Should licensed therapists be allowed to routinely offer telehealth treatment to international patients?

It’s a contentious issue even among clinicians and professional therapists. Strict licensing conditions for mental health providers are handled by individual states. They typically require therapists to work with patients in the same state.

According to Catherine L. Atkins, J.D., an experienced attorney at the California Association of Marriage and Family Therapists, U.S. therapists contravening the state licensing of their own or another state could risk fines or mandatory incarceration for a class B misdemeanor.

Talkspace among other leading mental health apps have found legal routes for U.S. licensed therapists to work with international clients in live sessions.

While cross-state licensing for Telehealth providers varies state to state, none of the therapists advertising on Psychology Today we spoke to were willing to set aside important conditions of their licenses, even to treat long-term clients who moved to a different state, for fear of breaching their licensing conditions.

As an example, if a licensed Washington therapist risks their license being revoked or suspended if they work with a client in New York, Texas, or an online client outside the U.S., for example in Canada or Europe, how do leading online therapy platforms like Talkspace and BetterHelp find ways of working around licensing restrictions?

Some advocates of licensing that allow international Telehealth at the provider’s discretion, criticize current licensing conditions as being restrictive and in light of the Covid pandemic, archaic and outdated. Critics say current rules too often unfairly preclude overseas clients as a new source of income to U.S. based providers.

The answer to that is they curate a vetted group of providers in accordance with National Committee for Quality Assurance (NCQA) standards which circumvent’s legal red tape and allows therapists to accept international clients.

Likewise, HostJane believes that everyone deserves to be happy and have equal and sustainable access to licensed, freelance therapists online.

While we wouldn’t go so far as some who denounce licensing in the post-Covid world that restricts access to essential U.S. mental health providers as “outdated and archaic”, we recognize being able to find a good therapist is a human right. HostJane addresses this issue by allowing freelance therapists, anonymously, under pseudonym, or through associated third-party providers, to offer their skills globally.

We’d love to hear your reactions and views in the comments.