This study explores the use of videoconferencing technology as a means of providing mental health consultations across distances. Analyses of 43 psychiatric interviews with 14 different patients using an interactive videoconferencing system over an 18-month period reveal that the telecommunications link compared favorably to face-to-face encounters in assessments by physicians and patients. However, telepsychiatry may hinder many of the ancillary practitioner-patient relationships that contribute to a psychiatric consultation and create a false sense of presence. The study stresses the importance of examining the new context created by implementation of any new communication technology, and of understanding the need for attention to secondary and peripheral contexts that could potentially be ignored because of telepresence.