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Comment by yboris | Hacker News Reader

Thank you for sharing. Sincerely curious what you mean by "A bit of money". I'm lucky that I didn't have to have therapy. My guess is unless your insurance/job covers mental health, it's at least $50/hour (closer to $100 or $150 if in a major city). Surely not much for the possible benefits (and on a developer salary), but I'm wondering how expensive such services are.

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AFOAF went through a tough time basically between the end of high school and a year out of college. Family stuff that was so hard to emotionally grasp and make sense of it absolutely paralyzed her. She went through many different forms of therapy; from affordable counselors, to a professor at her college (don't try that, they usually just want you to pay to be in a study), to a relatively average psychologist (~150/hr) who made her feel better able to cope with her mental state but did not provide her any tools to go beyond it.

Finally, when we moved to a larger area she found a first-rate CBT practitioner and the results were nothing short of outstanding. In less than 4 months she went from being completely dependant - afraid to drive a car, visit stores, or pretty much leave the house alone - to regaining her independence and returning to the person she was before everything happened. The downside was she had to wait 3 months for an opening and I believe sessions were in the neighborhood of 300$ and needed to be 2x a week at first if I remember correctly. Regardless it is the absolute best money she had ever spent, and was so much cheaper than the years of seeing a different psychologist who didn't help her move forward.

I guess the moral is if you are in a situation where you are incredibly anxious or depressed to the point where you feel it is irrationally preventing you from making progress or following through on things you want to do, CBT (from the right place) can change things you may have never thought possible.

AFOAF = A friend of a friend?

That's a rather obscure acronym.

"FOAF" is well-known, http://www.foaf-project.org/

Is that not code, for me?

I believe you're thinking of SWIM, or "Someone who isn't me," which is apparently used to avoid self-incrimination

Its literally just to protect privacy of someone close, nothing more. Shouldn't be interesting anyways but you never know how far doxxers will go.

European perspective incoming:

Every resident of Switzerland has to have obligatory health insurance. Therapy is part of the basic package that every insurance provider has to cover (for up to N sessions per year). The patient has to pay a cover of 10% of the cost on top.

This shifts the cost of therapy from $150/hr to $15/hr + basic health insurance premiums (<$500/mo). Note that this is general health insurance, so this will also cover physical health etc. (apart from dentistry for some reason).

I notice this trend of not covering dentistry through many countries. I think the issue is that a lot of dentistry work tends to be aesthetic and because of that it's hard to draw the lines on what should be covered.

> a lot of dentistry work tends to be aesthetic

Is this true? This is so far from my experience I'm actually curious what the numbers are. If you have a study on this, I'd love to read it.

Just a guess from my personal experience. Might probably be wrong.

Recently went canvassing myself. In NYC it ranges from 50-350/hr depending on who you're talking with and their exact licensing. Licensed psychologists will be more expensive than licensed mental health workers or counselors. Psychiatrists are the most expensive. However, depending on your level of therapy needed, online can be much cheaper.

From a US perspective, many therapists have a sliding scale based on income. "A bit of money" is the best description for it, as it won't be free but should never break the bank either.

In my experience, therapy made me more productive by enough to pay for itself. Also in my experience, your estimates are accurate.

In the UK you can get therapy on the NHS, but it's mostly CBT and not for any extended period. Psychotherapy, which is what is what most people need with long term mental health issues (like myself) is mostly private. You can pay anything from £50-150 p.h In the US, I'm not sure.

The NHS also offers a range of other talking therapies /counselling, e.g. counselling for depression. The waiting times here can be shorter than for CBT.

If you're in dire need for help (depends on your scores and initial phone interview), you will be seen or referred quickly (within less than a month).

Any GP will refer you. If you need help with your mental health, just ask your GP for a referral, fill out the form and you will get help. It's a great system. (Did I mention that this doesn't cost anything?)

For long-term psychotherapy, you need to go private, but in many cases, a short-term intervention (e.g. over 12 weeks) is sufficient to get you through the worst and on the right track.

I think most people who suffer from actual depression, not a just a bout of sadness need long term treatment. The NHS is poorly provisioned in this way, sadly. Just like a diabetic who needs insulin everyday people with serious psychological conditions need regular treatment. I'm lucky enough to be able to afford it, I don't know how I would cope if I couldn't.

There are different variations of depressions. In particular, it differs between acute and chronic occurrence.

As far as I know, acute occurrences tend to be more intense (as experienced and reported in standardised tests) on average than chronic ones. Here, the risk of, e.g. suicide is also highest. However, long-term depression has a much more long-lasting impact on one's life, so I don't want to downplay it in any way.

Acute episodes tend to have a duration of only a few weeks or months so short-term therapy can be of great help here.

I agree that chronic depression requires long-term support. Your analogy with insulin and diabetes is excellent. And yes, the NHS falls short in this area, unfortunately. It would be great if more people could get the care they need and I hope it will become possible.

So yes, the NHS is not without its flaws. But considering the little funding it receives, it provides excellent care. It just shouldn't be so underfunded. I also think that it is also remarkably well-organised compared to other countries, e.g. Germany, where everything is much more bureaucratic and expensive. I also think it's significantly that countries with more privatised health care like the US.

> 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?

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.

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.

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.

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.

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

Data point, $250/visit, SF Bay. I had great insurance, so it was between 60-90% covered, though out-of-network so I spent plenty of hours on the phone with insurers trying to get them to do their jobs.

IIRC, part of the health care reforms in the states requires them to cover mental health much like physical health, doesn't it?

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