PSYPACT: Increasing Access to Therapy Across State Lines

TL;DR: The Psychology Interjurisdictional Compact (PSYPACT) was created to help lower the barriers of access to therapy by making it possible for psychologists to work in PSYPACT-participating states even if the psychologist is officially licensed outside of that state.

That it can be difficult to find an available psychotherapist to work with is not a big surprise. So many of us who have tried to set up appointments with a psychologist, a licensed marriage and family therapist (LMFT), a licensed professional counselor (LPC), or other clinician can vouch for this! To begin with, even if you live in a larger town or city, you might be able to obtain a list of therapists not too far from you, but are they taking new patients? You find out they’re available, in general, but then you have to see whether their available times are a match for your schedule. And even if the moon and stars align thus far, it’s possible that they could turn out not to be a fit for you as a person and/or the issues you’re looking to address, despite being logistically adequate. If you happen to live in a rural area or a smaller town, just finding anyone at all within reasonable driving distance (if you even have a car) can become exponentially more challenging.

As it was in many other ways, COVID was a game-changer for the field of psychotherapy. The pandemic ignited an explosion in the availability of services through telepsychology (a.k.a., teletherapy or telehealth) which has allowed people to find a therapist who is a good fit for them, regardless of how far away they may be. Being able to see a therapist online using video software was not introduced during the pandemic, of course, but it suddenly became much more critical: with the need for social distancing, the only way to safely see patients was over the Internet using (hopefully) HIPAA-compliant tools to “meet” virtually. In fact, many therapists opted not to even renew office leases, especially as time went on, and began working exclusively from their home offices. Because everyone was receiving therapy online, it no longer mattered (most of the time) where the therapist was, as long as they were licensed in the state where the patient physically resided.

These events have dramatically changed the landscape when it comes to engaging in therapy, probably forever. Though there has been a return to in-person sessions, many people have found it much more convenient not to have to commute to an office to see their therapist. For some people, it is the only way they can continue to receive therapeutic services, due to scheduling, transportation, or other limitations. In my case, I started my private practice just before the pandemic hit and quickly found myself unable to see people in person. My practice grew as I continued to take on patients from all over the State of Oregon, the state in which I was first licensed. I’m a techie going way back, but I never in a million years planned on doing telehealth as part of my work. Nevertheless, here I am, doing online therapy almost exclusively.

So far, pretty much everything I’ve said here is old news. Why, then, am I bothering to write this article? Doesn’t everybody know about telehealth, these days? And who doesn’t remember being locked down during the pandemic and doing just about everything remotely? Yes, that’s pretty much all true. But there is one critical piece of information that I’ve only sort of alluded to in this article which is this: therapists are licensed by agencies in individual states to work with people who reside in that state. In other words, when I obtained my license as a psychologist in the State of Oregon, I was only licensed in Oregon and only allowed to see Oregonians in my practice. I have since become licensed in the State of Washington and, upon earning that license, was able to start working with folks who live in either Washington or Oregon, but only Washington and Oregon.

“What’s the big deal?” you may be asking. I mean, can’t people just find a therapist in the state where they live? Sure! That is, if you live in a state with an adequate number of psychotherapists, telepsychology definitely offers a lot of possibilities for finding someone who can meet your needs. But what if your state has too few clinicians? (Yes, this is a thing.) Or maybe you identify in ways which make it harder to find a therapist in your region who you feel can help you? If you’ve got a great therapist, but you move out of state — even temporarily (e.g., for school) — there’s a chance that therapist will no longer be able to see you except during your visits home. If you take a business trip or vacation to another state and you want to keep your therapy appointments while out of town, your therapist may not be allowed to see you, depending on where you’re going and where the therapist will be located at that time. Every state has their own rules about who can work with people physically located within the boundaries of their jurisdiction. You don’t even have to be a resident there. If you’re inside their borders, they make the rules.

So, that’s the bad news. You’re welcome. But guess what? There’s some really exciting good news that’s come about in the last few years, which is the existence of The Psychology Interjurisdictional Compact, or PSYPACT. Recognizing the need for greater access to psychotherapy, many states in the U.S. have introduced legislation within their state governments to make it possible for authorized psychologists to work with individuals in that state even if the psychologist is licensed elsewhere through the use of telepsychology. For example, as a psychologist licensed in the State of Washington (a PSYPACT state), I can do telehealth with people in other PSYPACT states. Although it doesn’t resolve all of the challenges for psychologists and potential patients inherent in state-based licensure, PSYPACT does significantly open up opportunities for patients to find a psychologist who feels like a good fit for them. When state lines are no longer an automatic “nope” for a therapeutic relationship, you can worry about other things. I think that’s pretty cool.

As for which states are part of the compact, at the time of this write-up, the following states are participating in PSYPACT, at this time:

• Alabama
• Arizona
• Arkansas
• Colorado
• Commonwealth of the Northern Mariana Islands
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Idaho
• Illinois
• Indiana
• Kansas
• Kentucky
• Maine
• Maryland
• Michigan
• Minnesota
• Mississippi
• Missouri
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

Do you see your state or territory on this list? Terrific! If you think you would like to do psychotherapy with me, please feel free to contact me. I’d love to hear from you.

If your state is not on the list, you can contact representatives of your state legislature. They’re the ones who decide whether to participate or not. For updates, you can visit the PSYPACT Map page.

I hope you’ve found this article helpful. There are some terrific psychotherapists out there. Through PSYPACT, getting access to them just got a lot easier.

Thank you for reading. Be kind to you.

Dr. A.