The End of Private Practice? AI, Big Business, and the Future of Therapy

I don’t usually write like this. Most of the time, I try to stay grounded. Thoughtful. Maybe even hopeful. But something’s been stirring lately, and I need to say it out loud: Something strange is happening in therapy.

And it’s starting to make me feel a little sick to my stomach. It’s not one thing. It’s everything at once. The way AI is creeping into the room under the banner of “efficiency.” The way insurance companies are redefining what a “good outcome” looks like. The way therapy platforms seem more interested in growth metrics than human beings. None of this is new. But it feels different now. It feels quieter, slicker, harder to name. Like a slow rearranging of the furniture while we’re still sitting on the couch. Efficiency sounds nice… until you realize what it replaces. AI is being sold to therapists as a gift: easier notes, cleaner billing, faster treatment plans. And maybe it does those things. But every time I see one of those tools in action, something in me recoils. Because therapy, real therapy, isn’t efficient.

It’s slow. It’s relational. It’s nonlinear. It’s deeply human. And I can’t help but wonder:

When we start turning this work into something clean and trackable, who benefits? Spoiler: it’s not our clients.

And it’s probably not us, either. Insurance companies are already using our data to define “good therapy.” There’s a phrase I keep hearing: value-based care. Sounds great, right? Better outcomes, not just more sessions. Who wouldn’t want that? But here’s the catch: therapists don’t get to define what “better” means.

Neither do clients. And once AI enters the equation, we’re not just working with someone’s pain. Instead, we’re generating data points. Those numbers become policy. Policy becomes reimbursement. And slowly, almost imperceptibly, our clinical judgment gets overwritten by an algorithm. Less sessions. Less flexibility. Less room to be human. Meanwhile, private practice gets harder and harder to sustain. Reimbursement goes down. Admin time goes up. The freedom to work at a human pace shrinks. And I see the options narrowing:

Take on more clients than you can ethically hold… or leave the field.

Join a platform that measures your worth in productivity metrics… or burn out trying to survive on your own. This isn’t theoretical. I know good therapists (attuned, seasoned, wise) who are being edged out because the system makes it impossible to stay. Here’s the part I really hate saying: There are companies out there using therapists’ names and profiles without permission. Engaging in deceptive practices, such as listing us without permission on platforms and copying our work to reroute potential clients to their systems. It’s been reported. It’s been challenged. But it’s still happening. And I wonder:

If they’re willing to bend the truth just to capture attention, what else are they willing to do? I don’t have a clean conclusion. I don’t have the energy to fight all of this today.

But I also don’t want to go numb. So this post isn’t a call to action. It’s more like a boundary being set out loud. I got into this work to sit with people. To listen well. To create space for pain, growth, and everything in between. That kind of work is slow, unscalable, and deeply meaningful. And no algorithm, no quarterly report, no “outcome metric” will ever convince me that therapy is better when it’s faster or cheaper or standardized. So for now, I’ll keep showing up.

I’ll keep trusting that real therapy (the kind that honors the whole person) is still worth protecting. Even if it’s inconvenient.

Even if it doesn’t scale. Even if it’s not what the system wants anymore.