One positive from the pandemic is that it has allowed for more access to mental health services. When it comes to remote and online therapy, the use has increased drastically since March 2020. I have talked about this topic many times. Prior to the pandemic, about 25% of my caseload was online. Fast forward to March 2020 and even now, my caseload has been 100% online and will continue to be for the time being. Although remote and online therapy has allowed people to stay connected, it has had some downfalls that many people are not aware of when it comes to online therapy.
Different rules. Every state (and country) and licensing board has different rules and regulations when it comes to providing remote services. They even have different definitions of what is considered “online therapy.”
Physical Location. Most of the time, YOU need to be physically located in a state that your therapist is licensed in at the time of your session. What does this even mean?
It means that if you are on vacation/a work trip in California and your therapist isn’t licensed in California, you cannot have a session with them.
It means that the college student whose permanent residence is in New Jersey but is away at college in Minnesota, cannot be seen by that NJ-only/non-MN licensed therapist.
It means that if you live in New York, but work in Connecticut, you can’t talk to your NY-only licensed provider if you are stuck at work.
*Due to the ongoing pandemic, many states have relaxed their licensure rules until the public health emergency is over.
Prior to the pandemic, there were some legal and ethical workarounds. If I knew that someone wanted to continue seeing me, but would be away at college or on an extended trip, I would call the licensing board for psychologists in that state and ask for a temporary license to practice. Again, each state had different rules when it came to temporary licensing. Some would only allow a certain number of sessions. Some wouldn’t care about the number of sessions but allowed you to practice within a certain date range. This was great. However, the pandemic has changed that and many states are doing away with temporary licenses. Why? Continue reading.
The pandemic has allowed a shift in the way therapy is conducted across state lines. You may have heard of some agreements between states that are allowing for therapists to continue to see patients out of state. PSYPACT is one for psychologists, and the Counseling Compact is for non-psychologist mental health providers that is also hopefully starting up soon. These are great! However, even these agreements have drawbacks. Remember what I said earlier about how each state has different rules? Well, that is coming out here as well. Each state has different licensure requirements and the requirements that are needed to join these agreements are sometimes not in line with what the states’ requirements are. I will give you an example:
Currently, in the state of New Jersey, a psychologist is NOT required to obtain education or training from an APA (American Psychological Association) accredited school. PSYPACT requires that the psychologist graduated from an APA accredited school at the time of their graduation. Even though I am licensed in multiple states, I cannot be part of PSYPACT. Why? My school was not accredited when I graduated. In order for accreditation to take place, one of the requirements is that the school has to have at least one class or cohort that graduated. I had the amazing opportunity to be part of my school’s first cohort. My school became accredited AFTER I graduated, and you are not allowed to be grandfathered in.
Due to agreements like PSYPACT coming into play, many states are doing away with their temporary licenses because they wouldn’t be needed in PSYPACT. Well, for those of us who cannot be part of PSYPACT or do not want to, or for those non-doctorate level mental health providers, that leaves us with the inability to see our patients out of state.
So, when the question comes up, “why can’t you see me while I’m on vacation/on a business trip/away at school?” This is why.
With all of this being said… When I notice that you are in a different location or room when I log into our sessions, or when I ask on audio-only phone calls where you are located, this is why. I have to make sure that you are physically located in a state I am licensed during the session. Aside from the licensure aspect, this is also very important from a safety standpoint. If there is an emergency, I need to know where you are. Did you know that I actually have the nearest hospital’s information in your chart for the home address on file? Seconds count in an emergency and I don’t want to waste time asking you where you are or trying to figure out where you are when that time could be spent getting someone to your location. Please, be honest about your location.
Part of my work is social advocacy. Allowing all individuals to access mental health treatment regardless of demographics and location is part of that social advocacy for me. Telehealth and sliding fees have allowed me to continue my social advocacy work. My fear is that PSYPACT and other agreements between states, although helpful, are missing a large number of licensed providers that could be offering therapy services to individuals. Currently, I am licensed to practice in New Jersey, New York, Florida, and Vermont. I will try my hardest to obtain licensure in as many states as I am allowed prior to PSYPACT taking over. However, even now, because of different state requirements, there are states that I will never be able to practice in.
My sarcastic phrase, “isn’t technology great,” is playing out in my head over and over.
This post was updated on 4/30/21 to reflect VT as an added state of licensure.