Continuing Education & Resources for Mental Health Professionals

Practice Resources

Telephone Therapy
Excerpts from Guidelines & Recommendations

            Telementalhealth professionals should be aware of who has regulatory authority and any and all requirements (including those for liability insurance) that apply when practicing telehealth in another jurisdiction (eg. across state lines), with particular attention to the additional responsibility that might apply in mental health encounters.  (American Telemedicine Association (Oct. 2009) Recommended Standards.   Retrieved from

                When working with a client who is not in Virginia, counselors are advised to check the regulations of the state board in which the client is located. It is important to be mindful that certain states prohibit counseling by an individual who is unlicensed by that state. (Virginia Board of Counseling, Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision. PDF Guidance Document 115-1.4.  Retrieved from )

             Conducting teletherapy over state lines may pose a special challenge, as rules and guidelines for telepsychological methods already vary from state to state.    (Article published in Virginia Psychogram, Fall 2009, Vol. 34, #4 titled “Telepsychology: To Phone or Not to Phone” by A.L. Walser, M. McLain & K. Kelkar. )

             “Questions about the control or regulation of telepsychology practice remain highly fluid. One survey (Koocher & Morray, 2000) documented considerable variability across licensing jurisdictions in the United States with respect to electronic practice across state lines. With state, provincial, and territorial governments regulating professional practice within U.S. and Canadian jurisdictions, the Association of State and Provincial Psychology Boards (ASPPB) has taken the  lead in attempting to foster interstate practice and mobility credentials for psychologists in North America. However, little agreement exists regarding interstate or international telepractice, and the fundamental concepts involved challenge attempts at resolution.”  (Koocher, G. P. (2007). Twenty-first century ethical challenges for psychology. American Psychologist, July-August, 378)  

            Another major issue identified repeatedly in discussions about providing health services, including psychological services, via telepsychology, has been about the legality (and ethics) of providing services across legal jurisdictions. The majority of those who have looked at the issues of telepsychology across state lines have cautioned psychologists to practice in the states for which they have a license (Alexander, 1999; Barnett, 2005: Heinlen, Welfel, Richmond & O’Donnell, 2003; Koocher & Morray, 2000; Kraus, 2004; Maheu & Gordon, 2000; Mallen, Vogel & Rochlen, 2004). There continues to be little state regulation of telepsychology practices in general and interstate practices in particular (Alexander, 1999). Since psychologists are licensed separately by each state, providing services to someone in a state where the psychologist is not licensed may put them at both an ethical and legal risk. Frueh et al. (2000) identify that “issues related to licensure, malpractice insurance coverage, and billing may generate confusion if the clinician-provider’s practice and the patient’s domicile are not in the same state. (From “Telepsychology Guidelines,” Ohio Psychological Association, 2010.  Online at

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