Online therapy platforms have expanded access to mental health care dramatically over the past decade. Services like American based BetterHelp made therapy easier to access for millions of people worldwide.
But as the mental health tech landscape evolves, many people are asking a deeper question:
Is there a more ethical, therapist-led alternative to large corporate therapy platforms?
One platform increasingly discussed as a BetterHelp alternative is It’s Complicated, a therapist-run network connecting clients with independent practitioners around the world.
This article compares BetterHelp and It’s Complicated so you can decide which therapy platform best fits your needs.
Quick Comparison: It’s Complicated vs BetterHelp
| Feature | It’s Complicated | BetterHelp |
| Platform model | Therapist-run platform partly owned by the community of therapists | Corporate subscription platform |
| Pricing structure | Pay per session to therapist | Weekly subscription model |
| Therapist independence | Full private practice autonomy | Platform-controlled ownership model |
| Therapist selection | Clients choose therapist | Platform matches therapist with client |
| Geographic focus | European, available internationally | US Based, available also internationally |
| Therapy formats | Online and in-person therapy | Online therapy only |
What Is BetterHelp?
BetterHelp is one of the largest online therapy platforms in the world. Founded in 2013, it offers access to thousands of therapists through a digital platform.
Users complete a questionnaire and are matched with a therapist. Therapy is typically delivered through:
- video sessions
- phone calls
- live chat
- asynchronous messaging
BetterHelp operates through a subscription model, where clients pay a weekly fee for access to therapy services.
The platform helped normalize online therapy, but it has also sparked debates about:
- subscription therapy models
- therapist compensation structures
- the role of venture-backed companies in mental health care
- Data privacy breaches and leaks leading to lawsuits
These debates have led many clients to explore alternative therapy platforms.
What Is It’s Complicated?
It’s Complicated is a European based therapist-run platform that connects clients with independent mental health professionals across the world.
It was founded by practising therapists (a psychoanalyst and a clinical psychologist) who wanted to build something that preserved what they considered the most important element of therapy: the relationship between client and therapist.
Rather than algorithmic matching, the platform lets clients browse and choose their own therapist based on language, specialism, therapeutic approach, and location.
Key facts:
- Over 2,500 therapists
- Sessions in more than 60 languages
- Online and in-person options
- Therapists run independent private practices through the platform and keep independence
- Secure video, scheduling, notes, and encrypted messaging included
The platform was founded by practicing therapists who wanted to create a system that preserves what many consider the most important factor in therapy: the therapeutic relationship.
Who uses It’s Complicated? The platform is widely used by expats, digital nomad and remote-working professionals, and people seeking therapy in a language other than the one spoken where they live. Because therapists on the platform practise in more than 60 languages and offer both online and in-person sessions, it has become one of the more common ways for people living in Europe to find a therapist who speaks their language and understands their context. Common use cases include finding an English-speaking therapist in Berlin, accessing online therapy as an expat in Germany, or connecting with a therapist who shares a cultural or linguistic background with the client.
Key Differences Between BetterHelp and It’s Complicated
1. Subscription vs pay-per-session
BetterHelp bundles therapy into a weekly subscription. Clients pay a recurring fee for access to sessions and messaging.
On It’s Complicated, clients pay per session directly to their therapist. There’s no subscription and no recurring charge outside of booked appointments. Therapists set their own fees.
For people who want flexibility or who aren’t sure how frequently they’ll need sessions, the pay-per-session model is often a better fit.
2. Therapist matching vs therapist choice
BetterHelp assigns therapists through an intake questionnaire and algorithm. Users can request a change, but the default process is platform-managed.
On It’s Complicated, clients can do both. Those who prefer to search independently can browse the full directory, filtering by language, location, specialism, and therapeutic approach. Those who want guidance can use the platform’s free matching service, where a therapy consultant recommends therapists based on the client’s needs, preferences, and circumstances, including factors like cultural background, identity, and language. There is no obligation to go with a suggested therapist, and clients can return to the consultants as many times as they need.
This matters clinically. There’s substantial evidence in psychotherapy research that the quality of the therapeutic relationship is among the strongest predictors of treatment outcomes. Giving clients control over who they work with is, in part, a clinical decision.
3. Therapist independence
BetterHelp therapists work within the constraints of the platform’s model, including how sessions are structured and how they’re compensated.
It’s Complicated is designed around independent practice. Therapists set their own fees, manage their own schedules, and decide their own working format. The platform provides infrastructure and client access, not control.
This is one of the reasons It’s Complicated tends to attract practitioners who want to maintain professional autonomy rather than work within a corporate-managed structure.
4. Community and professional network
BetterHelp functions primarily as a marketplace.
It’s Complicated also operates as a professional community, where therapists can collaborate with colleagues, make referrals, and participate in clinical events and discussions. The annual It’s Complicated International Psychotherapist Conference is one example of this.
Who Is Each Platform Better Suited To?
BetterHelp may suit you if:
- You want to start therapy quickly with minimal setup
- You prefer a subscription model with messaging included
- You’re comfortable with a platform-assigned therapist
It’s Complicated may suit you if:
- You want to choose your own therapist
- You prefer pay-per-session pricing
- You’re looking for therapy in a language other than English, or in Europe specifically
- You value clinical independence and a platform that’s run by therapists, not investors
Frequently Asked Questions
Is It’s Complicated cheaper than BetterHelp?
It depends on the therapist, since each practitioner sets their own fees. Some clients find the pay-per-session model more cost-effective overall, particularly if they’re not attending sessions every week.
Is It’s Complicated available outside Europe?
Yes. The platform hosts therapists from many countries and offers sessions in more than 60 languages, including for clients living outside Europe.
Can It’s Complicated match me with a therapist who understands my cultural background?
The matching service takes cultural background, identity, and language into account. Clients can specify preferences related to ethnicity, gender identity, sexuality, religion, or immigration experience. The aim is to connect people with therapists who can hold their context without it needing to be explained from scratch.
How does It’s Complicated compare to other therapy platforms in Europe?
Most large online therapy platforms (BetterHelp, Talkspace) are US-based and operate through a subscription model. It’s Complicated is European, therapist-run, and uses a pay-per-session model where therapists set their own fees. It is one of the few platforms offering both online and in-person therapy across multiple European countries in more than 60 languages.
A Note on Platform Models
The growth of online therapy has raised real questions about what gets prioritised when mental health care is delivered through a subscription service. Scale, automation, and low friction are useful, but they’re not the same as clinical quality or therapeutic fit.
Both platforms aim to improve access to therapy. They do so with different priorities, and those priorities shape the experience.
