should take my word for it because they sponsor some of my content? Absolutely not. Go do your own research. Talk to therapists who are currently members. Read the fine print of anything you’re considering joining. But here’s why I bring them up as a data point in this broader conversation. Their reimbursement rates are negotiated to be closer to what you’d actually charge yourself in private practice. For me in my area.

They were, for what my rates were at the time, they were significantly higher. They were like $60 more an hour than I was making. Nowadays, it’s significantly different, but because I’ve raised my rates over time. But this is a fundamentally different model than platforms who are paying therapists $30 an hour and maybe benefits that you have to work really hard to get or metrics you have to work for in order to get a raise. It’s not the same category of thing, and I think that really matters.

Whether I have a sponsorship with them or not. And again, I really want to emphasize, I am not with them currently. I started a sponsorship with them about a year ago. And a reason I agreed to work with them, despite not being an active member, was because it is a part of my story. When a lot of therapists ask me, you know, how did you get started? How did you do this? I don’t skip this part of.

You know, I was all private pay from the beginning. Like, yeah, I started private pay, but then I did credential with this platform for a short period of time as a strategic move to be private pay long term. And so I thought it was still in alignment to say, yeah, sure, I can promote this because I had a good experience with it. Easy to get on, easy to get off, served my goals. So that was really important to me. And again, I’m one of those people. I grew up

Low income, I was terrified to take a chance on myself by starting private practice. And being with Alma for five or six months genuinely did help make that transition less scary. And I don’t regret it. I genuinely don’t. Now I know again what is topical at this point is a lot of people are pissed at Alma because of a recent Aetna reimbursement change.

So here’s what got communicated to all partners of ALMA. I’m going to read to you literally some of the bullet points from the email that they sent. At a high level, Aetna recently communicated reimbursement consolidation changes affecting certain CPT codes and provider degree types. Alma was not part of the decision-making process and disagrees with the changes. Alma is actively engaging Aetna leadership and gathering provider feedback.

To help demonstrate the real clinical and operational impact these changes may have on providers and clients. Providers have been encouraged to complete a survey and participate in an upcoming town hall so their perspectives can be included directly in these conversations. So I get it. I recognize that changes like this are frustrating and impactful for many providers. And if this impacted me, if I was still a member of them and I got this update about my reimbursement.

Changing, i.e., lowering, I would be livid. I would be terrified. Now, Alma has shared that they disagree with the decision and they’re actively engaging Aetna while collecting provider feedback to help demonstrate, you know, the impact that this has had and why they should maybe reconsider. And you, if you are currently a member of Alma, obviously please do complete that survey, provide any feedback, go to the town hall if you can. But

The thing that I think is important here is that even though Alma is a venture-backed company, like this is ultimately Aetna that made the decision, right? And I think this is not as clear and simple as like a don’t shoot the messenger kind of thing, but we have to remember who the the real problem is, right? Like the real problem and why a lot of us try and go full private pay from the start. Like, yeah, like a venture-backed company is not.

Amazing for various reasons. And who’s the real like problem here? Like the real problem here is everything that’s going on globally and in the economy and with insurance patterns anyway. Right. I know that’s it’s so complex that that’s a whole nother episode I go into, but I think that there is something to be said for who is doing the wrong thing.

Right. And is Alma doing the wrong thing in this circumstance based on the information I have? I don’t think so. That sounds like insurance made a decision that impacted a company who does also happen to be venture backed. So yes, I have opinions, I have feelings about a lot of things. Yes, again, I recognize my privilege in I’m not actively impacted by this outside of I’m very aware of how I’m being perceived with Alma as a sponsor, ⁓ given

You know, everything that is going on at this point. So I think Alma is doing the best that they can with all of this. I mean, this is just not great news. ⁓ I really feel for the therapists who are impacted by this. But I think at the end of the day, that’s all we ever say, right? Is sure get off the insurance panel, get off the VC backed company, and then advocate for change. So if that is your decision, if you just choose to.

not at all join any of these companies or if you choose to leave them, just don’t make sure that you miss the part about advocating for change because just leaving these platforms, I don’t think is action enough if you feel that strongly about it. So just because I think Alma is doing a better job and, you know, prom ⁓ better compensates therapists than some of the alternatives out there, does that mean I think every therapist should join Alma? No.

Does it mean that VC-backed mental health companies are all equivalent? Also, no. The nuance is the point here. And that is my whole message that I hope you all hear is, you know, we know this about so many different things of binaries are dangerous, binaries are too extreme, and we miss a lot of the nuance. And so if you’re a therapist trying to navigate this landscape, what do I actually want you to take away from this conversation? A few things. Number one.

If you are in a position where you are considering partnering with any of these companies, do your homework on the specific company. Not all of these platforms are the same. Look at their reimbursements rates. Look at their business model. Look at what therapists who have worked with them are actually saying, not just the testimonials on their website, but in the Facebook groups, in the Reddit threads, in the real conversations. Some of these companies are genuinely trying to do right by providers. Some of them are not.

You deserve to know the difference before you sign anything. Number two, be honest with yourself about where you actually are. If you have the financial runway to go all in on private pay from day one, amazing. Do it. I will cheer you on. If you don’t, if you need income now, if you’re not in a place where you can wait for your marketing to compound, please do not let anyone make you feel like using a credentialing platform or joining a network.

Is some kind of failure or like you’re committing treason against all therapists. These things are tools. Use them strategically. Use them for as long as it serves you and leave them when they don’t. Three, stop demonizing other therapists’ choices. This one is for the private practice crowd, and I say it with love because I’m in that crowd. When a therapist chooses to work for one of these platforms, even one that pays less that the

Less than their ideal rates, it is not our place to shame that choice. We don’t know their circumstances, we don’t know their financial situation, their family situation, their capacity for the business side of things, their relationship with risk. What we can do is make sure people have good information so they can make informed decisions. That’s it, that’s the job.

Number four, hold the bigger picture. The problem of therapist burnout, unsustainable wages, and inaccessible mental health care is a systemic problem. And while VC-backed platforms are one piece of that picture, they’re not the whole thing. Insurance reimbursement rates that haven’t kept up with the cost of living are part of it. Graduate school programs that don’t teach therapists anything about running a business are a part of it.

A culture that still somehow believes therapists shouldn’t care about money is part of it. We need to be applying pressure to all of those things, not just directing all of our energy at the easy target of big bad tech.

Okay, that was a lot. And I want to be clear, I don’t think I have all the answers here. This is a conversation that’s still evolving, and I think the landscape of these companies is going to continue changing in ways that none of us can fully predict. What I do know is that therapists deserve to make informed choices. They deserve to be met where they are. They deserve a community that doesn’t shame them for navigating an imperfect system the best way they can.

And if you have thoughts on this, if you’ve worked with one of these platforms, if you have a hot take, if you disagree with me on something, I want to hear it. Come find me on Instagram, send me a DM, reply to my email list. If you want to learn more about Alma specifically, because maybe you’re newly licensed and you’re looking for a way to build a caseload quickly, or you’re an established provider and just tired of handling your own billing and credentialing.

I’ll link them in the show notes. There is no pressure to join. Again, do your homework, make your own decisions. I think it’s worth at least taking a look at what they offer. Okay, that is it for today. Thank you so much for being here and having this hard conversation. And I’ll talk with you next week.