Choosing Between Small Group Psychotherapy Practices and Large Online Therapist Networks: Pros and Cons of Each

February 9, 2024

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 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 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 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 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. 

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

Mission Driven, Localized Reach Profit Driven, Expansive Reach
Smaller, More Personalized Approach to Care Larger, Less Personalized Approach to Care
More Oversight & Quality Control Less Oversight & Quality Control
Therapist Received Clinical Supervise Little or No Therapist Clinical Supervision
Both In-Person & Virtual Sessions Strictly Virtual Sessions
Thoughtful, Less Rapid Access to Therapists More Rapid Access to Therapists
Diversity of Therapists May Be Limited Wider Diversity of Therapists to Choose From 
Employs Licensed Mental Health Practitioners Employs Licensed Mental Health Practitioners
Can Employ Pre-Licensed Student Interns Providing Sliding Scale or Pro-Bono Care Does Not Employ Pre-Licensed Student Interns
Higher Degree of Organizational Commitment Level of Therapist = Less Turnover Lesser Degree of Organizational Commitment of Therapist = More Turnover
May or May Not Accept Your Insurance or Offer a Sliding Scale Fee 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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