Ever Feel You’re in McTherapy?
What disappears when we optimize a system for scale
There’s a moment in every Starbucks transaction that feels almost like connection. Almost. The barista calls your name— as if they know you. The paper cup is warm in your hand. The space is designed to feel like a neighborhood café — unhurried, personal, yours. It’s what made them a billion-dollar company. And yet something is missing, something you might not be able to name if you’ve never experienced the real thing. The quirky owner who remembers your order. The well-worn table where you’ve had three important conversations. The place that actually knows you.
This is the future being quietly built for mental health care in America.
Private equity and venture capital have been steadily acquiring independent therapy practices, behavioral health companies, and mental health platforms for several years now. The consolidation is accelerating. And while the stated mission is always access — bringing mental health care to underserved populations at scale — the underlying logic is the same logic that gave us cars, fast food, big box retail, and Starbucks on every corner. Standardize. Systematize. Scale. Extract margin. Repeat.
The result, if left unchecked, will be thousands of branded behavioral health practices blanketing the country, each one offering and speaking the aesthetic of therapy with no guarantee of its substance. Professor Jonathan Shedler rightly calls this kind of talk, “therapy slop” and “pop culture therapy.”
What Gets Engineered Out
The fast food industry succeeded by solving for variability. Every burger, every fry, every doughnut, every experience had to be identical regardless of who made it or where. Quality wasn’t necessarily the goal — consistency and scalability were. It has to look good. A brand. You knew exactly what you were getting, and that predictability had genuine value in transient, time-pressured places — a highway stop, a suburban mall, an airport terminal.
Corporate mental health chains will attempt the same solution. They’re betting that most of us won’t know the difference. Manualized treatment protocols and worksheets. Metrics-driven outcomes. Productivity quotas that pressure clinicians to see more clients in less time, and penalize them if they don’t. Standardized session structures that leave little room for the unpredictable, nonlinear way that actual human healing tends to unfold. They will co-opt the language of therapy. Not will. They already have.
What gets engineered out in this process is precisely what makes competent therapy work. Not the techniques like EMDR or CBT — those can be manualized. Not the psychoeducation — that can be automated. What gets engineered out is the unique human relationship. The continuity. The enriching experience of truly being known by another person over time, through difficulty, through rupture and necessary repair, of learning about yourself more deeply. The thing that cannot be standardized because it emerges differently with every unique pairing of two human beings in a room. If you’ve ever experienced authentic depth work, you know what I’m talking about. It’s the difference between a thoughtful home-cooked meal on a Sunday versus a fast food value meal.
High clinician turnover — already endemic in community and corporate behavioral health settings — disrupts that continuity systematically. Clients cycle through providers. The therapeutic alliance, which research consistently identifies as the primary mechanism of change in therapy, gets treated as a soft variable rather than the whole point.
The Democratization Argument
The counterargument will be made loudly and it deserves to be taken seriously. Access to mental health care is a genuine crisis. Millions of Americans have nothing — no insurance coverage, no affordable options, no providers within reasonable distance. If corporate chains bring basic mental health services to underserved communities, that is not nothing. People who are suffering deserve something rather than nothing. But that’s like responding to a famine with bags of pretzels and potato chips. People won’t starve today. But feed a population nothing but empty calories long enough, and you’ve traded one crisis for another — quieter, slower, and just as deadly.
Access to a weak facsimile of therapy is not the same as access to therapy. And that distinction will be deliberately blurred.
In advertising law, there’s a concept called puffery — promotional language vague enough to avoid legal liability but specific enough to function as a promise. The wellness and corporate therapy industries have mastered this. The claims are warm, confident, and just imprecise enough to be unactionable. And unlike pharmaceutical advertising, which is required to disclose risks in the same breath as the promise, a branded therapy internet platform carries no such obligation. The visual appeal is delivered in high production value — like a food photographer’s set, where milk droplets are white glue and the browned turkey is painted. They’re never meant to be eaten.
The Starbucks and fast-food models work precisely because they sell “the feeling of” a premium high-quality caring experience (and charging you for it) while systematically watering down or removing what made the original premium. They sell the sizzle, not the steak. The branding is sophisticated. The optics are picture perfect. The language is warm. Your “barista” appears to be the sommelier of coffee. The cushioned chairs in the corner by the fake fireplace are comfortable, if you can find one. But if you pay attention to the workers behind the counter you’ll notice how hurried they are, and is the coffee really that much better than anywhere else? Clients who’ve never experienced the richness of deep relational therapy — and increasingly, given the rise of AI mental health apps and text-based platforms, many haven’t — will have no basis for comparison. They’ll go, feel mildly helped, (or not) and conclude that this is what “good” therapy is. But it’s not.
Some will cycle through these practices, find them insufficient without understanding why, and give up on therapy entirely. Not because therapy failed them. Because they never actually got therapy. And that’s not good for the profession, or for all of us as a whole. But it is good… for private equity investors.
The Two-Tier Future
What private equity consolidation ultimately produces is the permanent entrenchment of a two-tier mental health system that already exists in nascent form today.
Tier one: corporate chain McTherapy for people with insurance or limited means. Standardized, time-limited, productivity-driven. Staffed increasingly by lower-cost providers under pressure to meet quotas and to push clients through. The Starbucks of healing.
Tier two: private pay, independent, relational therapy for those who can afford it. Unhurried. Continuous. Capable of the mindful depth that actual transformation requires.
The cruel irony is that the people most damaged by systemic inequality — by the chronic stress of economic precarity, by the accumulated trauma of being treated as data points by every institution they encounter — are the ones who will be funneled into the shallower McTherapy tier. The people who need the most will reliably get the least value. This is what Community Mental Health looks like today, where many therapists get their earliest training out of grad school and then wisely move on to private practice. Clients are left to cycle through another therapist. Psychiatric emergency departments tell the same story — high volume, burn out, relentless turnover, clinicians making consequential decisions about human beings in crisis with minutes rather than hours, and little to no continuity of care once the door revolves again. Many patients report feeling like being pushed through a psychological meat grinder in these high-stakes assembly line settings for the masses. This is not what quality mental healthcare is supposed to be.
What We Can Do About It?
