The therapist workforce desires a partner to share their clinical and business burdens.
Outpatient mental health providers, in turn, seek to make therapists’ work as frictionless as possible, beef up support systems and develop hiring practices that match the increasing sophistication of prospective clinical employees.
“I can tell you it gets harder every year,” Lisa Miller, the chief operating officer of Lifestance Health Group (Nasdaq: LFST), told Behavioral Health Business. “They’re possibly the most sought-after segment out there. … We are extremely passionate about continuing to meet [the demand for] care, which means we have to continue to be attractive to clinicians as we recruit and we hire.”
Lifestance Health employed 8,349 clinicians at the end of the first quarter of 2026. That’s 11% more than a year ago. The Scottsdale, Arizona-based company is the largest provider of outpatient mental health services in the U.S. It operates 594 locations across 33 states, according to its website.
Demand for therapists in the U.S. was accelerated by COVID and diminished stigma about therapy. The federal government says counseling roles are among the fastest-growing of all professions. There has also been a flood of investment in the space to meet the increased demand for services. The confluence of the two creates massive demand for therapists as employees and contractors.
The therapists’ workforce also has more opportunities than ever before to engage in private practice. The rise of therapist enablement platforms has created several paths for therapists to build their own practice with some degree of autonomy and back-office support. However, that can come with trade-offs.
“For us, it’s about how we can create as much value [therapists] want or need so that this is the place [they] want to practice,” Jessica Crain, chief operating officer and co-founder of Mindful Therapy Group, told BHB. “Lots of our providers come to us saying they are on 17 different platforms … Our goal is, ‘Let’s make our services and our offering so good that those platforms become less relevant.’”
Jessica Crain owns and operates Mindful Therapy Group with Derek Crain, CEO and co-founder. The two are married. They founded the company in 2011.
A snapshot of the therapist workforce
Mindful Therapy Group recently surveyed its clinician workforce, a cohort of contracted health care providers about 2,300 strong; 204 responded to the survey. About 59% of clinicians report that the level of distress among patients is slightly (39%) to much higher (20%) than in years past. However, Mindful clinicians report at a rate of 78% that they are managing (40%) or are doing well (39%).
About 91% of clinicians report that world events are coming up during sessions with patients describing feelings of anxiety and fear (73%), frustration and anger (61%) and hopelessness (58%).
“There’s this assumption with therapists that [they] sit in that chair and they’re able to disassociate from problems that their patients bring in … and when they leave that session, it goes away — it doesn’t,” Derek Crain told BHB. “They experience vicarious stress, they experience vicarious trauma, and they sort of internalize all that. … This is a politically charged year; it’s charged macro-economically, it’s charged in many different ways. Not only are [therapists] experiencing that on the personal side as human beings, they’re taking on that vicarious stress and trauma with their clients as well.”
Miller said that Lifestance is seeing more care-seeking behavior among prospective clients but didn’t speak to if they are increasingly distressed. She attributes the increase to reductions in stigma, making people feel more comfortable using insurance coverage to get therapy.
Colleen Marshall, chief clinical officer for Two Chairs, told BHB that the provider continues to see clinical complexity like in other years but also notes the unique challenge that 2026 brings being an election year during a time of economic uncertainty and massive technological and social change.
Founded in 2017, Two Chairs is headquartered in San Francisco, California. It operates a hybrid in-person and telehealth model for therapy and psychology. It operates six locations in California, Florida and Washington.
“Clinicians need to feel like they know how to support the client with whatever they’re coming in the room with, especially like the uncertainty that shows up,” Marshall said. “One of the reasons measurement-based care is so important to us is it monitors the progress over time, but it also triggers conversations for the therapist to have informed decisions around what’s happening.”
Employment versus contracting
The fundamental employment strategies that outpatient mental health providers take either enable or limit how they can support the therapist workforce. Mindful Therapy Group engaged its clinicians as contractors. Lifestance Health and Two Chairs favor employing therapists as W-2 staff.
Derek Crain said Mindful Therapy Group affords its clinicians maximal therapy while also providing access to essential systems for independent practices. Because of the contracting approach, it does not institute efficiency measures such as requiring clinicians to provide a fixed number of therapy hours in a given week. The company still takes on back-office functions such as billing and scheduling and provides office space for therapists.
On the other hand, some clinicians want to avoid the risk of entrepreneurship and have more fulsome support as an employee.
“That’s why we invest in the W-2 model — it’s because we create intentional spaces for folks to have that support and have this regular feedback loop with our clinicians that is driving our specific strategy and roadmap so that what is on their plate isn’t burdensome,” Marshall said. “How do we get that out of their way so that they can really spend their time with their clients and make sure the caseload that they have is right for them?”
Two Chairs offers part-time and full-time employment. Therapists, like other highly educated professionals, are often afforded the opportunity to work in several different sectors, especially consulting, education, training and research. Marshall notes that therapists will often cycle in and out of employment settings based on wants and needs that change with time.
“All the things that it takes to run a business, clinicians don’t really get trained in that, so they have to learn it on their own if they’re going into private practice,” Marshall said. “For some folks, that works and they thrive. Others just find that that’s a burden, and they really want that to be taken off their plate.”
Actually listening to the workforce is key
Universally, the experts BHB spoke with for this story said that therapists want, as much as possible, to have non-clinical challenges taken care of for them so they can focus on patients and patient needs. They also want both autonomy to practice and a wide array of support for their careers and for the clinical needs of their patients.
Specifically, the experts said they want to eliminate as much as possible the pressures of billing and revenue cycle management for their clinicians. This is more important than ever as insurance companies have both increased interest and the capacity to question claims and payments en masse with AI. The Crains said there has been a marked increase in such activities by payers in the last 18 months.
However, the latest advancements in technology — artificial intelligence — have opened a can of worms among the clinician workforce. Listening and using the feedback from clinicians has been key for these organizations.
At Two Chairs, internal AI tools are optional for clinicians. Marshall said that providers are divided. On one hand, some providers have warmed to the possibility of greater efficiency. On the other hand, providers “don’t want anything to do with it.”
“Because autonomy and flexibility are equally important to them, when we roll these things out, we have to roll them out as a choice,” Marshall said.
While Mindful Therapy Group hasn’t established AI tools, they are working on establishing tools for providers who want them. Even among providers interested in AI, there are still concerns that providers need to address.
Jessica Crain said the company has “been very involved” with their electronic health record vendor in addressing provider concerns around “ethics and safety, the retention of that data, how it’s training, whether it’s closed loop.”
Similarly, each excerpt said they don’t believe that AI should replace clinicians, and this is a message they communicate to their workforce.
Clinician input can lead to key changes or enhancements to the strategy.
Mindful Health Group frequently polls local providers when considering new office locations, seeking input on commutes, parking preferences, local patient tendencies or other unique needs.
Last year, Lifestance Health converted its stock-incentive productivity incentive for clinicians to a cash-bonus program based on the feedback of clinicians, Miller said.
“We’re looking at different benefits in the coming year that we’ve heard from clinicians are important to them,” Miller said. She did not elaborate on what those were.
Hiring clinicians
While a unique workforce, therapists still look for factors in prospective employers that are common to other segments of the workforce: they want to feel like their input matters, develop new skills, advance their career and feel supported in their work.
At LifeStance, this comes, in part, in the form of continuing education and formal and informal professional consultations.
“They hold the emotions of their patients in their hands, and that gets burdensome and it gets isolating,” Miller said. “When they are around their peers … they can debrief, they can download and feel like they have partners that they can work with. That reduces that burden … the clinicians that we recruit really value that.”
Marshall said that the average recruiting conversation has been more sophisticated than ever. Conversation quickly moves past the classic questions of salary and benefits to much more specific elements such as questions of measures of accountability, the culture, whether or not the technology is a benefit or burden, opportunities to advance careers into management, etc.
This can create a problem if not handled properly.
Often, those handling daily recruiting tasks for scaling and scaled companies are not clinicians. This may lead to incorrect or misaligned expectations for providers coming in. The company ensures that clinical managers are part of the hiring process and that the clinical and recruiting teams have a feedback loop to create awareness of needs for changes in the market. It is through this feedback loop that Two Chairs started to learn about the interests and disinterests of providers when it comes to AI, Marshall said.