Questions? We have answers

1. Can I provide services to an existing client who may be temporarily in another state?
2. My state adopted PSYPACT. Can I provide services to patients who are out of state?
3. My state has not adopted PSYPACT. Can I provide services to a patient who is in a PSYPACT state?
4. My patient moved to another state permanently. Can I continue to provide services to that patient via telehealth?
5. Can I continue to provide services to a patient who is either temporarily or permanently in another country?
6. I will be temporarily out of state (e.g., for vacation, business, or a family visit). Can I provide services to my patients who are still in my home state via Telehealth?
7. I will be moving permanently from state A to state B. Can I continue to work via telehealth with patients in state A when I am living in state B?

Can I provide services to an existing client who may be temporarily in another state?

You may be able to provide services in other states by way of the Psychology Interjurisdictional Compact (PSYPACT), a state telehealth provider registry (e.g., Arizonaopens in new window and Floridaopens in new window), or a specific state law allowing for temporary practice by an out-of-state licensed provider. Temporary practice laws allow psychologists licensed in one state to practice for a limited amount of time in another state (e.g., 20 days per year) and may specify additional requirements such as obtaining a temporary permit or license. However, not all states allow for temporary practice. For information about another state’s temporary practice laws or telehealth provider registry law, please contact the state’s board of psychology.

My state adopted PSYPACT. Can I provide services to patients who are out of state?

The Psychology Interjurisdictional Compact (PSYPACT) is a multistate licensing compact allowing a psychologist licensed in a state that has joined PSYPACT to provide telepsychological services or temporary in-person services (up to 30 days per year) to patients in other PSYPACT states. A licensed psychologist in a PSYPACT state would need to obtain authority to practice through the compact by either applying for an E.Passport for telepsychology practice or an Interjurisdictional Practice Certification for temporary, in-person practice.

The psychologist would also need to abide by the regulations set by the PSYPACT Commission. Information about how to apply for authority to practice under PSYPACT and PSYPACT Commission rules for practice is available on the PSYPACT websiteopens in new window.

My state has not adopted PSYPACT. Can I provide services to a patient who is in a PSYPACT state?

PSYPACT facilitates interstate practice among those states that have joined the compact. Therefore, both the psychologist and the patient have to be in PSYPACT states for the psychologist to be able to provide services through PSYPACT.

Otherwise, the psychologist will need to comply with the other state’s policies allowing for temporary practice or establishing a telehealth registry for out-of-state providers, if any.

My patient moved to another state permanently. Can I continue to provide services to that patient via telehealth?

The interstate practice rules regarding PSYPACT and telehealth registries apply whether your patient is out of state temporarily or permanently. A state’s temporary practice provisions are not intended for long-term therapy. There may also be clinical issues to consider. If a patient is moving permanently out of state, they may benefit from transitioning their care to a psychologist in their new state of residence.

Can I continue to provide services to a patient who is either temporarily or permanently in another country?

You should be licensed or legally permitted to practice in the jurisdictions where both you and your patient are located, respectively. This includes international practice. It can be challenging, however, to determine the licensing laws (if any) in some foreign countries. Checking with the national psychological association in that country is a good place to start.

Clinical issues and patient welfare should also be considered. For example, will the time difference make treatment inconvenient? Will cultural issues be an important factor? Are there skilled therapists in the country where the patient is living? What are the local resources available if the patient were to be in crisis and need emergency services? In addition, there may be specific patient data privacy and security requirements that must be followed in that country.

I will be temporarily out of state (e.g., for vacation, business, or a family visit). Can I provide services to my patients who are still in my home state via telehealth?

You should be licensed or legally permitted to practice where both you and your patient are physically located when services are provided because you are arguably practicing psychology in both of those places.

Most states clearly consider you to be practicing psychology where the patient is located. Some states also consider you to be practicing psychology where you are located. Please check with the relevant state’s board of psychology to find out its rules for this situation.

I will be moving permanently from state A to state B. Can I continue to work via telehealth with patients in state A when I am living in state B?

As mentioned above, you could be considered practicing psychology where you are located, even if your patients are in a different state.  Maintaining your licensure in state A will allow you to continue working with patients in state A from that jurisdiction’s perspective.

If you are permanently living in a new state, it may be worthwhile to get licensed in that state. Licensure in your new state gives you clear authority to practice there. It also allows you to treat patients who live in your new state.

Whether you are considering interstate or international practice, it is always worthwhile to contact your malpractice company for a risk management consultation. The Association of State and Provincial Psychology Boardsopens in new window might also be a helpful resource.

1. I have been asked to release my client's records in connection with a legal proceeding, such as a lawsuit. Can I release the records if the client does not give consent?
2. The parents of my client would like to discuss my client's treatment, and the parents are divorcing. Mom is paying for my services. What should I do?

I have been asked to release my client’s records in connection with a legal proceeding, such as a lawsuit. Can I release the records if the client does not give consent?

In most states, you cannot release client records or testify without obtaining your client’s consent unless the request is a court order signed by a judge. There is a distinction between a subpoena and a court order that is critical to understand. 

Court order: A court order, issued and signed by a judge (not a judge’s clerk or an attorney) is a document that legally compels you to disclose information. If you receive a document identified as a court order on the first page and signed by a judge, you are generally required to comply. Still, you should attempt to only disclose the minimum necessary information as specified in the order.

If you are not sure whether the document is a court order, you may contact the court that issued the document and ask to speak to the judge’s clerk for clarification.

Subpoena: A subpoena, especially the first subpoena you receive in a matter, is typically not a court order. A subpoena is a demand for information issued by an attorney or a court clerk. Unless it is a court order, a subpoena generally requires client consent or authorization before you can release confidential information.

As a psychologist, you are likely a HIPAA-covered entity (e.g., a health care provider who electronically submitted information in connection with a 3rd party payment). If so, you must obtain a HIPAA-compliant written authorization from your patient to release specified information to a third party in this scenario. HIPAA authorization forms have specific requirements to be valid:

• A description of the protected health information to be used and disclosed
• The name(s) or other specific identification of the person(s) or class of persons authorized to make the requested use or disclosure
• The name(s) or other specific identification of the person(s) or class of persons to whom the covered entity may make the disclosure
• An expiration date or expiration event that relates to the individual or the purpose of the use or disclosure
• The signature of the individual and the date (or their personal representative)
• In some cases, the purpose for which the information may be used or disclosed

Note on Psychotherapy Notes: Psychotherapy notes have heightened protection under HIPAA. You must obtain a separate and specific HIPAA authorization from your client to release them. This is true even if the client has signed a general authorization for their other medical records.

If you are not covered by the HIPAA Privacy Rule, your state may require client consent to be in writing. While written consent is not required in all states, written consent is highly recommended to ensure that the client is making an informed decision and provides you with documentation for future reference. When obtaining consent, clearly explain:

• Exactly what information has been requested
• To whom the information will be disclosed (for example, to the requesting attorney)
• The purpose of the disclosure (e.g., to respond to a subpoena)
• That there is no guarantee that the information will remain confidential once disclosed
• The client's signature and date

If your client has an attorney, it is important to discuss the subpoena with the client’s attorney after you receive appropriate client consent to do so.

The parents of my client would like to discuss my client’s treatment, and the parents are divorcing. Mom is paying for my services. What should I do?

Sometimes it is complicated to determine who has authority to consent, especially in child custody cases. If it is unclear who has that legal authority in your situation, you may need to obtain additional guidance, such as from your malpractice insurer or an attorney in your state.

1. My client is threatening to do harm to self or others. What can I do?
2. My client is posting derogatory comments about me online that are not true. What can I do? What can I do about negative online reviews about my services?
3. Can I terminate a client if I determine that my services are not the best fit? Can I terminate a client if the client does not pay or show up for appointments?

My client is threatening to do harm to self or others. What can I do?

The 1976 “Tarasoff” case set the precedent on the legal mandate known as the “duty to protect” or “duty to warn” obligating practicing psychologists to use reasonable care to protect the intended victim against danger. This may include warning the victim or others likely to inform the victim of the danger, notifying the police, or taking any other reasonably necessary precautions.

It is most important that psychologists remain aware of relevant existing state laws, including case, statutory, and common law. Duty to protect statutes have been enacted in many states. Since statutory details vary from state to state, psychologists should refer to their state laws for guidance on circumstances where the duty may arise and necessary actions the duty may entail.

See the Mandatory Reporting page for additional information.

My client is posting derogatory comments about me online that are not true. What can I do? What can I do about negative online reviews about my services?

See Taking charge of online reviews for guidance on navigating negative online comments/reviews.

In instances of fake reviews or the individual not being a client, it may be helpful to check the site’s policy about having the review removed. However, it might require proof that it is a fake review.

It is good practice to use the same protocols whether or not it involves an established patient. Should you decide to respond, you should be generic and not acknowledge the individual personally.

Here is an example of a potential response to a review regarding unreturned calls: “It is our policy to answer all inquiries within x hours/days. We routinely verify that we follow up on all inquiries made to our office using the contact information that is provided. We encourage any who did not receive a call from us to please call us back so that we may try to be of service.”

Another good strategy is to ignore it. Seeing negative comments can be frustrating, but the actual impact is likely nil. People do not rely on such reviews to make decisions about professional services and research shows that they likely are not reliable. They are usually used to express happiness or dissatisfaction with a service or product.

Can I terminate a client if I determine that my services are not the best fit? Can I terminate a client if the client does not pay or show up for appointments?

The APA Ethical Principles of Psychologists and Code of Conduct (Ethics Code) provides a framework and guidance for handling treatment terminations. Specifically, Ethics Standard 10.10 (Terminating Therapy) addresses terminations as follows:

• Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.

• Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.

• Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

Many states have adopted the APA Ethics Code or similar ethical standards or rules of professional conduct for psychologists. Furthermore, some states have adopted specific statutes, regulations, or case law prohibiting abandonment. In general, psychologists are both ethically and legally required to terminate service in a manner that does not constitute abandonment of the patient.

1. My patient filed a bogus complaint about me with my state licensing board. Can I speak with an APA attorney?
2. The state licensing board is asking for a response to a complaint filed against me because my license lapsed. What can I do?

My patient filed a bogus complaint about me with my state licensing board. Can I speak with an APA attorney?

If a complaint has already been filed and therefore active, the psychologist would need to retain a licensed attorney in their state with experience with licensing board complaints, preferably with a background in psychology or mental health boards. Complaints require a response within a specified timeframe, and an attorney can offer guidance on how to respond to the complaint.

The psychologist should contact their professional liability carrier for risk management guidance and possible referrals to an appropriate attorney. Many malpractice policies provide coverage for the defense of licensing board complaints. Alternatively, the psychologist can contact the Bar Association in their state for attorney referrals.

The state licensing board is asking for a response to a complaint filed against me because my license lapsed. What can I do?

APA cannot answer specific licensing questions. Psychologists should contact their professional liability carrier. There may be rules governing the reinstatement of licensure in the state licensing regulations.