When Therapy Goes Big Tech: Is Bigger Better in Online Therapy?

Online therapy didn't just become popular. It became normal.

Over the past decade, large online therapy platforms have poured millions into advertising and awareness campaigns. They helped bring mental health conversations into living rooms, podcasts, and social media feeds. Therapy moved out of the margins and into everyday conversation.

In many ways, that's a good thing.

But as therapy becomes more accessible and more scalable, it's worth pausing to ask a quieter question:

What changes when care begins to operate like a tech platform rather than a relationship?

This isn't an argument against online therapy giants. And it isn't a critique of the therapists who work within these systems. It’s an exploration of how systems shape care, informed by my own experience on both sides of this model. It’s an invitation to understand the trade-offs that aren’t always obvious at first glance, but matter deeply when deciding what kind of support actually fits you.

Photo by Sarah Dorweiler | Unsplash

Why Large Platforms Make Sense at First

The appeal is easy to understand.

Large platforms reduce friction. Sign-up is fast. Matching is immediate. The commitment can feel low-risk: If it doesn't work, I can just switch. For busy, high-functioning adults who are already stretched thin, that ease matters.

There's also familiarity. Big brands feel legitimate. They show up everywhere. Their marketing has helped normalize mental health care in a way that has had real cultural impact. Therapy feels less intimidating and more acceptable than it once did.

For many people, that alone is meaningful. And for some needs, such as short-term support, stress management, or skills-based work, this model can be a reasonable entry point.

The appeal exists on the therapist side too. Large platforms offer a direct way to build a caseload without navigating lengthy insurance credentialing, upfront marketing costs, or the financial risk of starting a private practice in a crowded market. For many clinicians, especially early on, joining an established platform is a practical decision rather than an ideological one.

The question isn't whether these platforms offer something of value. It's whether scale changes the nature of the work itself.

When Therapy Adopts a Big Tech Model

Big Tech systems are built around a few core priorities: scale, efficiency, growth, and standardization. Those priorities work well for many industries.

Therapy, however, is relational by nature. When it's delivered at scale, the conditions around it begin to shift.

This isn’t about the quality or dedication of individual clinicians. Many excellent therapists work on large platforms. It's about the environment they're asked to work within, and how that environment quietly shapes expectations on both sides of the relationship.

I've seen this firsthand, both as a provider and in conversations with colleagues still working within these systems.

Matching vs. Relationship

One of the most advertised benefits of large platforms is the ease of switching. If the match doesn't feel right, you can simply try someone else.

On the surface, that sounds empowering. Sometimes, it is. Over time, though, I’ve noticed something shift.

When therapy begins to resemble browsing—scrolling through options until something fits perfectly—the posture toward the work can change. There may be less patience for discomfort, less willingness to stay through rupture or misunderstanding, and less room for the slower process of building trust.

From the client side, expectations can lean toward immediacy and constant availability. From the therapist side, continuity can feel fragile. When clients tend to disengage or disappear with little notice, there is less structural incentive to invest deeply.

Over time, therapy risks becoming transactional rather than relational, not because anyone intends it, but because the system rewards flexibility over commitment.

Efficiency vs. Depth

Platform-based therapy often prioritizes efficiency: quick matching, fast onboarding, measurable outcomes.

Depth-oriented work, however, requires time, continuity, and the kind of trust that doesn't develop in a few sessions. It requires staying with discomfort, tolerating ambiguity, and allowing patterns to surface organically rather than being identified and "fixed" immediately.

When the system is optimized for volume and turnover, the work can begin to favor what's measurable over what's meaningful. Symptom reduction over internal shift. Coping skills over relational change.

Again, this isn't about what individual therapists want to provide. It's about what the structure allows. I can tell you from experience: when you're working within a system designed for efficiency, it becomes harder to create the conditions depth requires.

The Economics of Scale

Platform-based models often operate on volume. Recent reports on therapeutic labor within large teletherapy platforms describe fractured schedules, high client churn, and unpredictable or opaque compensation structures. Pay is often lower than in private practice, and transparency around how compensation is calculated can be limited.

That isn’t accidental. These are venture-backed companies, and profitability flows upward. The system is designed to scale, not to prioritize therapist sustainability.

Why does that matter to you as a client?

Because therapist sustainability affects care. Lower reimbursement rates often mean therapists are working harder for less, which can lead to burnout, turnover, and reduced capacity for sustained, thoughtful engagement.

Burnout in these settings is not simply an individual issue. It is structural. And it’s difficult to sustain depth-oriented work under these conditions.

For work involving trauma, attachment, or long-standing relational patterns, that depth and continuity aren’t optional. They are foundational.

Blurred Boundaries

Another less visible issue involves clinical boundaries.

Some large platforms place limits on diagnosis, documentation, or formal treatment planning. Clinicians report being nudged toward a coaching-style model, even while high-risk and complex clients may still be assigned.

This creates a quiet tension: therapeutic responsibility without full clinical authority.

For clinicians, this can mean managing serious cases without clear pathways for escalation, discharge, or containment. For clients, it can blur expectations about what kind of care they are actually receiving.

In traditional private practice settings, clinicians control their scope of work, case mix, and treatment structure. Boundaries tend to be clearer because they are intentionally held.

Photo by Sincerely Media | Unsplash

What Gets Lost at Scale

When therapy is designed to operate efficiently and at volume, certain aspects of care can become harder to maintain over time.

Continuity of care.
High-volume systems often involve more therapist turnover, whether due to burnout, changing roles, or clinicians moving on to other opportunities. When that happens, clients may find themselves starting over with someone new. Rebuilding trust. Retelling your story. Hoping the next therapist is available long-term.

I've had clients come to me after losing two or three therapists through platform turnover. The disruption isn't just logistical. It's relational.

Clinical autonomy. 
In platform-based settings, therapists may work within standardized policies, protocols, or technology-driven constraints. While these structures support scale, they can also limit how flexibly care is adapted to an individual’s history, pace, or evolving needs.

Privacy and data considerations. 
Technology-based platforms necessarily collect and store data. Information may be used for research, improvement, or other purposes. While this is often outlined in terms of service, you may not always be aware of how your information is used, stored, or analyzed beyond the therapy room.

For some, this may be a minor consideration. For others, it matters more.

When a Smaller Practice Makes Sense

Smaller private practices operate under different constraints, and that changes how care is experienced.

Caseloads are limited. Continuity is prioritized. There is space for pacing, nuance, and long-term work. Therapists have greater autonomy over how they practice, which allows for integrative approaches and deeper relational engagement.

These practices also tend to operate with a different rhythm of availability. With fewer clinicians (often a solo provider or a small team), there may be less flexibility for urgent or frequent sessions, and backup coverage can be more limited. This pacing tends to work best for clients who are generally stable and able to manage between appointments.

This model isn’t better for everyone, and it isn’t always the right starting point. Not everyone is looking for depth-oriented, long-term therapy or a highly personalized, relational approach.

But if you are, a smaller, specialized practice may be a better fit.

In a boutique practice:

• The therapist sets their own policies, pace, and clinical approach

• Matching is relational rather than algorithmic

• Continuity is prioritized over convenience

• The work is tailored to you, not to a platform's model

• Your therapist has the capacity, autonomy, and stability to engage deeply over time

This doesn't mean small practices are inherently "better." It means they're structured differently: for depth rather than scale, and for relationship rather than efficiency.

Those structural differences shape the kind of care that’s possible.

Photo by photography | Pexels

Choosing the Right Online Therapy Model for You

Before deciding where to seek therapy, it's worth asking yourself a few questions:

What kind of support am I seeking right now?
Am I looking for support around a specific concern or set of skills? Or am I hoping for work that unfolds over time and focuses on patterns, relationships, or identity? Different models can support different needs, depending on where you are in the process.

How important is continuity to me?
Do I want to work with one therapist consistently over time? Or am I comfortable with a model where switching providers is possible, or where a therapist’s availability may change?

How much flexibility versus structure do I prefer?
Do I value the ability to schedule quickly or switch providers easily? Or do I prefer a more structured, relationship-based process that may involve longer wait times or a steadier pace?

How do I want my information handled?
Am I comfortable with a technology-based platform collecting and potentially using my therapy data? Or do I prefer a smaller practice with fewer layers between me and my therapist and more control over privacy?

What's my relationship to convenience vs. depth?
Do I prioritize ease of access and flexibility? Or am I willing to invest in a process that may require more initial effort but offers greater relational depth?

There's no single right answer. But clarity about what you're looking for can help you choose a model that truly fits.

So, is bigger better?
Better for what?
Better for whom?
Better at which stage of life?

For some people, large platforms are a useful entry point. For others, they can begin to feel thin over time, especially when the work requires history, trust, and sustained attention.

Many people move between models over time. That’s perfectly valid.

The question isn't whether big platforms are "bad." It’s whether the system you’re in is designed to support the kind of change you’re currently seeking.

If it isn’t, it's worth knowing that other options exist.

Here's what I've come to believe:

The more personal the work, the more the conditions around it matter.

Marketing can tell you what’s easy to sign up for. It cannot tell you what kind of care will truly support the work you want to do.

That part deserves a slower look.

Online Therapy for Women

If you’re drawn to depth-oriented, highly personalized therapy and want to understand the work beyond surface-level coping, you can learn more about my approach and background on the About Maria page, explore therapy for women designed to support lasting change, or return to the Graceful Mind Therapy home page for a fuller sense of the practice.

by Maria Perdomo-Torres, LCSW-S, MHA, CFSW

Maria Perdomo-Torres, LCSW-S, MHA, CFSW, is a bilingual psychotherapist and founder of Graceful Mind Therapy, a specialized private practice for accomplished women navigating anxiety, burnout, and the internal weight of high expectations. Her writing explores mental health, identity, emotional patterns, and the inner lives of women moving through complexity, responsibility, and growth.