All I need is affordable, mobile, professional therapy I can access from anywhere. Is that so much to ask?
In my last post, I talked about realizing how difficult it is to find therapy as a digital nomad in the US due to location-based licensing restrictions. Naïve me thought that in a post-COVID world, all I had to do was log on to a therapy platform and get matched. Nope!
In reality, mental healthcare in America is still heavily location-based.
Before I move on with sharing how I (hopefully) find a therapist as a digital nomad, I'm going on a quick sidetrack, because something is really bothering me.
COVID and emergency licensure
During COVID, most states declared a state of emergency and extended emergency licenses to therapists and other healthcare professionals. This allowed them to take on clients and offer healthcare services across state borders. Fast-forward three years later, and many states have rescinded those emergency measures.
Here's an updated list of interstate healthcare waivers, in case you're interested. Of the three states left with active waivers, Indiana's and Texas's will expire expire this month, and New Hampshire's in June.
Twenty-one states actually have active long-term or permanent out-of-state telemedicine policies (you can see the whole list here). But these laws vary by state and have a wide range of requirements, additional licensing fees, and limitations. Some states, like Utah, only allow therapists to offer temporary counseling to clients relocating out of state. Others offer reciprocal licenses to professionals in neighboring states (Virginia, Maryland, and Washington D.C.).
Well, what about teletherapy?
I was talking to a friend recently who just saw a new therapist on a big teletherapy platform and didn't click with them. She's moving states soon and I reminded her that she'd have switch providers when she moved anyway. She had no idea what I was talking about.
And that made me wonder: how obvious are teletherapy platforms actually making those restrictions? I didn't recall anything from my experience with BetterHelp. In fact, it took a therapist saying "sorry, no" for me to realize how difficult this process could be.
So I decided to dig into the websites and messaging of the top three platforms: BetterHelp, Talkspace, and Cerebral.
I wondered if I'd just failed to notice some mention of location restrictions on BetterHelp's website, but after a second look, I couldn't find anything on any major page like the Homepage or Therapist Jobs page.
After a few Google searches, I did stumble across an older Ask A Therapist answer that was good advice at the time, but may no longer apply (depends on the state).
Intake process: When I first signed up to the platform to find a therapist, the in-depth intake form didn't include any mention of location-based therapy. But it did ask me to state my current country and state.
I had a little more luck with Talkspace, but the messaging was...subtle, to say the least. Their main therapy page just says "find a licensed therapist near you," and their About Our Providers page only talks about professional qualifications.
Interestingly, their main page for providers does include a location-based disclaimer, as does this blog post about the benefits of working with the platform. There are more mentions if you dig through Help pages on their mission and how the services work.
Intake process: The first part of the intake form included a few questions about my mental health and the type of therapist I was looking for —and requested my state of residence.
Finally, I looked at Cerebral's website and messaging. Similar to Talkspace, Cerebral offers some level of medication support alongside therapy services, though theirs is more of a mix-and-match subscription.
Yet, again, there's no explicit mention of location restrictions on their Homepage, Plans page, Therapy page, or even the Terms and Conditions. I did find a Featured Snippet about prescribing providers and state restrictions, but that's the closest I got.
On the FAQ page, there are a few "X plans are available in all states but capacity will differ," or "therapist capacity and selection will differ by state," but again, nothing is stated outright.
Intake process: The first prompt was to give my zip code so they could determine that services are available in my area.
So, now the question:
Why are the top three biggest teletherapy platforms so shy about mentioning location-based therapy restrictions?
There could be a number of reasons, of course:
- They're waiting until all states' state of emergency interstate telehealth waivers become inactive in the next month or two.
- They have a lot of providers with multiple state, interstate, or reciprocal licenses and want to keep messaging open to attract more clients.
- They rely on their intake process of matching clients by current state and insurance provider
- Therapists or clients are under a mistaken impression that the platform has sufficient insurance to cover them in case of a violation (which in all fairness, was true for some during the pandemic)
Once the platform has done it's due diligence in hiring state-licensed professionals and connecting them with resident clients, perhaps that's where their due diligence ends. After all, they can't be held responsible if a client doesn't update their address when they move, right?
Maybe not, but I find it a bit concerning that there's a real lack of clear information about what therapy looks like for people who travel for work post-pandemic. It's easy to dismiss people like me because I'm in the tiny minority of US-based digital nomads.
But what about traveling nurses? Or people who have recently moved to a state their therapist isn't licensed in? Or those who have to follow new jobs to different parts of the country every few years?
We live in a much more mobile world than we did three years ago and the temporary flexibility we were allowed during the pandemic has now expired.
We need a better solution.