Thinking About Online Therapy? Here's What to Consider First

Let's talk about something important: finding the right therapist for you. I know if you live in the Bay area, that decision can feel overwhelming at times. I totally get it.

Online therapy platforms like BetterHelp, Talkspace, Rula, and others have made mental health support way more accessible, and that's genuinely wonderful. But like ordering from a huge corporation versus shopping at your neighborhood store, there are some real differences worth knowing about before you dive in.

The Therapist Carousel

Here's something that doesn't get talked about enough I feel: many therapists on these platforms are stretched thin. They're juggling huge caseloads, often underpaid, and unfortunately, that leads to burnout and turnover.

What does that mean for you? Sometimes your therapist might leave mid-treatment, and you'll be matched with someone new without much say in the matter. If you're working through trauma, grief, or deep relationship issues, that consistency really matters. Healing happens when you have time to build trust, not when you're starting over every few months.

Your Privacy Matters More Than You Think

Quick question: Did you know the FTC fined BetterHelp $7.8 million in 2023 for sharing user data with advertisers like Facebook and Snapchat?

Unlike private practices that follow strict HIPAA regulations, some platforms have been known to share information with third parties or use your data for targeted ads. If you're seeking help for something personal or sensitive, that's worth thinking about.

The Gig Economy Comes to Therapy

Many therapists on these platforms work as independent contractors (1099 workers), which means:

• No health benefits or job security

• Limited clinical supervision or ongoing training

• Pressure to see as many clients as possible to make ends meet

When your therapist isn't supported, it's harder for them to show up fully for you. It's not their fault, it's how the system is built.

Great for Some Things, Not Everything

If you're looking for short-term support—like managing stress, learning coping skills, or talking through a specific situation—these platforms can be helpful.

But if you're dealing with:

• Trauma or complex PTSD

• Specialized modalities like EMDR or somatic work

• Personality concerns

• Deep relationship or intimacy work

...you might find the platform model limiting. Many encourage brief treatment (6-12 sessions) and aren't set up for the longer, deeper work some people need.

Insurance Surprises (and Not the Good Kind)

A lot of platforms advertise being "in-network," but billing issues pop up all the time:

• Claims denied after months of sessions

• Surprise out-of-pocket costs

• Being matched with a therapist who's actually out-of-network

• Customer service that's hard to reach when you need help

It's frustrating, and it shouldn't be this complicated.

You Deserve Care That Feels Personal

Here's what I believe in my private practice: therapy isn't a product, it's a relationship.

When you work with a local, independent practice:

• You're treated as a whole person, not a number

• You can choose a therapist who truly specializes in what you're going through

• You get continuity, consistency, and real human connection

• Your care isn't dictated by an algorithm or corporate quota

I am here to offer trauma-informed, LGBTQ-affirming, kink-positive care that's grounded in your community and tailored to your needs.

So What Are Your Options?

If you're looking for alternatives to the big platforms, here are some ideas:

• Search for local therapists who specialize in what you need

• Use directories like Psychology Today or TherapyDen with filters for insurance, specialties, and sliding scale

• Call your insurance directly and ask for local in-network providers (then verify with the therapist!)

• Consider telehealth, but with a local licensed therapist, not a national corporation

The Bottom Line

Platforms like BetterHelp and others have done something important: they've made therapy feel more normal and accessible. That's real progress.

But accessibility and quality aren't the same thing. Your mental health matters too much to settle for convenience over genuine care. You deserve a therapist who knows you, sees you, and is in it for the long haul.

Ready for Something Different?

If you're looking for therapy that feels personal, grounded, and genuinely supportive, we'd love to talk. Athenian Counseling is here when you're ready.

Dr. Adrian Scharfetter PhD, LMFT, CST