The Digital Door
A practitioner-led alternative to platform care
Therapy is being industrialised. This is a framework for building an independent practice that stays open, ethical and yours.
This is a written reconstruction of a talk, not a transcript. The session was not recorded. What follows is the argument as it was delivered at the conference on 3 July 2026, rewritten for reading rather than listening. The slides are available below.
Therapy was independent, and heavily regulated. That is changing.
For as long as the profession has existed, therapy has been delivered by named, individually accountable people. To practise, you register with a statutory body. You work within your competence. You keep records. You carry insurance. If you harm someone, there is a register you can be struck off, and a complaints route that ends with a regulator rather than a refund.
That is not bureaucracy. It is the thing that makes it safe to tell a stranger the worst thing that ever happened to you.
What is replacing it is corporate, enormous, and regulated far more loosely. The company matching you with a therapist is not itself on any professional register. It answers to shareholders, not to a regulator of health professionals. When something goes wrong, you are a customer with a support ticket rather than a patient with a complaint.
Elizabeth Cotton names the mechanism precisely in UberTherapy: The New Business of Mental Health (Bristol University Press): the gig-economy playbook applied to psychotherapy, where platforms lower costs by depressing wages and standardising treatment. Therapy as e-commerce. Practitioners as interchangeable units.
This is the inversion at the heart of it. The regulated part, the practitioner, is being made replaceable. The unregulated part, the platform, is being made essential.
If you are the one looking for a therapist
You do not need to care about any of this to get help. But there is one question worth asking wherever you go, including here:
Who exactly is accountable to me, and to whom are they accountable?
A good answer names a person, names the register they are on, and gives you a way to check it. Mine is on the about page, along with the approaches I am actually trained in. A weaker answer names a brand.
That is the whole practical difference between a door and a platform. Behind a door there is someone who has to answer for what happens in the room.
One image for the shape of it
Ask how many people have taken a black cab in London in the last five years, then ask how many know what those drivers had to do to earn the badge. It is called The Knowledge: years of study, an exam only about half of candidates pass, and the number even attempting it has fallen roughly eight-fold in a decade.
Then came Uber, and overnight the question stopped being “is this driver an expert?” and became “is one here in three minutes?” Our training takes years, comparable to The Knowledge. Platforms are now competing with it not on expertise but on speed, price and availability.
This is not a future risk
It is already here, at scale. BetterHelp alone reports around one billion dollars a year, thirty-five thousand therapists and five million people served (Teladoc/BetterHelp, 2024 to 2025).
Meanwhile the need is enormous and the public system is stretched thin. In England, around one in five people report a common mental health problem in any given week (Mental Health Foundation). NHS Talking Therapies met their six-week access target 88.6% of the time (NHS Digital, December 2025), but a national average hides everything: experience varies wildly by postcode, and the longest single wait uncovered by a Freedom of Information request was close to three years (Mad in the UK, 2026).
Rising need. A strained public system. And into that gap step the platforms, on their terms. We can do better than that.
We already have the values
The infrastructure just has not caught up. Independent practitioners answer to three aligned frameworks.
| BPS Code of Ethics | Division of Counselling Psychology | HCPC Standards (2024) |
|---|---|---|
| Respect: dignity and self-determination | Reflective scientist-practitioners | Promote and protect service users |
| Competence: within limits of training | Creative, compassionate, collaborative | Work within knowledge and skills |
| Responsibility: public protection | Practice-based evidence shapes policy | Manage risk, keep records |
| Integrity: trust in the profession | An agile workforce for diverse needs | Be honest and open when things go wrong |
Read across any row and it is the same value in three voices. These are not aspirations, they are professional infrastructure. Platforms optimise for throughput. Our frameworks ask us to protect the person in front of us.
Accessibility is not a marketing feature. It is an ethical stance.
What we already knew
Open access worked. Walk-in services proved it: timely, flexible contact at the point of need, relational depth with flexible arrangements, and no gatekeeper standing between a person's distress and a qualified professional.
We had this. We have been letting it slip away, buried under bureaucracy, branding and fear.
The argument
We do not need another platform. We need digital doors. A thousand of them.
| Platform model | Digital Door model |
|---|---|
| Central aggregation | Distributed practitioners |
| Algorithmic matching | Neighbourhood relationships |
| Data owned by the platform | Records owned by the clinician |
| Subscription and commission | Open-source infrastructure |
| Visibility bought through marketing | Outreach earned through competence |
| Fundamentally competitive | Fundamentally collaborative |
The platform asks you to compete for a slot in its system. The door asks you to build your own, and connect it to others.
What a door is made of
The front door
A humane web presence. Transparent information about scope and boundaries. Direct booking, no referral required. Accessibility standards built in from the start, so the door genuinely opens for everyone.
The clinical philosophy
A single-session and one-at-a-time mindset, followed by stepped care when a course of treatment is needed and wanted.
The back end
An open-source clinical record you control, secure video, outcome measures and billing. CityEHR, supported by the GOSEHR initiative, holds the full record on a recognised international standard.
You own the code, the domain and the data. In plain terms: your client's story stays between the two of you, not on a company's server. No algorithm decides your visibility.
And the technical barrier has collapsed. A skeleton template plus current AI tooling means a practitioner can stand up a practice in a day, not a year. The technology builds the room. The relationship is still entirely yours.
The worked example
Everything above is running on this practice. You can walk through it as a client would: the single-session approach, the services and how they are scoped, what it costs, and the booking page with no waiting list and no referral. Sixty seconds from landing to booked. That is what a door looks like.
Why single-session thinking makes open access viable
Each session is whole and valid in itself. More sessions are available if a course of treatment is needed and wanted, but we do not bank on it.
About people
The client is the expert. People are always changing. Treat the person, not the diagnosis.
About therapy
One session can be enough. Get the client moving. Rapid change is the rule, not the exception.
About change
Clients have strengths and resources, and change happens in many forms.
The posture is collaborative, strengths-focused, hope-instilling, concrete rather than categorical, and it always leaves the door open. That mindset is the prerequisite for offering a walk-in slot.
It is also teachable and measurable. Joseph and colleagues developed a validated Single-Session Therapy Mindset Scale with a clear cut-off, so readiness can be screened rather than assumed.
That community has its own gathering: the International Single Session Therapy Symposium, in Exeter in September 2027.
Measures that fit the work
Standardised measures alone miss single-session change. Goal-based measures alone miss the bigger picture. A door needs both, built into the record.
- This person's goals: a pre-consultation questionnaire, the SWAN-OM for pre-determined goals, and Goal-Based Outcomes.
- Standardised: GAD-7, PHQ-9, the Work and Social Adjustment Scale, CORE-10, CORE-YP and the SDQ.
- Plus follow-up, tailored to each practice.
Neighbourhood psychology
Practice embedded in a community, not delivered to it. The language comes from community psychology, from Orford and from Kagan and colleagues.
The principle: therapists build a caseload through their own competencies and genuine community presence. Not directory listings. Not SEO tricks. Not platform algorithms.
In practice that is three to five anchor relationships: a GP surgery, a school, the voluntary sector, a faith community, a cultural project, the local authority.
The signal to all of them is the walk-in slot: one open-access session a week, digital or physical. That slot is how the anchors know you are real and reachable.
One place, concretely
Brent, in north-west London. GP referrals for mental health there have nearly doubled since 2021. Around one in six Brent children has a probable mental health disorder. Eighty-five per cent of residents are from ethnic minorities and over 150 languages are spoken, making it the second most diverse borough in England (Brent Council and Brent Health Matters).
The need is not absent. It is carried quietly, because one door is not enough for this much diversity.
A practitioner embedded there, known to the GP surgery, the school and the faith community, becomes a door people already trust.
One door, then a network
One door gives you a stable local caseload.
Ten doors in a city give access no platform can replicate.
A hundred doors nationally is a structural alternative.
It grows in three stages: a use case (one practitioner, one door), a working group (shared repository, a CPD cohort, a peer network), and a decentralised network of independent practitioners on shared infrastructure.
Not a platform. Not a franchise. A professional stance, where your visibility is built on competence and community trust rather than search ranking or referral fees.
The invitation
Open a walk-in slot
Check whether your own practice could offer one open-access session a week. That is the whole beginning.
Ask about the training
The single-session training comes with the door. It is an online course, open to any qualified practitioner. Single Session Therapy Online.
Build your own door
The framework is deliberately transferable: it uses established professional values and widely available tools rather than anything proprietary. If you want to talk through how to set one up, write to me.
Platform care will not fix itself. But we can build around it, one door at a time.
Shall we collaborate?
If any of this is useful to you, or you want to build one, write to me. I answer personally.
santiago@doortotherapy.comWhere this comes from
This framework was presented as “The Digital Door: A Scalable Framework for Accessibility, Single Session Thinking, and Ethical Independent Practice Online” at the BPS Division of Counselling Psychology Conference 2026, Manchester, on 3 July 2026.
Dr Santiago de Ossorno Garcia is a practising counselling psychologist in independent practice between London and Madrid, and a lecturer in psychology at Universidad Alfonso X el Sabio, Madrid.
- Download the slides (PDF)
- The personal position behind it: the manifesto
- Related research and publications
References
- Cotton, E. UberTherapy: The New Business of Mental Health. Bristol University Press.
- Hoyt, M. F., Young, J., & Rycroft, P. (Eds.). Single Session Thinking and Practice in Global, Cultural and Familial Contexts: Expanding Applications. Routledge.
- Porter, S., Pitt, T., Eubank, M., Butt, J., & Thomas, O. (2024). An Expert Understanding of the Single-Session Mindset. Journal of Systemic Therapies, 43(4), 14 to 38.
- Joseph, J., Kushwaha, R., Rajan, S., & Cannistra, F. (2026). Measuring Support Providers Perspectives on Single-Session Therapy: Psychometric Evidence for the SSTMS. Measurement and Evaluation in Counseling and Development, 59(3), 233 to 254.
- de Ossorno Garcia, S., Salhi, L., et al. (2021). The Session Wants and Need Outcome Measure: the development of a brief outcome measure for single-session therapy. Frontiers in Psychology.
- Salhi, L., de Ossorno Garcia, S., et al. (2023). Examining concurrent validity and item selection of the Session Wants and Needs Outcome Measure. Frontiers in Psychiatry.
- Orford, J. (1992). Community Psychology: Theory and Practice. Wiley. See also Kagan, C., et al. (2011).
- BPS Code of Ethics and Conduct.
- HCPC Standards of Conduct, Performance and Ethics (2024).
- CityEHR and the GOSEHR initiative: open-source electronic health records for clinicians.
