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LIFE TRANSITIONS & SELF-IMPROVEMENT | MENTAL HEALTH & WELLNESS

Choosing Between Small

Group Psychotherapy
Practices and Large Online
Therapist Networks: Pros and
Cons of Each
FEBRUARY 9, 2024

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 If you’re considering starting therapy, how do you know where to
begin? Do you start looking through your health insurance directory to
pick a provider’s name at random from a long list? Do you ask your
friends or colleagues for a confidential referral? Do you turn to Google
or Psychology Today to choose a local provider or try one of those
national online networks of therapists that you hear endless
advertisements on, such as Betterhelp or Talkspace.

Like most industries, psychotherapy is a business whose model of care

has gone through different evolutions since its inception. Originally a
service reserved only for the privileged and well-advantaged,
psychotherapy has, over the past decades, become ever more
accessible and en vogue, which is fabulous. However, the increase in
access doesn’t always equal quality of care or guarantee of a successful
therapeutic relationship or outcome.

The practice of psychotherapy is unique and not like other industries in

that its main “product” is the effectiveness of the therapeutic
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 relationship established between the therapist and client, and
relationships as we know are complex, multifaceted and not so black
and white.

With the proliferation of both small group private practices like Bhava
Therapy Group and large online therapy networks like Betterhelp,
Talkspace or Talkiarty, there are more options for where to turn to take
care of your mental health.

How Do You Know Who To Trust With

Your Mental Health?
I mean, we are talking about YOUR mental health and well-being, the
core of who you are and what sets the stage for the type of life
experience you live. Starting a course of therapy for any need ranging
from managing a temporary life transition to doing deeper trauma
processing and recovery requires a substantial amount of commitment
of your time, your energy, your resources and your trust! Let’s take a
closer comparative look at both small group psychotherapy practices
and larger psychotherapist networks and assess the pros and cons for
each across the following domains:

Organizational Mission, Values, Size and

Structure

Small Group Practices tend to be founded and run by a locally based

therapist or team of therapists driven by a mission to provide a
particular type or set of service(s) in their community which led to the
creation of a group. They tend to offer more of a personal and intimate,
familial setting. The founders’ personalities and approach to mental
health care tend to be inherent in the structure, mission, vision and
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 values guiding the practice. The size can range from anywhere from a
group of 3 to 50 or more therapists. Taking a team approach to care,
small group practices are usually managed in a way that fosters peer
support and collaboration amongst team members, offers individual
and group supervision and training opportunities for the team.

Large Online Networks tend to beare larger, therapy platforms or

networks bringing together hundreds if not thousands of therapists
from locations and often operate on a national or international scale.
Large online networks tend to be founded by corporations, backed by
venture capitalists or other business entities driven by financial benefit
to increase sales and profit share.

Access & Availability

Small Group Practices offer localized reach within the community(ies)

they are based in and licensed to work in. They can have the ability to
offer in-person care, which can be such a deeper and richer way of
working, in addition to teletherapy and tend to depend upon word of
mouth or local google searches as a way for clients to find them. Some
group practices stick to one geographic area and some offer services in
more than one. Small group practices offer a more individualized
approach to care, focusing on cultivating a strong therapeutic
relationship and therefore can take time to thoughtfully match clients
with therapists. As such, it may take some time to schedule an initial
consultation with a therapist and availability of appointments, especially
with specific desired therapists within that practice will vary depending
upon their individual schedules.

Large Online Networks by using online, digital and national media

advertising, they tend to draw in a big pool of both therapists and
clients from across the globe and therefore they can offer wider and
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 faster access among their therapists than a smaller localized practice
may be able to. Large online networks because of their reach are
restricted to working online or virtually through video or telephone
sessions and they do not have the option to provide in-person
sessions.

Diversity of Therapists

Smalll Group Practices the level of diversity of the team of therapists

in terms of cultural backgrounds, training, methodologies and approach
to care (what type of therapy is offered) is determined by the mission
driving the creation of the group practice. For example there are group
practices that are formed around one model of care such as CBT or
Somatic Work or focused on providing care to one population such as
the LGBTQ+ community. Other smaller practices that are composed of
a team of therapists from different backgrounds who, between them,
provide an array of different approaches to care

Large Online Networks have a broader reach, allowing clients to

access a wide range of therapists coming from different backgrounds
and locations offering a variety of different specialties and approaches
to care.

Quality Control & Personalized Attention

Small Group Practices by virtue of their structure and ownership,

offer both more of a personalized and intimate level of care as well as
have in place better quality control and oversight of the type of
therapeutic work and services being offered by their team of therapists.
Small group practices must offer their therapists consistent individual
and group supervision to uphold state licensure standards and also
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 fosters professional growth and well-being for their therapists.
Additionally, more personalized attention to individual clients’ needs,
issues and any related matters that may emerge is much more feasible
at a small group practice setting. Small group practices can employ
both licensed and pre-licensed (student interns) mental health
practitioners. Any pre-licensed mental health practitioners must be
closely supervised and can usually offer care at either a pro-bono or
sliding scale fee.

Large Online Networks while offering a larger directory of therapists

to choose from, large online networks cannot, by virtue of their
structure, offer such personalized and individualized care or quality
oversight or regular supervision for the therapists they employ. There
tends to be a lot of turnover of therapeutic staff as there is not a unified
mission holding them together as a team as you would find in a small
group practice setting. Large online networks mainly employ licensed
mental health practitioners as they are not equipped to offer the
necessary training and support that pre-licensed (student interns)
mental health practitioners require for their professional advancement.

Administrative Support & Confidentiality

Small Group Practices often have a more hands-on approach when it

comes to administration, employing specific persons dedicated to
billing or practice management and there is a specific and distinct chain
of command and point person to speak to for whatever issue may arise
such as billing, documentation, grievances and scheduling. Additionally,
the therapists may very well be directly involved in various aspects of
running the practice and have more awareness and capability of
attending to whatever issues that may arise and in a professional and
confidential manner.
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 Large Online Networks tend to have a centralized administrative
structure and/or technological system for managing and replying to
different issues that arise related to billing, documentation, grievances
and scheduling. It can be challenging at times to speak to a specific
person who is intimately aware of what a particular client may need.
Plus, in recent times, confidentiality breaches by larger online networks
have been discovered.

Side by Side Comparison of Small Group

Psychotherapy Practices vs. Large Online
Therapist Networks
SMALL GROUP THERAPY
PRACTICES
Mission Driven, Localized Reach
Smaller, More Personalized
Approach to Care
More Oversight & Quality Control
Therapist Received Clinical Supervise
Both In-Person & Virtual Sessions
Thoughtful, Less Rapid Access to
Therapists
Diversity of Therapists May Be
Limited
Employs Licensed Mental Health
Practitioners
Can Employ Pre-Licensed Student
Interns Providing Sliding Scale or
Pro-Bono Care
Higher Degree of Organizational
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LARGE ONLINE THERAPIST
NETWORKS
Profit Driven, Expansive Reach
Larger, Less Personalized
Approach to Care
Less Oversight & Quality Control
Little or No Therapist Clinical
Supervision
Strictly Virtual Sessions
More Rapid Access to Therapists
Wider Diversity of Therapists to
Choose From
Employs Licensed Mental Health
Practitioners
Does Not Employ Pre-Licensed
Student Interns
Lesser Degree of Organizational
 Commitment Level of Therapist =
Less Turnover
May or May Not Accept Your
Insurance or Offer a Sliding Scale
Fee
Commitment of Therapist = More
Turnover
Accepts a Wide Range of
Insurance and Often Offers a
Sliding Scale Fee

In conclusion, both models have their advantages and disadvantages. It

seems to come down to client preferences for accessibility,
convenience, quality of care and the degree of personalized attention
and support.

In other words to evoke that overused analogy…it’s not so much of a

comparison between apples and oranges, it’s more of a comparison of
say, Fiji or Gala Apples to Red Delicious Apples. Whereas Red Delicious
Apples may be ubiquitous (found in most gas and service stations), they
are not always so reliably satisfying in regards to freshness, crispness
and flavor. But a Gala or Fiji, or even a Honeycrisp or a Pink Lady Apple,
which may require a bit more effort and time to obtain, once you do
and take that first buy, you are certain it was worth it!

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