Teletherapy in another state

About a year ago I decided to separate from my husband. I was unemployed at this time so I decided to stay with family in another state. I asked my therapist about the rules regarding her seeing me while I was in another state. I asked her this both out of interest in attending a graduate program while living elsewhere and because I wanted to leave my husband. She said it would be no problem for me to do this and continue seeing her. Based on the information she gave me I decided that I felt able leave my husband and stay with family in another state temporarily.

Unfortunately things did not go entirely according to plan as it turned out that I had a condition that was causing me chronic pain in one of my feet, and this made working very difficult. The pain got really bad at one point and spread to my hips and low back. There were periods of time where I had to spend most of the day in bed. The dr. Wanted to exhaust all conservative options before deciding on surgery. I spent my days just trying to do pt and care for myself. It was very difficult. My therapist knew about all of this as it even impacted our ability to have sessions at times.

I am now going to have surgery (no date yet as I'm getting a second opinion) but will likely be in the next two to three months.

My husband and I are still legally married but leading mostly separate lives. We are good friends and I am seeing a dr. In the state we both used to live in as he works at a university with a good medical school and I have access to the best care there. I have also house sat and taken care of our cat when he travels. I am still a legal resident of this state and my name is still on our lease. We have filled no legal paperwork and have arrived at monetary decisions through discussions.

Yesterday my therapist informed me that her continuing to see me while I'm living out of state is illegal and she is no longer comfortable with our arrangement eventhough it has been like this for over a year now. I was extremely upset by this as it was not at all how I understood the situation. It seems very unfair for her to see me for so long and then suddenly change her mind. I don't know what to do. This is a therapy relationship of over 5 years. I feel I have made a lot of progress with her and that we were negotiating some later stage issues in therapy including my coming to see her more as a person and in a less idealized way. This hasn't been an easy process for me and I am still fighting this issue quite a bit often in the form of dissatisfaction with her. But this has all seemed rather necessary and part of the process. I'm also quite depressed due to my medical issues, not working, and not living where I would prefer. I'm afraid to lose her and I'm not exactly sure if I want to look for another therapist at this point. I've not always had the best experiences with therapists and was hoping this one would be the last for quite some time.

I appreciate any support, insight or advice that can be offered.

Hey, I’m really sorry this is happening. I can understand and would feel extremely upset by this if I were in your shoes, especially if the therapist told me they could see me over video indefinitely while in another state. It sounds like maybe your therapist wasn’t aware of the rules and laws when she made this commitment to you. Therapists are technically only allowed to provide therapy to clients in states in which they are licensed.

However, I do know that laws and restrictions have loosened up due to COVID. Therapists may be allowed to provide therapy to clients in another state under certain conditions due to COVID and each state has different rules around it (some have time limits for how long a therapist can see you and some states may not actually allow it at all). I saw my therapist from my hometown over video when I moved to another state but it was only for a set period of time while I was transitioning to a therapist here. I’m not sure if your therapist made the exception to see you because of the COVID restrictions loosening or if she just wasn’t aware of the laws.

First, I'd be really upset by this, too.


It seems like it should be OK if you're still a legal resident of that state, but I don't know the laws--it may vary based on state and the type of therapist (like an LCSW vs. a Licensed Psychologist), as they have different governing bodies. My therapist sees some college students who attend school out of state, and he still meets with them virtually during the school year. But I think because their permanent address is their parents' home (within our state), it's legal. So I would think it would be legal for you as well?

I'd ask your therapist if she could double-check, to maybe find out what would be needed for it to be legal. I wonder, too, if she'd be willing to meet with you on occasion (virtually or in person) when you're in state for medical appointments or to house-sit? Or if she could at least arrange to meet with you until your surgery. Out of curiosity, do you use insurance to pay for the sessions? If so, I wonder if that could be part of the issue, with insurance rules, that she may not be able to get reimbursement from them? My T is private pay, so he wouldn't have to deal with any of that (I submit for out-of-network benefits, but that's different).

Wow. I’d be really angry. Is it worth it to you to research this independently? Like look up the rules that her licensing body has about this?

It seems very specious for a number of reasons including that your legal residence is in the same state, that rules about tele-everything have relaxed considerably across the board since the pandemic and that online therapy platforms (like talkspace eg) connect clients with therapists regardless of geographic boundaries. And there are all those social media savvy therapists who basically advertise to everyone, everywhere.

The other question is, let’s say you find out that she’s totally wrong, how will that land? Will she be like, “omg thank for taking the time to do my job as conscientiously as I should have, thank goodness we can keep seeing each other!”

My understanding is that it has nothing to do with legal residency or permanent address of the client. The laws I'm aware of state that the therapist must be licensed in the state where the client physically is during the therapy session. Some laws were relaxed during COVID, some states have flexibility around people temporarily being out of state, some federal agencies (like the VA) cut across state lines, and some states have agreements with other states to honor their licenses (this is increasingly happening).

It sounds like either she ought not to have agreed to this in the first place, or like the relaxing of restrictions around COVID have been reinstated. Regardless, it's crappy, and I'm sorry you're going through this. It's so hard to find a therapist you click with, so I can understand not wanting to start over. I don't really have solutions, just lots and lots of empathy!

I believe Oliviab might be right. The last couple of months my appointments reminders have had a not that states if during my appointment the place I am sitting in is not in my home state, my appointment must be rescheduled.

I believe it is new so not sure if laws or insurance company policies have changed becak to pre-pandemic.

L might have to move out of state. So long as she keeps her license in CA and I live in CA, she can continue to be my therapist. She has confirmed this as well as T.

Frankly, reading your post, I was surprised your therapist said she could still see you while you were in another state. That is not legal - as your therapist needs to be licensed in that state too. IF she is not licensed, I don't see how she can continue seeing you.

She was in breach seeing you this long and could get in trouble over this. Frankly, she deserves to be... It is shocking that she did not know (did she even ask or check with her licensing body?). As a therapist, she ought to know about the 'rules and regulations' of her own profession.

If you were in other state on vacation type of thing and urgently wanted to talk to your t, then maybe would be ok. But you actually live in a different state so it’s different with logistics of licensing and insurance needs. Your therapist thought it’s ok to see clients who moved out of state for over a year?

I don’t think it has anything to do with your name being in a lease of something. You can live in a different country and have your name on property or lease elsewhere, doesn’t mean therapists can see people who live in different countries because their names are on something.

I am sorry it came to this but I blame your therapist for not looking it up ahead of time

So, I thought my therapist had mentioned something the other about an organization he'd joined so he could see clients virtually (legally!) in a neighboring state. I just googled, and it looks like if a therapist joins PSYPACT, if it's a state where that's allowed (looks like the majority of states), then they can legally treat someone in a different state, as long as that state participates in it as well (not sure if it applies to all states in the program, like if, say, a therapist in Pennsylvania could treat a client in Texas or only neighboring states. Also don't know if it's all types of therapists or only specific ones. But could be something to look into if your T's state and your current state are on the list. Looks relatively inexpensive to join (either $40 or $400).

I'm not in the US....but I would just go like, go to the right state (the old address if possible) for the appointments. So then the therapist can keep working with me legally and all that. The old address is still the legally registered one too anyway yeah?

Unless she lives by the state border, she’ll likely have to drive for hours or days or fly to a different state.

Maybe she shared that she lives close by and I missed it if it’s like an hour drive, it might be a good idea

This is… ridiculous. If you are practicing using a modality like phone or virtual platform where there is no real way of guaranteeing the location of the client, how can it be legally incumbent on the provider to ascertain that?

These clunky policies are all going to become obsolete in about a minute. Covid has fundamentally changed work forever.

Anyway Depletion, I’m sorry that you’re going through this, I’m sorry you’re in pain and I hope things get easier for you on all fronts very soon ❤️

Hi everyone. Thank you for all your responses to this issue. They have REALLY helped me feel like I'm not crazy for being upset. I'll write back later with more details and to answer specific questions when I have a bit more time.

Well, depends on what part of the country the OP is in. I'm in the mid-Atlantic, and besides my own, there are 4 different states plus DC within a 90-minute drive from me.

Yes in the first post it mentions she still goes back there

here in the USA -

therapists are certified / licensed by state.
Each state has a board of clinical social workers where certified / licensed treatment providers are registered.

each state board keeps track of each treatment provider in the state that they are registered in.

in order for a mental health professional to treat someone in another state the treatment provider must be registered with the other state.

example -

my therapist is registered in NY state and Vermont therefore he is able to treat clients in NY state and in vermont state.

that means when I am in NY I can see my therapist by what ever means he has available (telehealth, online, texts, in person whatever he has available.)

before 2018 he was only registered in NY therefore he was only able to provide services in New York State.

it would have been illegal for him to practice mental health in vermont because at that time he was not registered or had vermonts credentials for treating clients in vermont.

if he had tried to practice mental health services in vermont while not certified or licensed in vermont he could have not only lost his credentials but also been arrested for fraud/ pretending to be a treatment provider in vermont.

if you watch the news you will see all kinds of articles about doctors, therapists, psychiatrists that have been arrested for not being a doctor, therapist, or psychiatrist in the state they were trying to perform.

this is probably what your therapist is talking about. she may not be licensed or certified to practice mental health therapy in the state you reside in now. in order to continue treating you she may need to contact your new states board of clinical social workers to find out how to get that states degree's, licenses and certifications.

think of it like if you were seeing a medical doctor, you would want that medical doctor to have all the professional degrees saying they are a doctor. you wouldnt go outside on the street and trust the first stranger that says Im a doctor.

thats how the state boards are in the USA. treatment providers have to provide proof to the state boards in each state that they are who they say they are, have the knowledge and degrees they say they do and pass a test in order to work in each state.

my therapist has provided both New York and Vermont proof of who he is, that he has all the required college degrees and education and passed the state board testing process to be able to be a therapist in both New York and Vermont.

each state is different and has a set of criteria that has to happen before its legal for a therapist to treat clients in other states.

there is also a situation with insurance. insurance in one state will not pay for treatment in another state unless its an emergency situation.

example -

medicaid and medicare (state issued insurance plans) carries the disclaimer in their member handbook that they do not pay for out of state services unless its an emergency (a pregnant person goes into labor in another state, a broken bone while visiting another state and so on)

check with your therapist to see if they are licensed or certified to treat clients in your new state, if not shes right she most likely had a deadline time frame of when your temporary move changed to permanent and can no longer treat you while you live outside her credentialed area.

check with your insurance company, (all americans must have health insurance by law wither through work aka private insurance or state insurance options) they will be able to tell you what locations they pay for now.

Very true.

I was just saying that without knowing where she lives and which state she used to live, we can’t tell her to go there for therapy. I live only relatively close to one state (might make it to the border in 90 minutes, maybe 2 hours), no other states nearby. I live a quick drive from a different country’s border though lol but that’s no help for therapy

I don’t think it matters where she is physically for the therapy but rather where she lives. She lives in a different state. Going back isn’t the same as living there. By this logic people could just go to state borders and have therapy with whoever in all 50 states. It’s a question of therapist’s licensing and health insurance. Not where you physically sitting

In the early pandemic I did a virtual IOP program. At the start of each meeting we had to verify that we were physically in the state where the IOP was located. I got the impression it mattered where you were sitting, not where you actually lived.

ETA: Found this. Seems to be psychologist specific, but may apply to other types of therapists as well.

I was saying what *I* would be doing if I were in OP's situation. Also see my reply in post #16

The idea is OP doesn't necessarily have to give up, there may be options for her to continue with this therapist!

Worth checking out the rules and options to play by them without doing anything truly illegal/dangerous

If I were OP, I might just tell the T I moved back into state, move the furniture around and continue with online therapy... but then I am in a funky mood today

Haha yeah, that too, I didn't dare to suggest that

Anyway I hope OP will find a solution either way, whatever that solution may involve. It would be really stupid if OP had to stop therapy like that when it apparently has been working so well for years.

Hang the state flag behind you.

Hi Everyone, Thank you so much for all your support and kind responses. I truly felt understood and I appreciate all of the advice and insight that was given.

I did do some research on my own and I found that yes it does seem to be the case that for clients the state that your butt is seated in is what seems to count. This is all a rather stupid and antiquated law that was created in the 1950's before the internet and frequent travel between states. The Zur institute says as much if you would like to read for yourself: TeleMental Health Services Across State Lines. They also say that this offense if rarely prosecuted on it's own. So as long as my therapist isn't running a multi-state prostitution ring, stooping her clients or finding ways of offending the political official of the states she or I reside in it is unlikely that anything would happen.

I saw her today and she does seem to think we had a miscommunication about this issue when we had our initial discussion. I am somewhat frustrated by this as I did make monetary and living arrangements partially based on what I thought was my continued ability to see her, and may have asked for different things had I thought it was otherwise.

Fortunately, she has now agreed to continue to see me as long I have residency in the state that she is in and I am pursing activates that might defied as transitional (i.e. resolving a health concern while staying with a family member or attending graduate school). She says that given the length of the relationship and the overall success it's her interpretation of her ethical code that she should continue to see me under these circumstances.

I did suggest driving to the boarded I'm about 70 miles away. But this would leave me at a truck stop in the middle of nowhere. Not sure I want to do therapy there (and she says it's a stupid plan). I would also go see her in her office once a month if she was back to in person, but she seems to enjoy telehealth and wishes to continue in that way. I am sad about that, but it's no surprise. I also offer to pay her licensing costs for the state I'm in which would only be a few hundred dollars, but she declined and and does not wished to be licensed in the state i'm in. (I don't blame her it is a bit of a backwater).

This has been a painful experience, and I wish it had gone differently as I did feel betrayed. But I thing this goes to show that even in the best therapy relationships there will be problems and misunderstands that are difficult to endure--but they are not beyond resolution. It is wise to be mindful of this and to try to forgive the flaws of those who are helping you. I suspect my therapist's people pleasing tendencies and desire to follow ethics above rules (without ignoring the rules altogether) played apart here. As well as her preference to avoid bureaucracy and paperwork (she is self pay for this reason--and as said as much).

Thank you again to everyone who responded. It has been many years since I have been active here. It's nice to see some familiar faces in this thread. This forum is as helpful and kind as I remember it. Perhaps I'll stick around for a bit and see what use I can be.

Glad to hear she's willing to continue seeing you!