Be Successful in Private Practice

By Kirsten Avila

Listen up therapists! We are potentially on the verge of unknowingly selling out our profession to venture capitalists. If you’re in private practice, or if you’re using platforms like Talkspace, Headway, Grow, Alma, SonderMind, MDLIVE—any of the “we’ll handle the business for you” apps—this article is for you.

Headway’s network surpassed 48,000 providers by the end of 2024; Alma’s directory climbed to 24,000-plus therapistsas of December 2024; and Talkspace, while smaller, still lists more than 5,500 licensed clinicians on its platform. This is far from an inclusive list. That’s is large amount of therapists sharing their private practice earnings with venture-backed systems. We need to talk about where this road leads.

Each one of these platforms promises some version of the same thing: We’ll take care of the hard stuff—insurance, billing, referrals—so you can just focus on the therapy.

And on the surface, it sounds like a dream. For those of us who’ve spent hours on hold with insurance companies,  buried in credentialing paperwork, or avoided taking insurance because it’s too difficult and too risky it’s incredibly tempting.

Private practice used to be the holy grail in our field. It was the dream—the place you finally landed after gaining experience via agency work. More freedom, better income, and, ideally, a buffer against the relentless burnout that so many of us experience in community mental health settings.

So it’s no surprise that therapists are leaving their agency jobs in droves to make the jump into private practice. But here’s what’s happening: as they take that leap, many are signing up for these platforms to help bridge the gap. That’s not a bad strategy. When you’re just getting started, you need clients, structure, and income. Most of us weren’t trained in marketing, insurance billing, setting fees, or negotiating contracts. 

So we lean on these platforms to help us survive those early months (or years) of practice-building. And they do help—at first.

But the problem is, we’re building our practices using these platforms as a foundation. One that might not have our best interest or our clients’ at heart in the long run.

The problem is that once you’re relying on these platforms, they have all the control. They can change on you in a day, with no notice, and you either have to agree to their new terms, new pay rates, new expectations or go. In the last year I’ve watched platforms lower their rates, referrals dry-up, bonus structures get cut, and therapists get dropped from these platforms with no notice. All of a sudden they are working for lower pay, or not getting referrals because they have been unknowing being “phased out” of a platform.

I see it happening again and again. Therapists end up in what I call “platform hopping.” They use one platform while it’s good, but when referrals slow down or the pay changes, they add another. And then maybe another. Next thing you know, they’re scrambling to get licensed in more states just to unlock more client access, hoping the volume will make up for the drop in rates.

But the more platforms that come on the scene, the lower the rates get, the fewer the referrals become, and the harder it is to say no—because by then, they’ve built their entire practice inside someone else’s system.

And before long, they’re right back where they started: working too many hours for too little pay, only now without the protection or benefits that even a traditional job provides. No health insurance. No paid time off. No employer retirement contributions. No clinical supervision or shared liability. No guaranteed paycheck.

They’ve traded one kind of burnout for another—and it’s all wrapped in the illusion of freedom and flexibility. 

Many of these platforms were founded by clinicians who genuinely wanted to make things better—for therapists and for clients. The mission was solid: make therapy more accessible, reduce the administrative nightmare of insurance billing, and help private practitioners grow without burning out.

But here’s the kicker: they almost all start out great. Good pay. Flexibility. A true 1099-style setup where you still feel like you’re running your own practice. You get support without losing your independence.

But then… they change. And here’s why.

It almost always comes down to this: venture capital.

Once these companies get big enough, they start taking on investors. And those investors want to make money. Not slow, steady, thoughtful growth. But fast, scalable, high-return growth. The kind that makes headlines and raises valuations.

That’s when the shift happens. Therapist pay gets cut. Caseload expectations increase. Support gets thinner. Policies tighten. The platform starts feeling less like a tool that helps your practice, and more like a boss you never asked for.

Because when a company’s primary goal becomes keeping investors happy, the therapist stops being the customer. You become the labor.

These platforms start optimizing not for clinical outcomes, not for therapist sustainability, but for user retention, revenue per session, appointment volume, and “engagement.”

That’s why it’s critical—for our own wellbeing and for the future of our field—that we learn the skills needed to run and grow our own businesses. Yes, I’m talking about the stuff no one taught us in grad school: marketing, billing, negotiating, fee setting, and understanding the business side of therapy.

Because that’s how we protect ourselves and each other from getting swallowed by venture capital.

Think about it this way:
When was the last time you called a taxi?
Now think about the last time you took an Uber?

Private practice is the taxi. The platforms? They’re Uber, Lyft, Rides-on-the-Side—you name it. They are sleek, scalable, investor-backed, and designed to extract maximum value from the workers at the center of the model (that’s us).

And just like what happened with rideshare apps, we risk losing control over our work, our pay, and our profession if we let these platforms dominate the landscape unchecked.

So next time you start to feel that familiar panic—that your caseload is slow, your income’s dipping, and you need to do something fast—pause before jumping onto another platform, applying for another state license, or enrolling in yet another niche training you’re not even sure you want.

Instead, take that energy and put it into something that builds your foundation.

Take a class on insurance billing. Learn how to market yourself more effectively. Get support with SEO or branding. Join a peer consultation group. Reach out to other private practice therapists and ask what’s working for them. Learn how to run your practice like a business—because it is one, and you deserve to be in charge of it.

We don’t have to be at the mercy of platforms or investors. We have the power to take our profession back—one empowered therapist at a time.

Let’s keep this conversation going and build a strong therapist community along the way. To stay connected with me, subscribe to my Substack below, connect with me on IG and join my FREE Facebook Group for therapist referral sharing.