Teletherapy has been a lifeline during the pandemic, but as mental health professionals shift our work online, we have run into licensing laws that impede us in meeting the growing demand for mental health services. In fact, these outdated laws are actively undermining our ability to help.
In over a decade of working as a mental health therapist in Northern Virginia, I have worked with clients who live or work throughout the Washington metropolitan area. It is not uncommon for clients to travel around the Beltway to seek the services of a professional who either has a specialty they are seeking, takes their insurance, has an opening, or is conveniently located near their work. In “normal” times, this is not a problem: As long as clients come to me in Virginia, where I am licensed, I may work with them. But during the pandemic, I am only seeing clients online, and Washington, D.C., severely restricts my ability to talk online with its residents at their homes without a D.C. license.
This is a time of unprecedented need for mental health services, and I have been contacted by people in the district who are asking for help. Some needed immediate help. But because of the district’s licensing laws, I had to tell them no.
As a professional counselor, my job is to help people, and I’ve spent a lot of time and effort learning how to do just that. For me, there is nothing worse than seeing a need and having to turn a person away.
That is why I have joined up with the Institute for Justice, a public interest law firm, to file a lawsuit challenging the district’s licensing laws. Our legal claim is simple: As a professional counselor, I use words to help people, and under the First Amendment, the government cannot prohibit unauthorized talking.
Words are the basic tools I use to provide my services. I talk, I listen, and I use my words to help. Ironically, though, Washington penalizes me for my advanced training in how to use words. Only therapists with advanced degrees and training are required to obtain a license to talk to others about their feelings.
And while we have started by suing Washington, D.C., the same is true across the country. Seeing clients online, I can provide exactly the same experience whether someone is located in Virginia or in any other state. When someone contacts me looking for help, I shouldn’t need to consult an attorney to figure out if it is legal to talk.
Licensing laws are a patchwork, with each state adopting its own restrictions. It is hard even to keep track of what each state requires, let alone comply. And a violation is no laughing matter. Unlicensed practice can bring stiff fines or even time in jail.
These kinds of restrictions would be bad at any time, but they are a particular problem during the pandemic, when, as the Washington Examiner reported, we are seeing an unprecedented need for mental health services. This is a hard time for everyone. In the mental health community, we are hearing from people who are struggling with deaths in the family, with the pressures of isolation and loneliness, and with increased burdens that come with remote school, job losses, and other dislocations of the pandemic.
Some states have adopted temporary waivers of licensing requirements during the pandemic. But for counselors, temporary waivers raise difficult ethical questions. One of our foremost ethical duties is never to abandon a client. So can counselors take on new clients if they know they will have to abandon the client when a waiver expires?
Moreover, these waivers are incomplete. Out-of-state counselors can practice freely in some states, can practice in limited circumstances elsewhere, and cannot practice at all in some states. For people in need, those kinds of arbitrary and unnecessary restrictions can have serious consequences.
During this unprecedented time, we need to be making mental health services as accessible as we possibly can. In fact, we should do that all the time. Yet we continue to place arbitrary and unnecessary restrictions in the way of care.
My hope, so far unrealized, is that the pandemic will become a catalyst to tear down those restrictions. Pandemic waivers show that change is possible, but we can still do so much more. There are people in need across the country, and teletherapy gives us the means to help. The law should not stand in the way.
Elizabeth Brokamp is a Virginia-licensed therapist living in Fairfax Station, Virginia.
