As a therapist, you can be licensed in multiple states. This type of licensing is especially helpful now that more than half of therapy sessions are done via telehealth.
When offering therapy in multiple states, you must carefully observe and follow the rules and regulations in each state, which are likely to differ.
Why Get a License in Multiple States?
As a mental health professional, you might want to be licensed in multiple states for various reasons, including:
- Client Location. Because of virtual visits, mental health professionals can maintain relationships and continue helping clients, even if one party moves.
- Online Therapy. Online therapy has become increasingly popular, but therapists must be licensed in the state where their clients reside. By obtaining licensure in multiple states, therapists can provide online therapy services to these clients.
- Help Under-Served Areas. There are shortages of mental health professionals in some areas of the country. By being licensed in multiple states, a therapist may be able to serve clients in these areas.
- Assist Busy Clients. Some clients may have busy jobs or travel frequently. Because of their hectic schedules, they may prefer a therapist they can visit remotely. Being licensed in multiple states means you can help these clients, regardless of where they are.
- Increase Job Opportunities. Being licensed in multiple states can increase a therapist’s job opportunities, allowing them to apply for jobs in unique locations and work remotely. You may also be interested in job opportunities in a specialty that’s not as needed in the area where you live.
- Anticipating Relocation. You may want to be licensed in multiple states if you live in one state and plan to move to another. This need is especially relevant if you’re in private practice and want to keep clients in the original state you lived in while growing your practice in the state you moved to.
- Continuing Education Opportunities. Mental health professionals must obtain continuing education credits to maintain their licenses. Therapists who are licensed in multiple states can attend conferences and workshops in different states and earn credits toward this goal.
Being licensed in multiple states can give you more flexibility and opportunities to serve clients and advance your career.
Why Would Someone Want an Out-of-State Therapist?
Access to mental health treatment isn’t the same everywhere. Some locations don’t have many mental service options, and attending therapy in some places, like small towns, may not feel truly private. Sometimes, a counselor moves but already has a long history with a client who doesn’t want to start over with a new therapist.
Someone might want to work remotely with a therapist because of:
- Specialization. A therapist who specializes in a particular area of mental health or has expertise in a certain type of therapy may not be available in the client’s area. Working with a therapist not located in their state can provide clients access to specialized expertise.
- Increased Privacy and Confidentiality. Some clients may prefer to work with a therapist not located in their local area to maintain greater privacy and confidentiality. This need can be particularly important for clients in small towns or close-knit communities.
- Convenience and Flexibility. Working remotely with a therapist who isn’t in the client’s local area can provide greater convenience and flexibility, as the client can often schedule sessions at times that work better for them.
- Cultural or Linguistic Compatibility. Some clients may prefer to work with a therapist who shares their cultural or linguistic background to facilitate better communication and understanding.
- Reduced Stigma. For some clients, the stigma associated with seeking mental health treatment may be a barrier. Working with an out-of-state therapist can provide greater anonymity and help lessen these concerns.
How to Get Licensed in Multiple States
Getting licensed as a therapist in multiple states can be a complex but manageable process. Each state has its own licensing board and requirements for mental health professionals, so you’ll need to navigate them individually. Here’s a general guide on how to approach multi-state licensure.
Research Each State’s Requirements
Licensing requirements vary significantly. You’ll want to research exactly what you need to do and what qualifications you need to have to qualify in the states you want to have licenses in.
Apply for Each State License Separately
You’ll need to apply for a license in each state you want to practice in. Most states will require a separate application, along with relevant documentation, such as your degree, supervised experience, and exam results.
Depending on the state, you may need to complete additional supervised hours or pass a jurisprudence exam (state law exam).
Also, be prepared for state-specific licensing fees.
Consider Reciprocity or Endorsement
Some states offer reciprocity, which allows you to transfer your license with less paperwork and fewer requirements.
Also, if you’re already licensed in one state, some states offer an easier path for licensure by endorsement, often waiving certain requirements if you meet basic criteria.
You’ll want to research each of these options in the states you want to practice in.
Take Additional Exams if Necessary
Some states require a specific state law exam to ensure you’re familiar with local laws. If the states you want to practice in require exams you haven’t passed, you’ll need to arrange to take them.
Track Your Continuing Education Requirements
Each state will have its own CEU requirements to maintain licensure, so if you hold multiple licenses, you’ll need to keep track of all the state-specific renewal requirements.
Maintain Compliance with Each State
Be sure to renew each license in a timely manner, comply with CEU requirements, and stay updated on changes in state laws. Failure to do so compromises your license in that state and the legality of your practice there.
Options for Counseling Clients Out of State
With the rise of remote communication, mental health professionals can increasingly provide counseling services to clients outside of their home state.
But, providing counseling services across state lines can be a complex process, and you must comply with the rules and regulations of each state where you’re licensed to practice. This compliance can include obtaining licensure in each state, using HIPAA-compliant technology to ensure client privacy, and staying up-to-date on the legal and ethical considerations of providing counseling services across state lines.
You also must consider the logistics of serving out-of-state clients. You must carefully evaluate each option to determine the most appropriate and effective approach for each client’s unique needs and circumstances.
The most common options for counseling clients out of state are:
- Telehealth. Telehealth involves using videoconferencing technology to conduct therapy sessions remotely. It’s an effective way to provide therapy to clients in different parts of the country.
- In-Person. In-person counseling may be an option for clients located within a reasonable distance of the therapist’s office. This option may be more challenging for clients who live far away or have difficulty traveling.
- Online Groups. Online groups can be a good option for clients seeking peer support or group therapy. You can host online groups through videoconferencing, chat rooms, or forums.
- Telephone. Phone counseling is a good option for clients with unreliable internet access or who prefer not to use videoconferencing. However, sometimes insurance may not cover phone counseling.
Options for Counseling Overseas Clients
Providing counseling services to overseas clients presents unique challenges for mental health professionals. These challenges may include language barriers, cultural differences, and varying legal considerations, but serving overseas clients is possible.
Mental health professionals must be familiar with the licensing requirements and regulations that apply to their practice in their home country and the country where their clients are. You must use HIPAA-compliant technology to ensure client privacy, find language and culture translation solutions, and verify liability insurance coverage. By taking these steps and carefully evaluating each option, mental health professionals can provide effective and compassionate counseling services to clients worldwide.
Counseling overseas clients can present unique challenges, such as differences in time zones, cultural differences, and legal and ethical considerations. But logistical options exist for counseling services to clients located overseas.
Some of the most common options for providing therapy to overseas clients include:
- Email. Email can be an effective way to provide counseling services to overseas clients. It’s particularly useful for clients in different time zones who can’t participate in real-time sessions. If you use email to serve clients, you must ensure it’s private and secure.
- Online Support Groups. Online support groups can be a good option for overseas clients seeking peer support or group therapy. They can be conducted through chat rooms or forums and accessed from anywhere with an internet connection.
- Telehealth. Telehealth allows you to provide counseling services to overseas clients who may not have access to local therapists. However, you should know the legal and ethical considerations of providing counseling services across international borders.
Distance Counseling Laws by State
Distance counseling laws can vary by state. You have to be aware of the regulations that apply to you based on where you and your clients are.
Here are some of the key legal issues to consider:
- Licensure. Therapists must be licensed to practice in their clients’ states. Some states have specific requirements for out-of-state therapists, such as obtaining a temporary license.
- Telehealth Requirements. Many states regulate the use of telehealth or telemedicine for counseling services. Some states have specific requirements for telehealth providers, such as requiring informed consent, conducting initial evaluations in person, or using secure and encrypted communication technology.
- Privacy. The Health Insurance Portability and Accountability Act (HIPAA) sets national standards for privacy and security of health information. Some states also have additional or stricter requirements, particularly in telehealth or distance counseling.
- Breach Notification. Many states require healthcare providers to notify patients in the event of a breach of PHI. The requirements for notification may vary by state, and therapists must be familiar with the laws in the state where their clients are.
- The Tarasoff Rule. Healthcare professionals must warn or take reasonable steps to protect third parties from harm when they believe their client may pose a threat. The specifics of Tarasoff laws can vary by state, and therapists must be familiar with the laws in their clients’ locations.
- Mandatory Reporting. Many states require you to report certain issues, such as child abuse or neglect, elder abuse, or threats of harm to self or others. Mandatory reporting laws can vary by state. You must be familiar with them where you provide services.
- Age of Consent. The age of consent for counseling services may vary by state. Some states require parental consent for minors to receive counseling services. Other states allow minors to receive services without parental consent under certain circumstances. You’ll need to be aware of these laws in the states where you practice.
Tips for Practicing Therapy Across State Lines
Practicing therapy across state lines requires some extra care on your part. But there are steps you can take to ensure that you’re providing compliant services.
When practicing therapy across state lines:
- Understand Licensing Requirements. Each state has its own licensing requirements for mental health professionals, so it’s important to research the requirements in the state where you wish to practice.
- Complete the Licensure Process. To practice in a different state, you may need to complete a licensure process for that location and wait for approval before you start seeing clients. Approval can take weeks or months.
- Stay Updated on Requirements. Once you’re licensed in a state, stay up-to-date on the requirements for maintaining your license, such as completing continuing education courses or fulfilling other requirements set by the state’s licensing board.
- Use HIPAA-Compliant Technology. You want to ensure your clients’ information is protected, regardless of where you practice. That means using HIPAA-compliant technology for all client information and communication.
- Clarify Insurance Coverage. Insurance coverage for mental health services can vary by state, so it’s important to clarify whether your client’s insurance will cover services provided across state lines.
- Find Translation Solutions. When working with clients from different cultural or linguistic backgrounds, find solutions for language and culture translation to ensure effective communication and cultural sensitivity.
- Verify Your Coverage. Verify that your liability insurance coverage extends to the state where you practice to ensure that you are protected in case of a lawsuit or other legal issues.
Let All Counseling Connect You
If you’re licensed in multiple states or working on more expansive licensure, All Counseling can help you grow your practice. All Counseling allows therapists to create their own profiles in our therapist directory to showcase your skills and services to potential clients. By claiming your profile at All Counseling, you can easily connect with clients wherever you practice.
