I don't know where you live, but around here therapists in private practice don't have receptionists. And even an online therapist will need a dedicated work space, lest you are okay with them conducting therapy from their living room with the kids running around.

Here's how I think about fair fees for web services. A profile on Psychology Today costs $30 per month. Credit card processing costs about 3%. Google Apps for Business is $5 per month (premium email, video chat, calendar, storage space). So, all combined, I could purchase the same services individually for $35 per month plus 3% credit card processing fees. That's already netting all of the companies involved a profit.

Now, I am willing to pay a premium for the convenience of having it all in the same place. 10% seems like a fair price. But no, they are charging 38%. That seems outragious!!!

What's the actual cost of an office anyway? I live in one of the more expensive parts of the Bay Area. Cash price for therapy with a licensed psychologist seems to average around $150 per session. I just checked Craigslist and found therapy office space in good locations for under $2,000 per month. At 30 sessions per week, this hypothetical therapist collects $18,000 in client fees per month. Only 10% of that goes towards office space.

Online therapists still have most of the overhead that does not stem from an "office with waiting area." They still need to pay for college, graduate school, 2,000 hours of supervised work to get licensed, license fees, and 20-odd hours of continuing education each year to stay licensed. They still pay self-employment taxes. They still need liability/malpractice insurance. And they still need to document their work with each client.