Are We Moving from Pay-Per-Session to Subscription Therapy? What Private Practice Therapists Need to Know
The therapy landscape is shifting. From BetterHelp's unlimited messaging to boutique practices offering monthly packages, subscription models are everywhere. But is this trend right for you?
When I first heard about therapists offering "therapy subscriptions," my immediate reaction was scepticism. How can a therapeutic relationship be sold in a way akin to Netflix—pay monthly, consume content, and lose money if you don’t use it.
But after observing the market for the past year and speaking with colleagues who've implemented various models, the conversation is more nuanced than I initially thought.
The subscription trend isn't just coming from companies like BetterHelp. It's emerging from a real problem many of us face: the tension between providing consistent, effective therapy and the financial realities of both running a practice and making therapy accessible.
Why Subscription Models Are Gaining Traction
The appeal is obvious from a business perspective. Instead of income fluctuating wildly based on holidays, client cancellations, and seasonal patterns, subscriptions promise predictable revenue.
Clinically, CBT and other evidence based therapy normally thrives on consistency. We know that regular practice, homework completion, and sustained engagement lead to better outcomes. When clients pre-commit to a monthly package, they often show up more consistently.
“So, I do private pay. I charge about $85 per telehealth session. If someone is seeing me weekly, they have the option of paying $265 for the month or pay per session. It gives them a discount and it gives me that financial security. Makeup sessions are based on availability” Reddit Quote
The BetterHelp Model vs. Traditional Practice
BetterHelp has normalised the idea of unlimited messaging and therapy subscriptions for a monthly fee, but their model is fundamentally different from what most of us offer in private practice.
Their approach works because:
Volume compensates for lower per-interaction rates
Clients expect brief, supportive responses rather than structured therapy
The platform handles all administrative burden
For independent CBT practitioners, trying to replicate this model often leads to burnout.
It’s also unclear how ethical this is, as well as clinically appropriate. I’m sure many of you are thinking ‘sounds like a safety behaviour to me!’ and I’m with you on that.
“I pondered this the other day, as a client of mine has started using a concierge doctor.
In the end, the lack of a clear boundaries could lead to all sorts of issues, especially dependence, burnout, or fuzzy boundaries.
I think it ends poorly.” Reddit Quote
What Actually Appears To Work: Structured Subscription Models
I spoke with some therapists I've seen succeed with subscriptions, and they aren't offering unlimited access. Instead, they're creating structured packages that essentially provide discount for clients who are attending regularly.
Example packages:
The "CBT Standard" Package (£400/month) as an alternative to paying session by session £110 (i.e. £440 per month)
4 x 50-minute sessions
Access to personalised CBT worksheets
Clients receive a discount due to regular attendance
Financial clarity for the therapist
When Subscription Models Work Well
Based on conversations with colleagues using these models successfully, subscriptions work best when:
The client was going to attend regularly anyway: by paying in a subscription format, the client is saving money on sessions they were going to buy anyway.
You have clear boundaries, particularly around cancellations: Defined amounts of sessions, cancellation and sickness policies.
There's genuine added value: Beyond just packaging existing services, successful subscriptions offer generally something extra—resources, tools, or accessibility that enhances the therapeutic work.
Clear permission to end anytime with clarity around what that means: Most successful non-therapy subscription models operate on a "use it or lose it" basis for the current billing period—meaning clients can cancel at any time, but they've already paid for that month's services and any unused products don't carry forward.
“When I had a group practice, I talked to my attorney about it.
Some of his concerns that I recall were:
-- How to handle cancellations and no shows
-- How to manage a patient possibly feeling "obligated" to continue with services because they'd paid in advance
-- How to handle ethical concerns
I'd talk to an attorney about it and get some attorney approved paperwork if this is something you want to consider”
This doesn’t really seem ethical in therapy services, so how can we manage it? The therapists I spoke to say clients can cancel mid-month, and the remaining sessions are refunded but charging the sessions already used at full cost.
For example, if a client on the "CBT Standard" package (£400/month for 4 sessions) cancels after 2 sessions mid month, those 2 completed sessions would be charged at the full individual rate of £220 (2 sessions × £110), and they'd receive a refund of the rest.
This means they lose the subscription discount on the sessions they did attend, but aren't financially penalised for ending therapy when clinically appropriate. This approach respects client autonomy while protecting the subscription model—clients can always leave treatment, but the discounted rate only applies when they complete the full monthly commitment they initially agreed to.
The Financial Ethics Question
Many ethical questions come up — but firstly for me, I have quite a few clients on fortnightly sessions due to cost. Under a model like the one discussed, those clients end up paying more per session (£220 for 2 sessions) unlike clients who can afford more and then get a discount (£400 per month for 4 sessions). That doesn’t sit right with me - but having multiple subscription models may also get confusing.
The Future: Hybrid Approaches
The most sustainable models I'm seeing combine traditional pay-per-session with optional subscription add-ons.
For example:
Standard therapy sessions remain fee-for-service e.g. weekly pay
Clients can start and stop subscriptions as and when they like
This approach preserves the flexibility of traditional therapy while offering the consistency benefits of subscriptions where clinically appropriate.
Should You Consider a Subscription Model?
Ask yourself these questions:
Is your client base predominantly private pay and you have clients who would save money as they were likely to attend weekly sessions anyway?
Can you clearly define what's included without creating unrealistic expectations?
Are you prepared to set and maintain professional boundaries within a subscription framework?
Does this model serve your clients' clinical needs, not just your business needs?
Do you feel ethically ok about this?
If you can't answer yes to all questions, it may be best to stick with traditional models for now.
Certainly I am still at a cross-roads with this and remain on a traditional model until I figure out the answer. But, I do think the therapy market is changing and clients are wanting more options.
Certainly I’ve had clients ask ‘can I get a discount if I pay all sessions upfront?’.
The Bottom Line
Subscription models aren't inherently good or bad—they're tools that can enhance private practice when used thoughtfully and ethically.
The key is ensuring that any subscription model genuinely serves your clients' therapeutic needs and your business needs. Done well, they can offer the consistency that makes CBT most effective. Done poorly, they risk commodifying the therapeutic relationship in ways that compromise both ethics and outcomes.
The therapy landscape is evolving, but our core responsibility remains unchanged: providing ethical, effective treatment that puts client welfare first.
What's your experience with subscription models in therapy? Have you considered implementing one in your practice? I'd love to hear your thoughts and concerns in the comments.