[klipt]

> closer to $100 or $150 if in a major city

If therapy is just talking, surely there must be options for cheaply video chatting a therapist in a state with lower cost of living?

[calewis]

In my experience, you need to be there face to face. I can't explain it, but it's all the nuances and the uncomfortable silences. I was seeing my therapist for a while via Skype, even though he lives a few miles up the road. I now make the effort and see him face to face. It's so much better. But, like anything, what works for you.

[zwkrt]

There's something about physical communication that can't be replicated. You see the posture, the gears turning, immmediate reactions. You can't formulate what to say, you say whatever is at the forefront of your thought.

[nickbarnwell]

Teletherapy outcomes have yet to be thoroughly researched, but anecdotally most clinicians report a strong preference for face-to-face sessions. Part of the discomfort stems from legal concerns – how do you handle a patient who reports intense suicidal ideation with a plan being one of the big ones – but also the limitations of teleconferencing. Neither the typical therapist nor their patient is like to have access to a fancy $$$ teleconferencing setup; both are likely stuck using whatever $0.50 on the BOM selfie camera Apple chose for their latest iDevice. Seeing only the face, and a 720p at that, denies the clinician a lot of valuable information about the client's internal state, their physiological responses, and their body language. Not to mention connection issues. Imagine being someone who's kept a secret about their sexuality or childhood abuse and finally developed enough trust and worked up the courage to discuss it to your therapist only to be met with a "Connection lost…" or frozen image of their face.

Additionally, licensure for mental health professionals is handled on a state-by-state basis, making CoL arbitrage difficult.

[fragmede]

There are some companies trying to do teletherapy (eg BetterHelp), but video conferencing is a poor substitute for meeting in person, especially when a therapy session may often have the client crying, or panicking, or emotionally reacting very strongly. "Just talking" trivializes the contents of the conversation as well as the psychologist's role in the healing process.

[pova]

Also body language and eye contact (or lack of it) is a very important part of the session which cannot be recreated online.