In most states, laws defining acceptable practice for behavioral telehealth practitioners are antiquated, contradictory and confusing.
If José were to visit his mother in Florida because of her serious illness, for example, his regular Thursday therapy appointment with his psychologist in San Francisco cannot be conducted over videoconferencing or telephone without being in violation of both California and Florida state law. Of course, as soon as his psychologist violates state law, she is automatically in violation of professional association ethics codes, too.
In this case, if the therapist were to receive an emergency call from José during his visit to Florida, the therapist would most likely be able to legally take the call, but it would have to be limited to solving the emergency at hand, rather than focusing on José’s regular therapeutic process.
What about all the consumers finding therapists online who are licensed over state and international borders? A number of online counseling companies have hired licensed clinicians who don’t realize that they are in direct violation of state law. Such violations are occurring every day by a large number of residential care facilities who use Skype or other online video channels to conduct family visits.
How can so many licensed professionals be breaking such important laws? Most therapists have not undergone specific telehealth training, despite requirements by their ethical codes that they be competent in all services delivered. Many online companies are well aware of these facts, but look the other way, or worse yet, intentionally recruit naïve therapists who are eager to develop an income stream through the Internet.
These therapists shoulder all the risk, and in some cases, through contract language even indemnify the company for any trouble caused by their violation of relevant laws. Unfortunately, policing of licensees and professional education are not the purview of licensing boards, so they have to wait for someone to get hurt and file a complaint before invoking the law.
Don’t agree? You’re not alone
Regulators will be the first to tell you that state licensing laws no longer make sense, but the process of changing the law is much more complicated than many would imagine. State laws were not designed to address the current capabilities of technology, and new laws are being considered to accommodate it, but take years and herculean efforts to change. Meanwhile, practitioners who attempt to practice legally and ethically have been chaffing under the yolk of undue restrictions since the rise of the internet. As a result, current laws not only make little sense, but many practitioners aren’t following them.