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In April 2020 Ariela Safira was excited about the opening of her mental wellness startup, Real. It was supposed to be a clinic in Manhattan’s Flatiron District offering affordable, in-person group counseling to its young members. Thanks to the pandemic, the studio has yet to open. But the situation forced a pivot that now has Real offering an innovative service that Safira says makes proven therapy methods available to just about everyone.

Even before the pandemic, Real aimed to provide accessible, preventative mental health care to keep folks from having a meltdown in the first place. The traditional one-on-one therapy model just doesn’t work on a mass scale, Safira says, because it's expensive, impractical for many, and there aren’t enough therapists to go around. “The entire system needs to be rebuilt,” she says.

When the pandemic hit, Real started experimenting with different online therapy stategies—which led to some unexpected findings, Safira says. Many patients chose to attend group sessions anonymously, with their cameras off. And the most popular option turned out to be on-demand therapy, available 24/7, that eliminated human interaction altogether. For many, Safira found, the biggest barrier to care wasn’t cost—it was the vulnerability and discomfort of talking with a therapist.

“It completely opened our eyes to a better solution,” Safira says.

The result: an online service that, with the exception of the occasional therapist-led group discussion, is limited to self-service treatment. Similar to a gym membership, Real is providing customers with mental health equipment and instructions, but no personal trainer.

Anu Duggal, founder of the Female Founders Fund, which has invested in Real, is a fan. She met with many mental health startups before funding Real’s $6 milllion seed round in July 2020 and says most were just replicating the one-on-one therapy model online. “There was nothing new or different,” she says. “Real’s approach really stood out. ... I think the one-to-many model enables millions of people to be potential Real customers.”

New York-based Talkspace says it has it has served 2.9 million members since its 2012 launch with services ranging from one-on-one online therapy sessions to self-guided options. Last year’s earnings topped $113 million.

Real, which is still headquartered in the Flatiron District, has 53 employees. It is now an app-based service that offers resources for creating a mental health care routine, starting at $13.75 a month.

Its main offering is a menu of multi-segment, on-demand videos that the company refers to as “Pathways.” Each Pathway addresses a different issue. The two most popular: “Getting to Know Yourself” and “Communicating Like a Damn Good Partner.”

Participants are prompted to complete reflections and writing exercises both during and after watching segments in the Pathway. The process is entirely self-guided.

A self-guided Pathway on the Real app 

Members can also make use of “Real Pulse,” a mental-wellness check that includes questions culled from widely used diagnostic assessments to measure factors such as self-esteem and anxiety level. While the feature provides no actionable recommendations based on the results, it helps members assess their mental wellness every month to track their overall journey.

Monthly live-streaming events, meanwhile, have members attending therapist-led group video meetings to discuss topics such as “How Can I Get Grounded?”

The results, so far, are promising. An in-house study of 452 participants completed in December found members across the severely depressed population who completed a single Pathway saw an average 10-point reduction on their PHQ-9 score, a standard depression assessment. That decrease is nearly double what is considered a clinically significant drop. Similar results were found on a standard test for general anxiety disorder. “We are outperforming one-to-one therapy,” Safira says.

Dr. Jeffrey Cohen, an assistant professor of medical psychology in the Department of Psychiatry at Columbia University, says a large number of academic studies show that digital mental health care works. “Overall, we have enough data to suggest that virtual therapy performs just as well as in-person, and has the benefit of being more accessible to people,” he says.

Safira says Real’s biggest hurdle—aside from its pandemic pivot—was finding backers willing to prioritize user experience over fast growth. To her surprise, she found that venture capitalists focusing on consumer startups were more willing than traditional health care investors to exercise patience.

Real spent most of 2021 improving the clinical efficacy of its Pathways, which currently focus mainly on the needs of its original intended customer base. Its members are 60% women, most are between 24 and 48 years old, and roughly half have never seen a therapist.

This year, the company is making use of a $37 million Series B funding round announced in April to expand its Pathway offerings to service additional population segments. The ultimate target audience?

Everyone in the nation, Safira says.

The next step, of course, is growing the membership from thousands to millions. The strategy is twofold. First, Real will partner with employers and health insurance companies to make the service even more affordable. Second, it will market directly to potential customers by partnering with brands and events in the hopes of de-stigmatizing therapy—a Real membership will be seen as just like going to the gym.

“No,” Safira says, “we don’t want to be associated with a hospital. Sorry!”

How Real stacks up to industry giant Talkspace 

Anne Kadet is the creator of Café Anne, a weekly newsletter with a New York City focus. She previously was the city business and trends columnist for The Wall Street Journal. Have a story idea or a startup you would like to see featured in a future column? Write to [email protected] .

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