Mental health care made for YOU
Startup matches patients with therapists to build strong relationships and improve outcomes
The zealous work ethic and hustle that make Silicon Valley the center of entrepreneurship has a serious downside — they take an emotional and mental toll on workers. So in true Silicon Valley fashion, efforts are afoot to tackle the problem by innovating the mental health industry itself. One such innovation is Two Chairs, a San Francisco-based startup that aims to improve the experience of seeking talk therapy.
Alex Katz founded Two Chairs in 2016 after watching his partner, as well as family and friends, struggle to navigate the mental health system to find a therapist they trust.
The company’s main feature is a questionnaire and matching software that asks patients about their personal background, expectations for therapy and emotional needs before pairing them with one of the company’s more than 40 full-time therapists. It’s based on research that shows a strong relationship with a therapist can improve a patient’s outcomes.
Two Chairs is also trying to remove barriers and the stigma of seeking therapy by simplifying the experience and giving its clinics a positive, modern vibe, Katz said. Each of Two Chairs’ six Bay Area clinics are decorated with nature-inspired decor, and patients can enjoy tea or sparkling water while they wait, or decompress with essential oils after a session.
Two Chairs is an out-of-network provider, meaning it does not bill insurance companies directly, and charges $149 for an initial consultation, $180 for a full session of therapy and $50 per person for group therapy sessions. The company has served 2,000 patients since launching and opened its sixth clinic in downtown San Jose in September.
Q
Why do you think it’s hard to get started with therapy?
A
There are so many people who don’t think therapy is right for them or has applicability in their lives, and even once someone says they want to seek out help, the challenges are big, like
your primary care provider not knowing where to send you. So people are turning to Google or their insurance company and are presented with a huge list of names. That’s not even engaging with the fact that therapy is about a relationship with a therapist who you trust and understands what you’re going through.
Q
Are there common misconceptions people have about therapy?
A
That only people diagnosed with a mental illness can benefit. It’s helpful to think of mental health on a continuum — with illness, or the inability to function, on the one hand, and flourishing or high well-being and high functioning, on the other. Similar to our physical health, people can be completely disabled by a mental health issue, or lead a happy and fulfilling life, or fall somewhere in between like most of us do.
Q
How does your company make therapy easier to access?
A
The basic idea is, clinical research has said that the relationship is the best predictor for outcomes of care. We’ve created our own methodology, based on the client’s needs, lived experiences, identity, what’s bringing you in. You fill out an online questionnaire and then you come in for an in-person consultation, and based on all that, the clinician uses technology and their clinical experience to match you with a therapist.
That nuanced conversation … starts with, what is the problem or goal the client is coming in with, and finding a therapist who has expertise in that area, like a new mom struggling with postpartum, or someone who’s just moved to the Bay Area for a job with lots of stress. The second piece is the identity and background of the therapist and client. For a lot of folks, being with a very specific person and identity — ethnic, gender or socioeconomic — can be important and enable a trusting relationship.
Q Why did you choose to employ your therapists and run brick-and-mortar clinics, rather than contracting with individuals or going through insurance networks?
A
All the therapists are salaried employees of the company — that was an intentional choice we made from the beginning. It’s challenging, emotionally demanding work ... and making sure people feel they have the right financial stability allows them to focus on the work and delivering great care.
The work we’re able to do is at the intersection of in-person care and technology … the combination of that intuition and software is a huge driver of the quality of care. There’s a bunch of mental health startups that are trying to replace therapy with an app or texting, and we think those approaches have value, but nothing will ever replace a really great, in-depth, in-person relationship.
Q Your company is not part of an insurance network and charges a fee of $180 a session. How does that affect accessibility?
A The vast majority of therapists are out of network. Nationally, the number is more than 80%, and the underlying reason is health insurance companies haven’t invested enough in mental health. The result is a lot of therapists can’t accept insurance because of the way the system works.
You see all throughout health care folks don’t know what the cost of care is, and it’s next to impossible to shop for the right care for them. We’ve tried to keep things really simple for our clients, so we’ve said therapy at Two Chairs should cost one specific price, and we want our clients to not have to think about it more than that.
People with out-of-network benefits are able to get reimbursed for a substantial portion of the cost of care, and we’ve built a care coordination team to walk our clients through benefits and file claims on their behalf.
The second step is we’ve developed a group therapy program, focused in particular on work stress and anxiety, and we’ll develop other types of groups. Research says it’s just as effective as inperson, individual therapy, but can be more affordable.
Q Do you think there’s something about society now that makes therapy more important? What about in the Bay Area?
A Mental health and therapy has always been important, but there’s something about this moment in time that has raised the stakes. I read this book, “Reclaiming Conversation” by Sherry Turkle, and it’s all about how … technology is getting in the way of more of our interpersonal relationships, and more people feel lonely and that they lack meaning and purpose. But it’s optimistic because we as humans are capable of creating great relationships and finding meaning in our lives … and tools like therapy can be a really big part of how we get back to what fundamentally sustains us. That’s part of the motivation of the company.
When we decided to begin developing a groups program, by far the most common is the stress and anxiety that people feel related to their work. For folks in the Bay Area, work is a source of purpose and joy but also a profound source of stress, and people are working harder than ever. Having a group of people in a room who share those concerns … and providing space for them to process and learn from an expert, makes a big difference in how people can manage the stress and anxiety of their work.