Israeli-born entrepreneur Alon Matas chuckles when discussing the fact that his online counseling site, BetterHelp, gets a disproportionate number of customers from the United Arab Emirates, Lebanon and Jordan.

It has nothing to do with his origins, said Matas, nor the origins of the employees at the company’s Sunnyvale headquarters (only four of 40 have Israeli roots).

Rather, he said, it’s due to the fact that mental health therapy is not readily available — or culturally acceptable — in those countries.

Though the bulk of the company’s clients are Americans (followed by Britons, Canadians and Australians), those three Middle Eastern countries have a much higher per capita rate of participation in BetterHelp.

“If you live in Lebanon, Jordan [or] the UAE, it is impractical for you to go to a therapist. It’s a stigma, it is almost inaccessible,” Matas said. “I want to help people wherever they are, no matter their ethnicity or background.”

After moving to the Bay Area nine years ago, and after founding three startups in Israel, Matas launched BetterHelp in 2013 after struggling with his own mental health issues. He said he was turned off by the cost, inconvenience and rigidity of visiting a traditional therapist, so he used his engineering and product development skills to create the website.

“I never pretended to be a therapist,” he said. “To get consumers what they expect, you need more than just knowing about therapy. You need to know how they want the service to be delivered. My personal needs were not met by the system.”

According to its website, BetterHelp is now the world’s largest online therapy site, with nearly 500,000 clients since its inception and more than 3,600 licensed counselors, all of whom are independent contractors.

Clients pay $200 a month for unlimited service — which means they can communicate with their therapist at any time through an internal messaging system, or set up video or phone appointments. As with traditional therapy, insurance doesn’t cover the costs for most people.

A questionnaire helps clients get matched with a therapist, and clients also can specify, for example, if they want someone who specializes in LGBT issues or is a person of faith. The counselor selected must be from the same U.S. state as the customer, due to regulations.

Some use the service for a week or two to deal with a temporary problem, while others have been customers since 2013.

“Our target market is really people who have never been in therapy and won’t go to traditional therapy, or people who were in therapy and won’t go back again because of the inconvenience or cost,” Matas said. “People who don’t want to be seen going to a therapist.”

The service also has made therapy available for the first time to people in remote areas. Alaska, for example, has a lot of people who use BetterHelp. Another client pool is Americans (and their spouses) who work overseas for U.S. companies; they often struggle with adjusting and find there are no mental health professionals available in the foreign country.

The therapy is traditional, similar to what a client would get in a psychologist’s office. A 2017 study by the Berkeley Well-Being Institute found online counseling was a “viable alternative” to face-to-face therapy.

“The point is we’re not trying to be innovative,” Matas said. “We’re not trying to come up with new ways to do therapy or self help. We’re trying to do the tried-and-true practice of therapy and make it more accessible, more convenient [and] more affordable, but use established methods.”

The American Psychological Association doesn’t have specific guidelines or advice regarding online counseling, but said consumers should be aware that little outside research has been done on the industry.

Caroline Vaile Wright, the APA’s director of research and special projects, said safety and effectivity are concerns.

“How do you know if your information is private? It’s hard to ascertain training and licensing of people on the other end,” said the Ph.D. in counseling psychology. “If something were to go wrong, how would you know how to go about remedying that?”

Wright said that while virtual therapy could reduce barriers to therapy for some people, it’s hard to judge the value of online counseling without more research.

“It’s promising, but it’s largely untested as a way of receiving care,” she added. “The technology is evolving so much faster than the research can keep up.”

Matas said about 15 percent of those seeking help through BetterHelp are told they’d be better off with traditional, face-to-face therapy — for example, people with addiction issues. And he said anyone considering suicide or threatening violence is told to immediately contact a crisis hotline, call 911 or go to an emergency room.

Matas said BetterHelp, which has customers from 168 countries, including Israel, has benefitted from the growing acceptance and visibility of mental health issues. For example, NBA All-Star Kevin Love has openly acknowledged his struggles with depression, writing about his anxiety attacks on the Players’ Tribune, a forum for top athletes. He later became a paid spokesman for BetterHelp.

“When we started five years ago, mental health was considered a dirty topic and today there’s a lot more openness about it,” Matas said. “It’s becoming more legitimized and more something you don’t need to be ashamed of.”

BetterHelp, which recently added a site specifically for teens, was bought in 2015 by Teladoc, a public telemedicine company based in New York. But the virtual counseling service retained its name and Matas remains in charge, and he said he is in no rush to create another startup.

“We’re growing exponentially and we have barely scratched the surface,” he said, noting that there are many who need help but are still not getting it. “I’m committed to keep it growing. I really feel lucky that we’re able to do something that touches people’s lives so directly and does social good, and makes a good profit for shareholders.”