Online therapy: which startup is ahead?
In our mental health market deck, you will find everything you need to understand the market
SUMMARY
Grow Therapy is ahead in online therapy today, with Spring Health and Alma now close enough to make it a real two-company race.
Grow has the strongest completed commercial record. It facilitated seven million visits in 2025, has reached more than two million patients and produced $617.4 million of verified 2024 revenue before describing its annual revenue as exceeding $1 billion.
Spring has built the broader system. The Alma acquisition connects employer benefits, health-plan distribution, care navigation and infrastructure for independent clinicians, giving the combined company access to more than 170 million people.
The biggest gap between the leaders is evidence versus potential. Grow has already delivered the stronger recent numbers, while Spring’s expected $1 billion of combined revenue and $6 billion to $7 billion valuation still depend on the integration working as planned.
Headway owns the largest provider network by far, with more than 80,000 therapists and psychiatric providers. Yet its public evidence on patient volume, revenue and platform-wide outcomes remains much thinner than its supply-side scale would suggest.
Rula is the most credible challenger outside the top four. Its average insured session costs $15, its median wait is one day, and its clinical report draws on more than 10 million sessions rather than a small pilot.
Lyra remains the research leader. More than 20 peer-reviewed studies, one-year follow-up data and evidence of lower healthcare claims give it a level of clinical credibility that the faster-growing marketplaces have not yet matched.
Two Chairs shows the trade-off between control and scale. It employs and trains more than 600 clinicians directly, reports unusually strong matching and outcomes, but remains tiny beside networks with tens of thousands of independent providers.
Spring has the broadest moat, Headway the strongest provider network effect and Grow the fastest usage flywheel. Brightside is the clearest specialist in higher-acuity virtual care, where ordinary weekly therapy is not enough.
The ranking can still move. Spring could overtake Grow if the Alma combination delivers in practice, Headway could jump by disclosing patient and revenue figures that match its provider scale, and Rula could enter the top four by sustaining its access, pricing and outcomes while proving faster annual growth.
This market map, featured in our mental health market deck, highlights top companies and startups in the mental health market
Which online therapy startups are actually worth comparing?
The real online therapy race currently includes eight private companies with enough patients, providers, payer relationships or clinical depth to deserve a serious comparison.
We include Grow Therapy, Spring Health with Alma, Lyra Health, Headway, Rula, Two Chairs, Brightside Health and SonderMind. They overlap, but they have built very different businesses.
Grow, Headway and Rula make it easier for independent clinicians to accept insurance and find patients. Spring and Lyra sell mental health benefits mainly through employers and health plans. Two Chairs employs its clinicians more directly and puts unusual emphasis on therapist matching and measured outcomes. Brightside treats a wider range of clinical severity through therapy, psychiatry and intensive programs. SonderMind combines a national provider network with tools for therapists and insurers.
We treat Spring Health and Alma as one company because their acquisition has closed. BetterHelp belongs to Teladoc, while Talkspace is public and has agreed to be acquired by Universal Health Services. They remain important competitors, but they are incumbents rather than independent startups.
Talkiatry also sits just outside the main field. It now employs more than 800 psychiatrists and 300 therapists, but psychiatry remains the center of its business. Charlie Health belongs in virtual intensive outpatient care, which involves several hours of treatment each week rather than ordinary outpatient therapy.
Private funding figures vary slightly between databases, especially when debt is included. The table therefore uses rounded cumulative amounts rather than pretending every dollar is perfectly comparable.
| Startup | What it mainly does | Approximate funding raised |
|---|---|---|
| Lyra Health | Mental health benefit for employers and health plans | $915 million |
| Spring Health with Alma | Employer care, navigation and provider infrastructure | $636 million combined |
| Grow Therapy | Insurance-covered therapy and psychiatry marketplace | $328 million |
| Headway | Insurance, billing and patient-acquisition infrastructure for clinicians | $321 million |
| SonderMind | National therapy network and provider technology | About $276 million |
| Rula | Insurance-covered therapy and psychiatry marketplace | About $263 million |
| Brightside Health | Therapy, psychiatry and higher-acuity virtual care | About $114 million |
| Two Chairs | Therapist matching and measurement-based clinical practice | $103 million |
Is Grow Therapy already the clear leader?
Grow Therapy is ahead overall today, although Spring Health has moved close enough that the race is far from settled.
Grow currently has the strongest combination of verified revenue growth, completed appointments, affordable insured care and recent expansion. The company facilitated seven million visits during 2025, bringing its lifetime total to 10 million therapy and medication-management appointments. It has also reached more than two million patients.
Spring became a much larger threat after completing its acquisition of Alma. The combined business now gives more than 170 million people access through employers and health plans. The Wall Street Journal reported that the two companies expect to generate around $1 billion in combined annual revenue and could be worth between $6 billion and $7 billion.
Grow leads on completed commercial performance. Spring has built the broader system, covering employer benefits, health-plan distribution, care navigation and infrastructure for independent clinicians.
Headway still has the largest therapist network, while Lyra has the strongest long-term research record. Rula is the closest company behind that group after crossing 10 million sessions and publishing detailed figures on prices, availability and patient improvement.
If you want more recent data on this point, please see our latest mental health market report.
As this chart shows, and as featured in our mental health market deck, search interest in men’s mental health has been rising steadily
Who is making the most money from online therapy?
Grow Therapy currently has the strongest proof of revenue, with Spring Health and Alma operating in the same general range after combining.
The Financial Times and Statista verified that Grow’s revenue increased from $3.6 million in 2021 to $617.4 million in 2024. Grow has since described its annual revenue as exceeding $1 billion, although that newer figure has received less independent scrutiny than the 2024 result.
Spring and Alma expect around $1 billion in revenue during their first year together, according to reporting by The Wall Street Journal. Grow’s $617.4 million represents revenue already produced during a completed year, while Spring’s figure remains an estimate for the combined company.
Private companies also use the word revenue differently. Large amounts of money may pass from insurers through the platform before clinicians are paid, and public disclosures rarely show how much the company retains.
Even with that limitation, Grow and Spring are the only two private online therapy groups with credible public evidence of revenue approaching $1 billion.
Is anyone growing faster than Grow Therapy?
Nobody we can measure is growing faster than Grow Therapy at a comparable size.
Grow’s verified revenue increased roughly 171 times between 2021 and 2024. That equals a compound annual growth rate of 455.6%, which placed it first among all companies in the Financial Times ranking of the Americas’ fastest-growing businesses.
Spring Health said its own compound annual growth exceeded 80% over the previous three years. Two Chairs reported an eightfold expansion in revenue over three years, equivalent to approximately 100% annual growth, but it began from a much smaller base and has not disclosed recent revenue.
Headway has lately grown fastest on clinician supply. Its network increased from around 50,000 providers in early 2025 to more than 80,000 currently, or roughly 60%.
Rula may also be expanding quickly, but it publishes cumulative sessions rather than enough annual figures to calculate a reliable growth rate. Grow remains the fastest-growing company for which we have comparable revenue data.
This chart, featured in our mental health market deck, illustrates yearly VC investment in mental health startups
Who has the biggest therapist network without losing control of quality?
Headway has the biggest online therapy network, but Grow currently shows the strongest combination of provider scale and real patient activity.
Headway has more than 80,000 therapists and psychiatric providers accepting insurance through its platform. That is more than three times Grow’s 26,000-provider network and around three and a half times Rula’s 23,000. Alma brought about 26,000 clinicians into Spring Health, although Spring has yet to publish a clean combined figure after removing overlap.
Headway can add clinicians quickly because it handles credentialing, insurance claims and patient acquisition while leaving therapists in independent practice. That model offers less control over treatment methods, availability and the patient experience than a directly managed clinical group.
Grow’s smaller network completed seven million visits in one year, equivalent to roughly 269 annual appointments per listed provider. Rula reports more than 112,000 available appointments each week, close to five open weekly slots per provider, while operating through one electronic health-record system.
Two Chairs has chosen greater control over raw scale. It directly employs more than 600 clinicians, trains them in measurement-based care and says 98% of patients are matched successfully on the first attempt.
Headway has solved provider recruitment better than anyone else. Grow has produced more evidence that a large independent network can remain heavily used, while Two Chairs maintains the tightest control over care.
| Startup | Disclosed provider network | How much control the platform has |
|---|---|---|
| Headway | 80,000+ | Mainly independent clinicians using Headway for insurance and administration |
| Grow Therapy | 26,000+ | Independent clinicians using Grow’s marketplace and practice tools |
| Spring Health with Alma | At least 26,000 from Alma | Mix of provider infrastructure, contracted care and managed navigation |
| Rula | 23,000+ | Independent network operating through one clinical and administrative system |
| SonderMind | More than 8,000 in its last detailed disclosure | Independent therapists and psychiatric providers |
| Two Chairs | 600+ | Clinicians employed and managed much more directly |
| Lyra Health | No current directly comparable figure | Mix of affiliated practices, contracted providers and global partners |
| Brightside Health | No current public figure | More tightly organized virtual clinical teams |
Which platform gets people into therapy fastest and cheapest?
Rula currently offers the strongest public combination of low insured prices and immediate appointment availability.
Rula says patients pay an average of $15 per session through insurance. Its latest clinical report also shows a median wait of one day and more than 112,000 open appointments during a typical week.
Grow comes very close. Patients pay an average of $21 per visit, one-third pay nothing and appointments are generally available within two days. It also gives patients 26,000 provider profiles to search rather than automatically assigning one therapist.
Headway advertises prices as low as $0, but the company does not publish a national average. Spring and Lyra may cost employees nothing when an employer pays for sessions, although people cannot usually join unless their workplace or health plan offers the benefit.
Brightside’s therapy membership costs $299 for four monthly video sessions and unlimited messaging, or roughly $75 per scheduled session before valuing the messaging.
Rula wins for the average insured patient based on the figures companies currently disclose. Grow offers nearly the same affordability with more patient choice.
If you want more recent data on this point, please see our latest mental health market report.
This chart, featured in our mental health market deck, shows why Talkspace is winning in mental health
Who is actually delivering the most therapy?
Grow Therapy appears to be processing the most care each year, while Lyra and Rula have also reached serious clinical scale.
Grow completed seven million visits in 2025 alone. That works out to roughly 583,000 visits per month or 19,000 per day. Its annual volume equals 70% of the 10 million appointments it delivered during its entire first five years.
Rula has passed 10 million cumulative therapy and psychiatry sessions. Lyra has reported nearly 12 million sessions, while Two Chairs has crossed one million.
Some companies count appointments, others count sessions, and some include psychiatry, coaching or medication management. Annual volume remains the clearest comparison, and Grow is the only leader currently disclosing several million completed visits within one recent year.
Whose online therapy seems to work best?
Lyra Health still has the strongest overall research record, while Spring, Two Chairs, Rula and Grow each lead on a narrower type of evidence.
Lyra has produced more than 20 peer-reviewed studies across treatment outcomes, lasting improvement, workplace productivity and healthcare spending. Its research found that more than 81% of patients who improved maintained their gains at a one-year follow-up. Another analysis found a 26% reduction in annual healthcare claims costs among participants.
Spring studied nearly 53,000 patients and found that 92.3% reliably improved or recovered from anxiety or depression, while 61.7% reached remission. After completing the Alma deal, Spring said 92% of members achieve meaningful clinical improvement and employers see mental health claims costs fall by 52%.
Two Chairs examined 18,721 patients and 755 clinicians. Outcomes improved by 24% after clinicians completed six months of training in its measurement system. Another study found results for anxiety and depression were up to 2.5 times better than published results from ordinary practice settings.
Rula’s latest clinical report covers more than 10 million sessions. It found that 71% of patients with moderate-to-severe symptoms achieved meaningful improvement within eight weeks. Grow reports that 80% of clients show measurable symptom improvement within 30 days.
These percentages are not directly comparable because the companies treat different populations and define improvement differently. Lyra leads overall because its findings have been repeated across more studies, outcomes and time periods.
| Startup | Strongest public evidence | Our judgment |
|---|---|---|
| Lyra Health | 20+ peer-reviewed studies and one-year follow-up data | Deepest evidence base |
| Spring Health | Outcomes analysis covering nearly 53,000 patients | Strongest evidence at large scale |
| Two Chairs | 18,721-patient study and outcomes up to 2.5 times stronger than benchmarks | Best measurement discipline |
| Rula | Clinical report built from 10 million+ sessions | Best recent transparency |
| Grow Therapy | 80% reporting measurable improvement within 30 days | Huge dataset, younger research record |
| SonderMind | Outcomes tools and predictive analytics infrastructure | Credible system, fewer fresh comparisons |
| Brightside Health | Specialized programs for depression, crisis and higher-acuity care | Clinically differentiated, less comparable |
| Headway | Measurement tools available to providers | Strong infrastructure, limited platform-wide outcomes proof |
If you want more recent data on this point, please see our latest mental health market report.
This chart, featured in our mental health market deck, illustrates yearly funding for mental health startups
Who has the easiest route to millions of patients?
Spring Health currently has the strongest distribution system because it can reach patients through employers, health plans and Alma’s clinician network at the same time.
The Spring and Alma combination supports more than 170 million people worldwide. Spring brought relationships with companies including Microsoft, Target, BlackRock, Pfizer and Coca-Cola, while Alma contributed a large clinician network and broad insurance access.
Grow’s 125-plus insurer relationships cover around 220 million people in the United States. It has also begun selling to employers and health systems, adding workplace benefits and primary-care referrals to its original insurer-led model.
A person whose insurance accepts Grow has a possible route to the platform. An employee whose company actively pays for Spring or Lyra receives a stronger reason to use it, so covered lives and active benefit members should not be treated as identical.
Lyra directly serves more than 20 million people through employer contracts. Rula accepts 124 commercial plans alongside Medicare, Medicaid and employee-assistance programs.
Spring has the broadest route to patients today. Grow has the largest visible U.S. insurance footprint, while Lyra remains especially strong among large global employers.
Which startup can handle more than ordinary weekly therapy?
Spring Health now offers the broadest mental health platform, while Brightside goes furthest into higher-acuity direct virtual care.
Spring already covered self-guided support, coaching, therapy, psychiatry, specialty care and navigation. Alma adds insurance administration, billing, scheduling and practice tools for independent clinicians. The combined business can follow someone from an employer benefit into insurance-covered care without forcing a complete change of system.
Lyra offers a similarly broad clinical path through self-guided tools, coaching, therapy and medication management. Its global delivery network gives it an advantage when multinational employers want one mental health partner across many countries.
Brightside stands out when a patient needs more than weekly outpatient therapy. It offers psychiatry, crisis care, suicide-prevention support and virtual intensive outpatient programs. Its expansion into substance-use treatment and full Medicare Part B coverage also gives it access to populations that consumer therapy apps often avoid.
Rula has expanded from individual therapy into psychiatry, couples therapy, family care and treatment across more than 90 conditions. Grow combines therapy with medication support and has started building between-session tools inside its app.
Two Chairs added psychiatry to its therapy business and employs those clinicians directly. That allows closer coordination between medication and therapy, although its geographic and provider scale remains smaller.
Spring wins on breadth across the entire system. Brightside handles the widest range of patient severity inside a direct virtual-care model.
This chart, featured in our mental health market deck, compares the main business model options for tele-mental health platforms
Which online therapy startup would be hardest to copy?
Spring Health has built the hardest overall position to reproduce because a competitor would need to copy several connected businesses at once.
A new company could build therapist-matching software, an AI note-taking tool or a patient app within a relatively short period. Recreating national insurance contracts, employer relationships, provider infrastructure, clinical data and years of published outcomes would take far longer.
Spring now controls a route from the buyer to the clinician. Employers and health plans pay for care, Spring guides patients toward the right service, and Alma helps thousands of clinicians accept insurance and run their practices. That combination also creates more opportunities to keep a patient inside the same system when employment or insurance changes.
Headway has the strongest provider-side network effect. More than 80,000 clinicians use its infrastructure. That attracts insurers seeking broad coverage and patients seeking choice, while those relationships make Headway more valuable to additional clinicians.
Lyra’s advantage comes from employer trust and clinical research. A rival can claim strong outcomes, but producing more than 20 peer-reviewed studies and proving reductions in healthcare claims requires years of data and stable customer relationships.
Grow is building a volume advantage. Millions of yearly appointments generate information about search behavior, appointment availability, provider performance, engagement and outcomes. Its insurance relationships also create a barrier that a new marketplace could not cross quickly.
Spring has the broadest moat. Headway owns the strongest clinician network effect, while Grow is building the fastest data and usage flywheel.
If you want more recent data on this point, please see our latest mental health market report.
Who is getting the most from every dollar raised?
Grow Therapy appears to be using venture capital more efficiently than the other online therapy leaders with credible revenue disclosures.
Grow has raised $328 million. Its verified 2024 revenue of $617.4 million equaled roughly $1.88 in annual revenue for every dollar ever raised. Using the company’s newer billion-dollar revenue claim would lift that ratio above $3.
Spring and Alma raised about $636 million combined. Their expected first-year revenue of approximately $1 billion would equal around $1.57 for each dollar of historical funding. That remains a strong result, although it relies on a forward estimate and combines two established businesses.
Lyra has raised more than $900 million, nearly three times Grow’s total. Lyra used that money to build global care, enterprise distribution and a deep research program, but it has yet to disclose a recent revenue figure with the same credibility as Grow’s.
The comparison says little about profitability. Paying a therapist for a completed appointment can consume a large share of marketplace revenue. Employer platforms also spend heavily on sales, clinical operations and customer support.
Still, the capital has clearly produced different levels of visible commercial output. Grow’s verified revenue already exceeded its cumulative funding by a wide margin before its latest acceleration. No rival has disclosed a stronger relationship between money raised and completed commercial scale.
This chart, featured in our mental health market deck, shows how market revenue is split across customer segments in the mental health market
Who has gained the most ground lately?
Grow Therapy has the strongest recent momentum, while Spring Health has made the biggest move to reshape the market.
Grow recently raised another $150 million at a $3 billion valuation. More importantly, it has expanded from a therapy marketplace into a platform sold to insurers, employers and health systems. Its employer program lets patients keep the same therapist when they move from employer-funded sessions to ordinary insurance, while its Circle Medical integration sends primary-care patients directly into treatment.
Spring’s completed acquisition of Alma is the category’s biggest strategic event. Alma’s insurance relationships give Spring a route to continue care when patients change jobs or plans, addressing a major weakness of employer-funded mental health benefits.
Headway has expanded from around 50,000 to more than 80,000 providers and acquired the team behind Tezi, an AI-native recruiting company. Rula has published its first detailed annual clinical report, launched a national brand campaign and expanded psychiatry across all 50 states.
Lyra has added distribution through Workday Wellness and the Thatch benefits marketplace. Two Chairs published two recent peer-reviewed studies. SonderMind’s AI note-taking tool has produced more than 100,000 insurance-ready clinical notes and reduced average documentation time from around 20 minutes to four.
Grow currently has the strongest mix of financial, patient and product momentum. Spring’s acquisition could have the larger long-term effect, but the integration still has to deliver.
Which online therapy startups are actually ahead?
Grow Therapy is the startup ahead overall today, with Spring Health now close enough to make this a genuine top-two race.
We give Grow first place because completed commercial performance deserves more weight than expected synergies. It has the strongest verified growth, the largest disclosed recent annual treatment volume, affordable insured sessions and a widening route through insurers, employers and health systems.
Spring ranks second, but its ceiling may now be higher. Alma gives it provider infrastructure and health-plan reach that complement Spring’s employer relationships, navigation and clinical programs. A smooth integration could put Spring ahead because it would control more parts of the patient journey than Grow.
Lyra holds third place through research, employer trust and global coverage. Its position looks durable, although the company currently shows less visible growth than the top two.
Headway ranks fourth because its provider network is far larger than anyone else’s. We keep it below Lyra because public evidence around patient volume, revenue and platform-wide clinical outcomes remains thinner.
Rula follows closely in fifth. Its combination of 10 million sessions, next-day access, low insured prices and unusually detailed outcomes reporting gives it a realistic path into the top four.
Two Chairs ranks sixth. It may provide the most tightly controlled therapy experience in the field, but its direct-employment model has produced hundreds of clinicians while marketplace competitors have reached tens of thousands.
Brightside takes seventh through its higher-acuity care, public-insurance reach and specialized programs. SonderMind ranks eighth because it remains a substantial national company, although its recent commercial scale is harder to see.
The ranking could change through three developments. Spring could prove that the Alma combination works in practice. Headway could disclose patient and revenue figures matching its provider scale. Rula could maintain its current access and outcomes while showing faster annual growth.
For now, Grow has earned the clearest answer to the original question. Spring is the closest challenger, while Lyra, Headway and Rula form the next group rather than sharing an equal position.
| Rank | Startup | Why it ranks here |
|---|---|---|
| 1 | Grow Therapy | Strongest combination of verified growth, annual care volume, affordability and recent expansion |
| 2 | Spring Health with Alma | Broadest platform and strongest overall moat, with integration still to prove |
| 3 | Lyra Health | Best research record, global employer reach and long-term clinical credibility |
| 4 | Headway | Largest provider network and strongest insurance infrastructure for clinicians |
| 5 | Rula | Excellent access, transparent outcomes, low prices and substantial treatment volume |
| 6 | Two Chairs | Strong matching and clinical control, but much smaller provider scale |
| 7 | Brightside Health | Best positioned for higher-acuity virtual care and public-insurance populations |
| 8 | SonderMind | National reach and useful provider technology, with less visible recent commercial momentum |
If you want more recent data on this point, please see our latest mental health market report.
This chart, featured in our mental health market deck, shows how therapy matchmaking platform technology has evolved over time
OUR METHODOLOGY
This analysis asks which private online therapy startup is ahead based on the evidence available today. We compare eight companies across commercial scale, growth, provider capacity, treatment activity, affordability, speed of access, clinical evidence, distribution, breadth of care, defensibility, capital efficiency and recent momentum.
The comparison includes Grow Therapy, Spring Health with Alma, Lyra Health, Headway, Rula, Two Chairs, Brightside Health and SonderMind. BetterHelp and Talkspace remain important competitors, but they sit outside the independent-startup ranking. Talkiatry is centered more heavily on psychiatry, while Charlie Health belongs more naturally in virtual intensive outpatient care.
We prioritized evidence of completed activity over potential. Completed annual revenue received more weight than management forecasts, delivered appointments mattered more than theoretical capacity, and measured outcomes mattered more than broad claims about quality. Active employer, payer and provider relationships also received more weight than the total number of people a company might technically be able to reach.
The figures are not perfectly comparable. Some companies report gross revenue that includes money later paid to clinicians, some count therapy sessions while others include psychiatry, coaching or medication management, and provider totals can mix therapists, psychiatrists and other professionals. Funding totals are rounded because databases also differ on debt and predecessor entities.
Clinical-outcome percentages were assessed in context rather than ranked mechanically. The companies treat different populations, use different time periods and define improvement in different ways. We gave more credit to peer-reviewed work, large patient samples, repeated findings and longer follow-up than to a single company-reported percentage.
The final ranking is an editorial aggregation rather than a fixed score. Strong evidence across several dimensions counted more than dominance in one metric. That is why Headway’s enormous provider network does not automatically put it first, and why Lyra’s research record keeps it near the top despite less visible recent growth.
Key sources include the Financial Times and Statista ranking of the Americas’ fastest-growing companies, the Financial Times profile of Grow Therapy, The Wall Street Journal on Spring Health’s acquisition of Alma, Spring Health’s announcement that the transaction closed, Grow Therapy’s 2026 access and affordability report, Headway’s official platform data, Rula’s 2026 Annual Clinical Report, Lyra Health’s twentieth peer-reviewed study announcement, and the two recent Two Chairs studies on measurement-based-care training and comparative anxiety and depression outcomes.
We also used official product, payer and care-model pages to verify network size, prices, appointment availability, coverage and clinical scope, including Grow Therapy’s payer materials, Headway’s patient FAQs, Brightside Health’s intensive outpatient program and Medicare expansion, and current company disclosures from Spring Health, Lyra, Rula and Two Chairs.
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