We often get asked about doing reunification therapy, or any form of family therapy, when parents or family members reside in differing states. We even see court orders ordering parents or a family into cross-state therapy, and judges and attorneys are surprised how difficult that has become to effectuate. This is likely because for about two+ years around the time of Covid, starting from sometime in 2020 to sometime in 2022 or 2023, all states waived restrictions against providing therapy across state lines via telehealth. However, those waivers have all expired, and rather than use the opportunity to progress to a permanent allowance of online therapy between a therapist in one state and a client in a different state, the states regressed to their pre-Covid mandates that restrict the cross-state practice of psychotherapy. One has to get creative to make these cases work!
The issue is that of state licensing. A clinician must be licensed in the state the client is in to provide therapy online to that person. So, in the case of reunification therapy, if one parent and the child are in NC, but the other parent is in another state, the therapist must be licensed in both states the parents are in to work the case. These are pre-Covid state licensing laws; during Covid states waived these requirements, and as long as you were licensed in one state, you could provide online sessions to clients in any state. All of those waivers have expired and have states reverted to the old way where you must be licensed in the state the client is in during the session. It’s not about the client’s residency, but literally about where that client is when the session takes place. For example, if the out-of-state client is in a neighboring state to NC, and drives across the border into NC and uses their tablet or phone to have an online session, that is allowable because the clinician is licensed in NC and the client is physically in NC at the time of the session. As such, clinicians licensed in NC can provide online therapy for clients living anywhere in this state.
The state licensing boards for Psychologists are addressing this issue via Psypact. The Psychology Interjurisdictional Compact (PSYPACT®) is an interstate compact designed to facilitate the practice of telepsychology across states. Forty states participate, but currently ten do not. Also, most psychologists have not signed up yet. The application process is tedious and expensive. Hence, for most psychologists, unless they need clients and believe potential clients will find them searching online for care from another state, there is no incentive to sign up. Nonetheless, it seems likely over time more and more psychologists will do so, especially if the application process becomes easier and more affordable. Please note, as of yet this has only been state psychology boards who created a cross-state practice compact; counselors, social workers, and marriage and family therapists all have their own licensing boards and have no such compacts yet to allow them to practice telehealth across state lines.
This becomes tricky for attorneys and judges trying to help parties have cross state therapy for things like co-parenting therapy, family therapy or reunification therapy, because you need to find a therapist who specializes in that area of therapy … AND… is licensed in both states, OR, is a psychologist who is a member of Psypact. For families with money, time, and/or less of a drive/flight, we have parents who come to NC for their sessions (from VA, SC, DC, KY, TN, FL, etc.) Some come all the way to the Triangle to have in-person sessions. Some just drive across the border into NC we can hold the session for them online. Our social workers have also, for some cases, obtained a temporary or limited license in that other state in instances where the second state offers such options, which not all do.
Stay tuned to our Forensic Newsletter! As changes occur, we will keep you updated. This is an important issue in the therapeutic care of families living across states.