Why Choosing a Small Therapy Practice Matters More Than Ever

When you search for “therapy near me,” chances are the first results you see come from big corporate platforms like BetterHelp, Alma, Headway or similar entities. These companies spend millions on advertising and search engine optimization (SEO) to dominate the internet.

But just because they appear first doesn’t mean they’re the best choice for your mental health care. In fact, working with a small, independent therapy practice may offer better care, stronger privacy protections, a healthier long-term future for mental health access, and build a stronger community in the future.

Here’s why choosing a small practice could make all the difference.

1. Personal Care, Not Corporate Protocol
Therapy works best when it’s about you—not algorithms or quotas. Large platforms often emphasize quick intake and high-volume scheduling, leaving little room for deeper connection. Therapists may be pressured to see too many clients, too fast. We often hear complaints from clients who tried out these platforms only to be ghosted by their therapists.

At a small practice, your therapist sets their own caseload-which often starts at the first point of contact when you are seeking therapy, tailors treatment to your needs, and builds a genuine therapeutic relationship. It’s care that prioritizes quality over quantity.

2. Protecting Your Privacy and Data

Big platforms are not just therapy providers—they’re tech companies. And like many tech companies, their business models raise concerns about how personal data is stored, analyzed, or even monetized. What happens when that business gets bought out by another corporation who wants that data?

Small practices, on the other hand, are directly accountable to state licensing boards and ethical standards. Your records are kept private, secure, and never shared for corporate gain.

3. Insurance and Affordability: The Hidden Costs of Marketplace Domination

While companies like Alma or Headway market themselves as making therapy “easier to access with insurance,” the reality is more complicated. These platforms negotiate contracts with insurance networks to benefit the company first—not always the client or therapist.

There is also a specific advantage that these corporations have over small practices- small practices run by therapists are responsible to their licensing boards and must be licensed in and/or have a base company in the state they are billing the insurance company from. This usually means that they can only bill the insurance company where their business is primarily based/has a formal US postal address. Insurance reimbursement varies widely from state to state. A therapist in Washington may get an insurance reimbursement rate of $175/session but a therapist in Missouri may only get $57/ 45 minute session.  Big corporations can set up corporate offices anywhere where they can get maximal profits from insurance and use that as the state from which they are billing and corner insurance markets. They get to bill where they can the biggest payday, but independent practices cannot do that. Essentially, they distort the market. BIG payday for them. They also get to offer more money to the clinicians that work for them (while still taking a huge cut for themselves), which makes other clinicians wonder why they cannot get paid that same rate from their local business and they demand raises that independent practices and non-profits cannot compete with, drying up eligible employees and clients from local businesses.

The end risk is Market Domination: Just as Walmart’s scale pushed small businesses out of towns, venture-capital-backed therapy platforms flood the internet with paid advertising and SEO dominance. This leaves smaller practices buried in search results, regardless of the quality of their care.

This is followed by Price Pressure: Once corporations dominate a market, prices often rise. While BetterHelp may initially seem cheaper, consolidation creates leverage to set rates higher once competition disappears. Private equity firms have already started buying up private practices, eliminating competition.

By contrast, Independent practices often offer more flexible options, like sliding-scale fees, out-of-network reimbursement support, and transparent billing. You work directly with your therapist—not a corporate middleman.

4. Ethical Oversight and Accountability
If something goes wrong with your care on a corporate platform, responsibility can get blurry. Many of these companies call themselves “tech platforms,” distancing themselves from ethical oversight.

At a small practice, your therapist is directly accountable to professional boards (such as AAMFT, APA, or state boards) that enforce strict codes of ethics. This means a higher standard of care and accountability.

5. Supporting Diversity in Therapy
Just as Walmart pushed many local stores out of business, corporate therapy platforms risk creating a monopoly in mental health care. When fewer companies control access, prices eventually go up and services become less personalized.

Small practices protect diversity in the field. They offer specialized services for trauma, family systems, LGBTQ+ care, BIPOC communities, and other areas that might get overlooked in a one-size-fits-all corporate model that is subject the winds of change with DEI initiatives.

6. SEO and Visibility: Why You May Not See Small Practices First

The reason BetterHelp or Alma appear at the top of Google isn’t because they’re the only or best option—it’s because they spend heavily on SEO and ads. Independent practices don't usually have those resources to keep up with the big dogs, which means these independent or non-profit practices may be harder to find online.  Most clinicians we know used to use Psychology Today as their main source of referrals, but over the past couple years have found that Psychology Today's marketing budget is no match for larger corporations, and our referrals from there are down 65% from 2020-2023. In fact, I recently found that when searching specifically for referrals for a client on Psychology Today, my google search re-routed me to another website that initially looked like Psychology Today's search index, but it turned out to be another site entirely. Going back and researching again, I had to scroll down several items before I actually reached Psychology Today's real website.

Things like this have become a real problem as well trained, licensed clinicians have repeatedly found thein information stolen from other databases and placed on their platforms to make it seem like we work for them. The client finds us and selects us, but they are then re-routed to another clinician. The potential client is told we have been notified of the referral, but we are not. It is a scam to route them into their corporation, using more reputable clinicians in a bate and switch scheme. Clinicians end up having to fight and threaten litigation to get their names removed from these databases.

When you choose a small practice, you’re choosing to look beyond the first page of search results and invest in care that’s personal, ethical, and community-focused.

Conclusion: Your Choice Shapes the Future of Mental Health Care

Every time you choose where to get therapy, you’re making more than a personal decision—you’re shaping the future of the field. By supporting small practices, you help protect affordable, ethical, diverse, and client-centered mental health care.

At Healing Reflections Therapy: Diversity, Trauma, and Wellness Services, we believe therapy should always be about human connection, community building, accountability, and trust—not corporate profit.

If you’re ready to explore therapy that puts you first, contact us today.