Can I Practice Therapy Or Telehealth Across State Lines? Exploring Options

Whether you are a certified mental health counselor or a person seeking remote counseling, you might wonder about the rules for finding or practicing therapy in different states. For practical purposes, location might seem irrelevant to the client and counselor when therapy sessions happen over audio or video rather than in person. However, there are strict laws surrounding whom certified mental health counselors can provide counseling.  

Exploring the laws related to practicing telehealth across state lines and how they were affected by the COVID-19 pandemic can be valuable. You may also learn more about obtaining remote therapy from any location. 

As a client, can I access telehealth across state lines?

While articles and lists that detail the specific jurisdictions and circumstances that allow mental health counselors to deliver healthcare services across state lines are available online, these resources may become dated quickly. Laws surrounding telehealth services changed multiple times during the COVID-19 pandemic and continue to evolve.

One way to identify if you can legally obtain online therapy from healthcare providers located in a different state from you is to identify and ask the specific provider you're interested in. Out-of-state providers and out-of-state physicians like psychologists, mental health counselors, and psychiatrists can make themselves aware of the federal and state laws related to their practice and where they can legally practice telehealth.

If you don't want to contact individual therapists to find out where they can practice, you may consider using an online therapy platform. This platform provides clients access to various providers that can legally practice therapy where the client lives.

As a therapist, can I practice therapy in multiple states?

Whether a therapist can practice therapy in multiple states or across state lines can depend on their license, the laws of the state they are licensed within, and the laws of any states they also want to practice in. Contact the department that licensed you to learn the specifics of telehealth laws in your state.

You may also consider consulting a lawyer before offering remote therapy to clients living outside of your state. The laws related to telehealth have changed at a rapid pace in recent years and continue to evolve. A lawyer who specializes in this type of licensing may have the most up-to-date information and advise you on where and how you can lawfully practice teletherapy.

Another option for therapists and counselors is to join a network of counselors who can offer therapy in various states. If you are a counselor, you can apply to be part of the National Counseling Compact, organized by the American Counseling Association (ACA). In the compact, you can get licensed to work in the 28 states approved to be part of the compact via federal legislation. You can apply online and learn more about your eligibility on the website. 

Which states can I practice therapy in?

There isn't a federal law in the US allowing therapists to practice teletherapy across state lines. Different states have different laws regarding telehealth, so certified mental health counselors are often limited to practicing therapy in the states allowed by their license.

Many states only allow therapists to practice therapy with clients who also live in the state where the therapist holds a license. Generally, these rules apply based on where the therapist and client live rather than where they are physically located. For example, in some cases, a therapist could provide telehealth to a client while either the therapist or the client were traveling out of state, as long as they legally reside there. The ability to provide services across state lines due to temporary travel is usually allowed through temporary practice laws.  

However, some states have exceptions to rules requiring therapists only to provide services to clients within their state. For example, some states allow clinicians licensed in other states to offer telehealth to residents in their state. Others allow clinicians licensed in other states to move to their state and register as providers rather than requiring them to obtain a new license. In this case, the therapist could provide services to clients in their previous and current states as long as their original permit remains active.

An agreement called PSYPACT allows psychologists in 39 states to practice telepsychology across all 39 states. PSYPACT only applies to psychologists and behavioral health professionals with doctoral degrees. Licensed mental health counselors often hold master's degrees rather than Ph.Ds or Psy.Ds, which means they would not be able to practice across state lines via PSYPACT but could join the Counseling Compat offered by the ACA. 

If you want to practice therapy in multiple states, consider speaking to a lawyer to ensure you follow all relevant laws. Telehealth laws can be complex and may quickly change. In addition, the above information is not legal advice. A lawyer can guide you more specifically toward solutions. 

How did the COVID-19 pandemic impact telehealth?

The US federal government significantly expanded the availability of telehealth practices, including teletherapy, at the start of the COVID-19 pandemic. Laws passed in 2020 made it easier for clinicians to provide telehealth services by allowing any clinician to bill for telehealth services instead of requiring a special telehealth license. The laws began allowing clinicians to give telehealth sessions from anywhere, including their homes.

When the US government declared the COVID-19 public health emergency (PHE), some states changed their laws to allow an out-of-state provider to provide telehealth across state lines through cross-state licensing. The public health emergency expired in May 2023. Some states have kept these expanded laws in place even though the public health emergency is considered over, while others have allowed them to expire. State licensure laws and what a state license enables healthcare providers to do can vary from state to state.

Organizations like the American Psychological Association (APA) are working to advocate for increased telehealth options across the country. They also urge practitioners to advocate for increased telehealth availability.

Support options

As a client, online therapy may provide several benefits. Attending therapy sessions from home can be convenient, saving time and money, as it doesn't require travel. A research study found that many clients who switched from in-person to online therapy during the COVID-19 pandemic found online therapy "effective and satisfying."

Research also showed that during times of isolation, online therapy reduced clients' loneliness. Although people may no longer be isolated due to COVID-19, researchers suggest that online treatment could also reduce the loneliness that often stems from isolation experienced with depression.

If you want to learn more about trying online therapy, platforms like BetterHelp are available. Online therapy can connect clients with providers licensed to practice in their area. In this way, you can obtain remote therapy without having to research or worry whether the right provider for you is licensed in your state.