With today’s technology we are an ever mobile yet increasingly connected society. For example, a client who you have been treating in office and perhaps with a few phone sessions when he was stuck downtown at his office has now relocated out of state and wants to continue his therapy sessions. With telephone, Skype and e-mail, why not? Why not expand your practice and “see” patients across the country, especially if you have expertise in an area of treatment?

Over the past decade or so therapists have been warned of the pitfalls of telehealth. For example, bogus identities, unintended recipients, individuals lurking in group therapy sessions. There can also be misunderstanding or unavailability of the nuances of communication (verbal and nonverbal) through e-mail or the internet. In more recent years, various Codes of Ethics or statements from national organizations (ACA, APA, etc.) have provided guidelines about the need for informed consent, maintenance of privacy and confidentiality, and billing issues.

Most recently individual states have started to enact statutes regulating telehealth. While all 50 states have laws regarding general telehealth, only few have laws specific to psychologists and therapy. Few state licensing boards also have enacted formal regulations regarding telehealth practice. However, it seems to be only a matter of time until more states enact laws to protect their residents and to hold therapists accountable to their residents. The APA Practice Organization recently published an article about legal basics for psychologists and telehealth that has a concise review of the current legislative actions regarding this topic (APA Practice Organization. Telehealth: Legal Basics for Psychologists, Summer 2010)

Telehealth can be viewed in two broad categories: practice within state and practice across state lines. Within state, the therapist need only refer to the state specific statutes and good clinical practices. Providing therapy across state lines is a little trickier. The APA article noted that there is a strong legal argument that the therapist should be licensed in both the state in which the therapist resides and the state in which the client resides. Most states allow nonresident therapists to obtain a temporary license to practice for a prescribed number of days a year (often 30 days total). Although this may be cumbersome, it will decrease the probability of licensing board sanctions for practicing within another state without a license. Another alternative, for psychologists, is to obtain an interjurisdictional practice certificate to facilitate temporary practice in other states.

Framework for risk management: (1) Review the telehealth laws in your home state and the state of your client. (2) Contact the psychology board of your home state and the state of your client to identify specific telehealth policies. (3) Confirm with your insurance carrier the limitations , if any, to your policy for telehealth for in-state and between-state clients.

File under: Law & Ethics