The Middle Path

What The Middle Path does

The Middle Path, Inc. is a privately held, 100% woman-owned behavioral health operator founded in 2016 in Knoxville, Tennessee by Hope Cooke, MSW, LCSW, LISW-CP, CDBT. The company provides Dialectical Behavior Therapy (DBT)-based Intensive Outpatient Programs (IOP) and Individual Counseling (branded as The Bale Group) for adults, adolescents (ages 11-18), first responders, and individuals with substance use disorders, with a differentiated care model that integrates evidence-based DBT skills (mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness) with holistic adjuncts such as equine therapy, art therapy, horticulture therapy, yoga, and sound therapy. Clinical outcomes are measured using the DASS 21 instrument at intake and discharge to track reductions in depression, anxiety, and stress.

Service delivery is hybrid: four physical facilities in Knoxville, Chattanooga, and Kingsport, Tennessee, plus Charleston, South Carolina (operated at Barrier Islands Psychiatry, with an affiliated sober living home called Turtleback Home), combined with a Virtual IOP offering 8-week live DBT therapy groups. The company maintains multiple registered sub-brands (The Middle Path, The Middle Path Recovery, The Bale Group) and trademarks, and is CARF-accredited for its Charleston substance use program.

The business model is predominantly fee-for-service, in-network billing with five major commercial payers (Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, UMR), supplemented by a $35-per-session cash-pay option and self-pay DBT skills classes. Revenue is operationally diversified across recurring IOP enrollment cycles, individual counseling, virtual delivery, and substance use programming, with go-to-market driven by self-referral (free intake assessment), healthcare provider referrals, community conference presence, and earned media.

Name

The Middle Path

Legal name

The Middle Path, Inc.

Website

https://themiddlepath.life

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

11–50 employees

Short description

The Middle Path is a 100% woman-owned, multi-site behavioral health operator delivering DBT-based Intensive Outpatient Programs, individual counseling, and substance use treatment across Tennessee and South Carolina, serving adults, adolescents, and first responders via in-person and virtual channels.

Ownership category

akta.pro rank

Product category

Outpatient Behavioral Health / Mental Health Therapy

NAICS

Outpatient Mental Health and Substance Abuse Centers (621420), Residential Mental Health and Substance Abuse Facilities (62322)

SIC

Services-Offices & Clinics Of Doctors Of Medicine (8011), Services-Health Services (8000)

akta.pro primary industry

Peer Support, Recovery Coaching & Sober Living Services (HLAFACAN)

akta.pro secondary industries

Residential Mental Health Treatment Centers (HLAFACAC), Meditation Retreats, Workshops & Immersive Programs (HSADAJAF)

Keywords

• Dialectical behavior therapy
• Intensive outpatient program
• Mental health counseling
• Substance use treatment
• Holistic therapy services

Headquarters

HQ city

Knoxville

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Infrastructure, Marketing or Sales, Technology or R&D, Others

Revenue model

1. Insurance-Based IOP Services: In-network billing with major insurance providers including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, and UMR for Intensive Outpatient Program services
2. Insurance-Based Individual Counseling: Individual counseling (Bale Counseling Clinic) billed through insurance for mild mental health challenges or maintenance care
3. Cash Pay Services: Self-pay option at $35 per session for those without insurance coverage
4. Self-Pay Skills Classes: DBT-informed skills classes and support groups for personal development and wellness, not requiring insurance or diagnosis

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels7 records

Core offering

The Middle Path is a DBT-based outpatient behavioral health practice delivering Intensive Outpatient Programs (IOP) and individual counseling across four facilities in Tennessee and South Carolina, plus a virtual IOP. Services span adult and adolescent mental health, substance use disorder treatment, and integrated holistic therapies (equine, art, music, horticulture, yoga, sound, mindfulness), with sober living available at Turtleback Home. The company serves individuals experiencing emotional dysregulation, mood/anxiety disorders, trauma, relationship challenges, and first responders.

Product overview

The Middle Path is a holistic mental health therapy practice offering a unified service portfolio centered on Dialectical Behavior Therapy (DBT) and Intensive Outpatient Programs (IOP). The core offering consists of DBT-based IOP services for mental health and substance use disorders, supplemented by Individual Counseling through The Bale Group sub-brand. Programs are delivered across four facilities (Knoxville, Chattanooga, and Kingsport, TN; Charleston, SC) in-person and virtually. The company provides a full continuum of care including adolescent/teen IOP, adult IOP, virtual IOP, and specialized substance use recovery programming through The Middle Path Recovery brand. Holistic therapy services (yoga, art therapy, horticulture therapy, equine therapy, sound therapy, mindfulness) are integrated into treatment programs as supporting modalities. The organization operates Turtleback Home, a sober living facility in Charleston, SC.

Differentiator

Problem solved

Functional benefit

Brands

• The Bale Group: Outpatient therapy program offering individual therapy, family therapy, group therapy, support groups, aftercare groups and DBT skills classes. Named after a group of turtles (bale) symbolizing resilience and mutual support.

Products and services

• Adult Intensive Outpatient Program (IOP) A structured DBT-based intensive outpatient program for adults with moderate to severe mental health symptoms, requiring 9-30 hours per week of group therapy integrating mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness skills. Available in-person at Tennessee locations and virtually.
• Adolescent/Teen Intensive Outpatient Program (IOP) DBT-based IOP designed for adolescents and teens ages 11-18, integrating holistic therapies (equine, art, music, horticulture, yoga, mindfulness) to help young people manage emotional regulation. Offered in-person at all Tennessee facilities and as after-school virtual teen groups.
• Individual Counseling (The Bale Group / Bale Counseling Clinic) Lower-intensity individual, family, and group therapy plus support and aftercare groups offered 1-3 hours weekly, designed for mild mental health challenges or maintenance after higher-level care. Insurance-based or $35 cash pay. Also offers DBT skills classes and support groups.
• The Middle Path Recovery (Substance Use Disorder IOP) A specialized DBT-based intensive outpatient program for substance use disorder, operating at the Charleston, SC facility inside Barrier Islands Psychiatry. CARF accredited for addiction treatment.
• Turtleback Home (Sober Living) A sober living home in Charleston, SC that provides transitional housing as part of the recovery continuum for individuals completing the substance use IOP at The Middle Path Recovery.
• Holistic Therapy Services Holistic wellness services integrated into IOP programs, including yoga, art therapy, meditation training, horticulture therapy, equine therapy, sound therapy, and mindfulness activities that support the healing process alongside DBT.
• Virtual Intensive Outpatient Program (Virtual IOP) An 8-week DBT therapy group delivered online with live, fully interactive instruction, providing remote access to the same IOP curriculum offered in person.
• DBT Skills Classes and Support Groups (Self-Pay) DBT-informed practical-skills classes and support groups covering emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness for personal growth and wellness, available without insurance or formal diagnosis.

Quantifiable outcome

• DASS 21 scores show significant reduction in depression, anxiety, and stress levels over 8-week program
• +3 more outcomes

Named customers7 records

Segments1 record

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Ten partnerships are on record, tiered core and minor.

• Mental Health Association of East Tennessee (MHAET)coreStrategic or Co-development Partner · 1 November 2025The Middle Path displayed at the MHAET Conference November 2025. Hope Cooke serves as Board Member of East Tennessee Mental Health Association.
• Barrier Islands PsychiatrycoreStrategic or Co-development PartnerThe Middle Path operates at Barrier Islands Psychiatry location in Charleston, SC, offering DBT-based addiction treatment. Hope Reneau serves as Clinical Director of this location.
• GI for KidscoreStrategic or Co-development PartnerPartnership to bring better health to children. Featured on WATE-TV discussing collaborative health initiatives for pediatric patients.
• Low Country Peer Support ProgramcoreStrategic or Co-development PartnerCollaboration to bring IOP services to first responders including police and firefighters. Working with Center for Firefighter Behavioral Health and Lowcountry Firefighter Support Team.
• University of Tennessee College of Social WorkcoreStrategic or Co-development PartnerHope Reneau serves on the Advisory Council. Former Field Liaison and Field Supervisor for social work students. Hosts interns from the program.
• Blount Chamber of CommerceminorGTM or Marketing PartnerChamber membership for business networking and community engagement in Blount County area.
• University of Tennessee (Evolve Conference)minorOthersThe Middle Path exhibited at the Evolve Conference at UTK, connecting with students and professionals.
• Lakeview HealthminorGTM or Marketing PartnerWellness on the Water conference interview and collaboration for mental health awareness content.
• Futures Recovery HealthcareminorGTM or Marketing PartnerWellness on the Water conference interview and collaboration for addiction recovery awareness.
• Coastal Oaks RecoveryminorGTM or Marketing PartnerWellness on the Water conference interview and collaboration for mental health/recovery content.

Scale indicators6 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Rogers Behavioral Health: Multi-location behavioral health system operating DBT and specialty IOP/PHP programs for anxiety, depression, and OCD; directly comparable to The Middle Path's DBT-IOP model across multiple US geographies.
• Charlie Health: Virtual-first intensive outpatient program for teens, young adults, and adults with mental health and substance use needs; the closest virtual-IOP direct competitor to The Middle Path's 8-week virtual DBT offering.
• The DBT Center of San Diego: Outpatient clinic specializing exclusively in Dialectical Behavior Therapy for adolescents and adults; closest direct DBT-focused peer in terms of modality specialization.
• Newport Healthcare: Provides residential and IOP mental health treatment for adolescents and young adults; comparable adolescent IOP programming and multi-state footprint.
• Oxford House: Largest sober living network in the US, peer-run recovery residences; directly comparable to The Middle Path's Turtleback Home sober living component in Charleston.
• Brightside Health: Telehealth platform delivering therapy and psychiatry for anxiety and depression; comparable virtual delivery model and overlapping payor mix, competing for self-pay and insured IOP-eligible patients.
• Lakeview Health: Multi-site addiction and mental health treatment provider offering IOP and residential services; comparable to The Middle Path's 'Mind Response' first-responder and Charleston substance use programs.
• Cerebral: Online mental health platform providing therapy and medication management; overlapping virtual IOP/therapy space with potential to encroach on The Middle Path's virtual DBT offering.

Broad incumbents

• Ellie Mental Health: National mental health franchise operating outpatient clinics across the US with broad therapy services; comparable multi-site outpatient model but broader service mix and franchised delivery.
• McLean Hospital: Harvard-affiliated psychiatric hospital with DBT programs and McLean Anxiety Mastery Program; comparable DBT clinical depth (founder Hope Cooke trained there) but operates at inpatient/academic scale.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/themiddlepathknox
• Instagraminstagram.com/themiddlepathdbt?utm_medium=copy_link
• Xx.com/themiddlepathtn
• LinkedInlinkedin.com/company/themiddlepath

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles11 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about The Middle Path