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The question of whether a psychotherapist should be licensed in the same state as their client comes up quite a lot. It’s a topic that’s sparked plenty of debate, and immigration lawyers might have a different outlook than your licensing board. This means you’ll need to consult both before making any decisions.
Many therapists have done psychological evaluations in states where they are not licensed and had no problems. It’s possible, and sometimes immigration lawyers promote this practice. However, only your licensing board has the power to suspend or revoke your license. Therefore, no matter what anybody else does or says, it’s important to be careful and make sure you’re complying with your state’s board’s regulations.
Can I practice teletherapy with clients in states where I don’t hold a license?
Teletherapy, otherwise known as telehealth, is the provision of remote healthcare services and treatments. It’s often provided via a video call or phone call, and in this case, facilitates psychological evaluations. (NEJM Catalyst Organization, 2018)
Since immigration evaluations are part of federal cases, many clinicians believe they are not bound to state lines, especially for teletherapy. However, it’s widely believed that you cannot work with clients outside of the state you’re licensed to practice in, even if it happens to be a teletherapy session. Furthermore, most practitioners have decided to stick to this sentiment, regardless of the current COVID-19 pandemic regulations. It makes it far easier to ensure that you remain compliant throughout the year and don’t compromise your license.
Nevertheless, as a result of the pandemic, state governors have also made it a top priority to increase access to teletherapy services and ensure that more qualified clinicians are on the job. According to an article published by the American Psychological Association Services website, many licensure waivers have been instated. It temporarily suspends state-based licensing requirements for out-of-state clinicians while we’re in the midst of a public health emergency. The article was last updated on November 7, 2020, and it still holds the same information. However, it’s still challenging to keep up with the latest trends and changes. (American Psychological Association Services, 2020)
The course of action is to always check in with your own state’s licensing board and try to follow normal regulations as much as possible.
What are the regulations during the COVID-19 pandemic?
The COVID-19 pandemic has also made the process of conducting immigrant evaluations far more complex. This makes it even more important to consult your licensing board before making any major changes to your practice.
For example, several states like the District of Columbia have allowed US clinicians to temporarily practice in their states, even without the corresponding state license. However, it’s a requirement for them to at least be licensed in another US state. On the other hand, states like West Virginia are allegedly letting clinicians work with clients they had before the pandemic. It was easier for clients to travel across state lines to see therapists before any pandemic restrictions were instated. This means clinicians might be working with clients who live one state over but commute to the same state as them for work or family. (Federation of State Medical Boards, 2020).
The Federation of State Medical Boards has released a detailed document that stipulates how the telehealth regulations have been modified for the pandemic per state. Admittedly, it’s a very long document with many different factors to consider. Additionally, once COVID-19 restrictions have been lifted, the temporary regulations outlined in this document are bound to change. This means you could potentially end up in a position where you’ve dedicated your time and energy to a client that you can no longer serve due to sudden changes in regulations.
Should I practice in a state where I don’t hold a license?
In summary, you should aim to practice in the same state where you hold your license. There’s probably plenty of immigrants in your own state that could benefit from your services. As of 2020, the US immigrant population has reached more than 40 million, and they live almost everywhere in the country. Based on these figures alone, you should be able to find your clients in need of your services nearby.
Many clinicians have been debating the idea of practicing in a state where they aren’t licensed. Working across state lines could allow a greater number of immigrants to receive their evaluations. However, it might put the actual clinician at risk. You don’t want to find yourself in a position where you unknowingly breach the healthcare boards’ regulations in your state.
Sometimes clinicians consider practicing where they aren’t licensed because there aren’t enough local therapists who know how to do immigrant evaluations. However, this reflects on a far more significant issue. The end goal should be to train as many clinicians as possible as the demand for qualified clinicians in this particular field is incredibly high.
American Psychological Association Services. (2020). Retrieved 16 December 2020, from https://www.apaservices.org/practice/clinic/covid-19-telehealth-state-summary
Federation of State Medical Boards. (2020). Retrieved 16 December 2020, from https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf
NEJM Organization. (2020). Retrieved 16 December 2020, from https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268
I’m Cecilia Racine, and I teach therapists how to help immigrants through my online courses. As a bilingual immigrant myself, I know the unique perspective that these clients are experiencing. I’ve conducted over 300 evaluations and work with dozens of lawyers in the various states. Immigrants are my passion, I believe they add to the fabric of our country.
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