Psychology Licensing
Last year, after PSYPACT legislation died in California, I began the process of getting licensed in additional states. I am excited to share that I am now licensed in Texas, Washington, and Virginia, with a possible 1-2 more coming in the next year. During this process, I realized that many patients do not know what this means or what PSYPACT is, so here is a brief explainer.
What is PSYPACT?
PSYPACT is based on state-specific legislation developed to help psychologists practice across state lines. As telehealth gained traction and various states experienced shortages of mental health providers, this legislation was introduced to increase access to providers for patients in areas without enough psychologists. Prior to PSYPACT, providers could only provide mental health services within the state where they were licensed. So for me, being licensed in CA means I can only see clients when they are physically located in the state of CA. Over the past 10+ years, various states have signed on to PSYPACT by introducing state-level legislation saying essentially, “if you are licensed in one of these participating states, you are allowed to work with patients in our state.” You can see an interactive map of participating states here.
Why get licensed in multiple states if PSYPACT exists?
There is a caveat in the legislation that you are only eligible to sign up for PSYPACT if the state of your primary residence is participating. So while I am now licensed in PSYPACT-eligible states, I reside in CA and therefore cannot enroll in PSYPACT.
Why is CA not participating?
Ultimately, I am not the behind the scenes making these decisions, so I can’t say for sure. But I can say, it’s a difficult decision. Each state has a board of psychology (BOP) that exists to protect consumers from harm. When there is an abuse of power, fraud, unethical business practices, malpractice, etc. patients have the right to make a report to BOP of their state and have that provider investigated. So each BOP creates a list of legal and ethical requirements and expectations from their licensees to limit risk of harm to consumers.
Regulating an entire field of healthcare is a big task and many BOPs have insufficient funding to keep up with demand. So there are pros and cons to opening up to PSYPACT—Pro: there are fewer administrative burdens around dispensing licenses and there are more providers available to consumers (they can shop almost anywhere in the country for a therapist). Con: it becomes less clear which BOP to report to when there is a problem. It also shifts the onus of responsibility to the individual psychologists to self-enforce knowing the laws and regulations of each state. For example, each state has different requirements around how, when, and where to report child abuse. These expectations are typically communicated by and tested for through a state’s “jurisprudence exam” or the licensing exam that focuses on laws and ethics specific to each state. This requirement is functionally removed for all PSYPACT providers—again, easier administratively for everyone, but harder to enforce and track compliance for consumer safety.
Another consideration comes in the form of what treatments are permissible in different states. For example, some states still permit conversion therapy for minors. This is a practice that is not legal in California, as research has shown it to be actively harmful to consumers. So how can the BOP protect consumers from harmful practices, like conversion therapy, if they participate in PSYPACT? If a parent in CA wants conversion therapy for their child, they could simply hire an out-of-state clinician to do it. So how does the BOP protect CA consumers from harm in this instance?
Another example is with terminology. The term “ clinical psychologist,” is regulated in CA, meaning that for someone to call themselves a clinical psychologist, they must have a doctoral-level degree in psychology and be licensed to provide mental health services. This is why many masters-level clinicians use the term “psychotherapist.” This denotes that the type of therapy is mental health (as opposed to physical or occupational), while also signaling that they do not have a doctorate. Alternately, doctoral-level researchers who are not licensed have to specify “research psychologist” to indicate that they are not licensed to provide mental health care. Alternately, in other states “psychologist” may have a broader definition (e.g., you can have a masters degree) or “clinical psychologist” is not a permissible term, as they do not have a license specifically for that. All this to say, each state defines acceptable forms of treatment, terms, and laws and regulations differently. When participating in PSYPACT, it is difficult to enforce these protective measures because it is unclear who is actually providing services within the state.
So what next?
It’s unclear. As of right now, there are 42 states and territories participating in PSYPACT, which is impressive. But overall it points to a growing tension of whether licensure should be (a) regulated and monitored state-by-state, as this seems increasingly difficult with modern technology and cross-state practices or (b) regulated on a federal level, which gets into questions of states’ rights and legal minefields. For now, it appears that a shared legislative agreement between states has been sufficient. It is currently managed by a Commission of representatives from each of the participating states that then elect a 5-member Board. How this will play out in the long-term legally and pragmatically is unclear, but if you are currently in a PSYPACT state, you can see a therapist who is licensed in any PSYPACT state. Each provider has to opt-in to participating in PSYPACT, but those who do typically include that in their advertising.
Hopefully, this empowers you to know more about what to look for when finding a therapist that is the right fit for you. If you are interested in working with me—and live in CA, TX, VA, or WA—feel free to contact me!
