Two Chairs and the Problem of the First Chair

A therapist’s office has a curious piece of furniture: the empty chair. Before a patient sits down, nobody quite knows whether the person across from it will be the right person to talk to. Credentials can be checked. Availability can be searched. Chemistry is harder. When Alex Katz opened the first Two Chairs clinic in downtown San Francisco in 2017, he made that awkward uncertainty the starting point for a business.

Six rooms, then a different room

The original conviction was architectural as much as clinical. Katz thought in-person therapy offered the best chance of good behavioral health care. By the time Two Chairs announced its $21 million Series B in 2019, it had opened five more Bay Area clinics and helped more than 2,000 clients. There was a recognizable startup plan here: build an excellent local experience, then copy it.

COVID-19 interrupted the copying. Therapy moved to video, and so did the company’s center of gravity. A later published study of its care found that about 99% of sessions in the examined cohort took place by teletherapy. The most important change was not that a couch had become a screen. It was the realization that the room had been carrying less of the treatment model than Two Chairs first believed. Matching, clinician support and feedback could move with the patient.

Two Chairs now sells an integrated outpatient service: individual psychotherapy, psychiatric care in available states, and care coordination that helps patients navigate both. People can seek help for anxiety, depression, trauma, adjustment and many other conditions. The company advertises more than 100 clinical specialties and more than 30 treatment methods. Its customers are the patients who book appointments, the health plans that pay for covered care, and the referring providers who need a dependable place to send someone.

The first appointment is a sorting problem

Many therapy services begin with a directory: search a specialty, scan a photograph, choose an opening. Two Chairs puts a licensed clinician in front of the choice. In a roughly 45-minute video matching appointment, that clinician asks about symptoms, preferences, practical needs and schedule. A proprietary matching system helps identify a therapist. That creates a human moment before the therapeutic relationship begins, though it also adds a step and a cost.

The company argues that this step earns its keep. It reports that 97% of clients describe a strong relationship with their therapist. In its published patient cohort, 89.9% of initially eligible patients reached a fourth session. A poor match can end therapy before therapy has much chance to work, so retention is more than a customer metric. It is a clinical opportunity.

There is a second match to make: therapist to employer. Two Chairs puts clinicians on payroll as W-2 employees and offers benefits, supervision, consultations and continuing education. The distinction matters because it gives the organization more room to train people in the same clinical practices, and it gives therapists a support structure beyond their own appointment calendars. It also brings fixed costs. A marketplace can add a contractor more lightly than a clinical employer can hire and manage a colleague.

The questionnaire has a job to do

Before sessions, patients complete brief measures of depression, anxiety, quality of life and the strength of the therapist relationship. Therapists can see the results in a dashboard alongside diagnoses, plans and earlier scores. If symptoms worsen, or if the relationship feels weak, the numbers are intended to prompt a conversation and a change in care. That is measurement-based care in ordinary language: ask whether treatment is helping, then act on the answer.

Two Chairs has invested in the unglamorous part of that idea: getting people to use it. Its 2025 observational study examined 2,984 adults in a primary cohort who began care in the first half of 2024. More than 95% of measurement surveys were completed. By the twelfth session, 71.3% had achieved the study’s definition of clinically meaningful improvement; among those who completed a course of care, the figure was 79.2%.

These are useful results, with limits. The study looked backward at care delivered by Two Chairs, and it cannot isolate which part of the model produced improvement. It also used published studies for comparison rather than randomly assigning patients to competing services. The company’s claim of outcomes up to 2.5 times better than standard practice is a comparison of reported results, not a clinical trial verdict. The more solid lesson is operational: a large practice got patients and clinicians to complete the measures routinely, and it published enough detail to let others inspect the work.

“People often have to piece together their mental health care journey on their own.”Alex Katz, announcing psychiatry in 2025

A health plan is another chair at the table

The economics explain why payer relationships matter. Two Chairs lists self-pay rates of $260 for the first therapy appointment and $226 for each ongoing session. It says most in-network clients pay $30 or less after meeting their deductible, though the amount depends on the plan. Aetna, Kaiser Permanente, Florida Blue and other insurers are among its network relationships. A 2025 partnership with Curative offers eligible members therapy at $0 under that plan’s terms. As of 2026, the company says its insurance partnerships reach more than 30 million covered lives. That is potential access, not 30 million patients.

The company’s 2024 $72 million Series C equity-and-debt financing brought its announced total capital raised to $103 million. It expanded therapy into 19 additional states in March 2025, reaching 22 states, and added psychiatry in April. Psychiatry is a consequential addition: patients who need both talk therapy and medication often have to manage two calendars, two records and two sets of referrals. Two Chairs wants those services in one coordinated system. It does not make the problem of clinician supply disappear, but it gives patients fewer handoffs to manage.

For someone deciding whether to use the service, the practical sequence is simple: check insurance and state availability, book the matching appointment, discuss preferences frankly, then watch whether the fit and symptoms improve over the next few sessions. For a health plan or another provider, the example is less about copying an algorithm than copying the discipline around it: make a considered match, support the clinician, measure what happens, and be willing to change course.

What travels

The name Two Chairs suggests a private encounter, and that remains the thing being sold. The company’s technology, capital and insurer contracts organize the encounter at scale. Its most interesting idea is that therapy’s quality can be managed without pretending therapy itself is mechanical. The first chair belongs to the patient. The second belongs to a clinician who can listen, check the evidence and stay long enough to learn what it means.