HMN 2024: Traveling This Holiday Season? Your Therapist May Be Unavailable

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A typical conversation with a client this time of year may go like this: The client says, “I’ll be out of state for the holidays, so I’ll have to meet with you virtually while I’m away.” I then have to reply, “Sorry, if that’s the case I’m not allowed to meet with you but I’ll help you find local resources.”

Clients are usually baffled by this, and they should be. It’s a travesty of consumer protection that clients in need are cut off from treatment by licensed providers simply because of their current location. In the post-pandemic 21^st century, the technological barriers for distance treatment have been eliminated but the political ones remain firmly in place, preventing often essential patient care at a time of year that is extremely stressful.

The problem is that generally health care providers are licensed on a state-by-state basis to practice with clients contained within that state’s borders. This state-based regulation arose to meet the needs of the industrial era of the 19^th and early 20^th centuries, when it was impossible to receive health care remotely. Each state looked out for its own residents, a system which worked for that time and place, before worldwide instantaneous communication was a thing.

However, even today a client’s physical presence in a state at the moment of treatment often means a therapist must be licensed in that state. For example, say a therapist is licensed in California. Unless there are local laws or other complications like insurance requirements specifically preventing it, the therapist might be permitted to be anywhere in the world when they meet virtually with clients. But for many therapy services, the client has to be physically present in California when the therapist is working with them.

The consequences of these telehealth restrictions can be felt by all types of clients. For example, in addition to these limitations impacting the mental health of many of my traveling clients, I would have loved to volunteer some time to treat hurricane victims when the East Coast was impacted, but because they are not located in California, I wasn’t able to. And I don’t even know how these laws would impact treatment in other places such as refugee camps, federal detention centers, or people currently on a boat or plane whose jurisdiction may not be known even to them.

Many states even prevent therapists licensed there from practicing with clients who are located outside of their licensed jurisdiction. For example, say a therapist is treating an activist who is placed under house arrest as a political prisoner while traveling abroad. A U.S. state might have a problem with the therapist having a telehealth session to check in on the client.

For example, to provide telehealth services outside of California, the state’s license requires that “a licensee or registrant meets the requirements to lawfully provide services in that jurisdiction and delivery of telehealth services are allowed by that jurisdiction” (CAMFT, 2016). That is, because a tyrannical regime in a different part of the world doesn’t allow telehealth treatment from the client’s California-based therapist, California’s regulatory language indicates it might penalize the therapist for providing mental health care services, actively helping that regime to enforce the injustice of denying needed client treatment.

The previous example may seem rare, but many other examples of potential denial of treatment occur all the time. For example, if one member of a separated couple is staying out of state, that couple may not be able to get couples counseling anywhere unless they can find a therapist licensed in both states.

Calls for reform may seem like dry political issue but these flawed policies are having real effects on vulnerable people every day. Having 50-plus separate regulatory systems in the U.S. alone is a bureaucratic nightmare and simply not sustainable in the modern world. Some exceptions to these restrictions exist based on license type and other factors. And some inter-state agreements do exist. But it’s not nearly enough. We have to do more.

If we accept telehealth restriction as a serious problem, the next question is, “What can we do about it?” Call me cynical, but I don’t think writing well-reasoned emails to individual politicians will accomplish anything. But this is doable. We don’t need an overhaul of the entire healthcare system to make this work. For example, maybe a federal law can be enacted that allows for temporary treatment across borders by any U.S. licensed practitioner. Or at the very least a law that allows a client’s current therapist to continue treating them during travel.

What I suggest is raising awareness. Share this piece and others with as many people as possible until there is enough public momentum to actually sway the politicians to allow clients to receive needed health care treatment across borders.