Psychologists have long faced a structural barrier: the inability to continue seeing clients across state lines. PsyPact, now active in 41 states plus Washington, D.C. as of this writing, provides a lawful pathway for licensed psychologists to maintain telepsychology services when clients cross borders, and to engage in limited in-person practice under a regulated framework. (PsyPact, n.d.; APA, 2018) Without it, clients and therapists alike remain constrained by geography rather than clinical need.
Imagine a business executive who maintains a weekly therapy appointment to manage stress and decision fatigue. If she travels to a non-PsyPact state on a long trip, she cannot legally continue with her regular therapist. Her progress stalls, her coping buffer weakens, and she loses a key part of her support at exactly the time she needs it most.
Consider an athlete who regularly competes in different states. His mental conditioning, anxiety management, and performance mindset are part of an integrated plan developed over months. Disrupting that plan for a game or tournament out of state severs the thread. He either pauses therapy or starts with a new, short-term provider who lacks the history and nuance of his unique situation.
A touring musician or actor faces similar disruption. An actor cast for three months in a non-PsyPact state may find his mental health care suspended, just as stress, role demands, deadlines, and public scrutiny intensify. The result is a forced therapeutic hiatus during the most vulnerable stretch of production or finding a short-term alternative, which is an unnecessary disruption in his therapy. Bouncing back and forth between therapists is not a best practice of care.
A college student is another typical example. A student moves for school across state lines after beginning therapy while living at home. If the school’s state does not participate in PsyPact, the student must either terminate treatment prematurely or attempt to switch therapists at a time of heightened emotional need precisely when stress is spiking
The cost of discontinuity is not trivial. Therapeutic progress depends on consistent contact, trust, and responsiveness to emergent changes in life context. In a large study of psychotherapy transitions during the COVID-19 shift, patients exhibited fewer disruptions—fewer gaps of over 45 days between appointments—when telehealth was available (Ahmedani et al., 2023). The ability to preserve contact across distance matters for stability. Continuity of care is strongly associated with better outcomes, fewer relapses, and stronger alliances (Galvin et al., 2022).
A recent analysis at federally funded health centers showed that patients using telehealth had higher odds of continuity in counseling services compared to nonusers (Picillo et al., 2025). That is, telehealth is not just a convenience, it is a mechanism for resiliency in care delivery. When it comes to mental health, crises, increases in symptoms, and relapse are often worsened by transitions, so the capacity to maintain the same therapeutic relationship across state lines is a public good.
With 82% of states adopting PsyPact, the holdout states that have not yet joined are not being passive, but effectively creating barriers their citizens’ mental health. This constrains access and continuity, particularly for populations who travel, relocate temporarily, attend out-of-state schools, have extended vacations, or engage in multi-jurisdictional careers. In many areas, local provider supply is insufficient. Interstate access helps fill gaps and equalize opportunity (KPI Institute for Health Policy, 2025).
Concerns about licensure integrity, oversight, or accountability are often raised, but PsyPact has been carefully structured to speak to those issues. It requires that psychologists hold a valid license in a PsyPact jurisdiction, secure an E.Passport and an Authority to Practice Interjurisdictional Telepsychology (APIT), comply with continuing technology-relevant education, and adhere to the rules and scope of practice of the client’s state (PsyPact, n.d.; ASPPB, n.d.) and have awareness and compliance with the rules of the state where the client is located. This preserves oversight and accountability while enabling mobility.
The American Psychological Association is actively educating the public and key organizations about PsyPact and its legitimacy (APA, 2024). States such as New York and Massachusetts now have active legislation under consideration. For them and all remaining states, the path is clear: adopt the compact, reduce regulatory friction, and ensure your citizens are not cut off from essential services by map lines.
Let’s use a driver’s license as an example. We take it for granted that your state license is valid in all 50 states, making it possible for you to travel freely across the country. Now imagine being in a state like Montana and wanting to travel to Oregon, but Idaho doesn’t recognize your license. Look at a map of the country: now you have to drive through Wyoming, into Utah, then Nevada, then finally to Oregon. It makes little sense. Now imagine trying to navigate good continuity of care for existing clients or offering access to people who are underserved with such an unreasonable constraint, particularly in this highly mobile, technologically-connected culture.
The time for all states to join PsyPact is now. Clients deserve continuity of care. Therapists deserve a working structure that reflects the reality of modern mobility. States deserve to enhance public mental health capacity without compromising standards. Let no state delay the adoption of PsyPact any longer.
The good news is that Southeast Psych Nashville has several providers who are PsyPact approved who can serve clients across 41 states. If you are in other states and you are highly mobile or in transition, you may want to check out the PsyPact providers near you. The link below can help you with this.
Search for a PsyPact Provider here: https://directory.psypact.gov/
References
Ahmedani, B. K., et al. (2023). New research finds greater continuity of psychotherapy after shift to telehealth. Psychiatric Services. Retrieved from https://www.psychiatry.org/news-room/news-releases/continuity-of-psychotherapy-with-telehealth (American Psychiatric Association)
American Psychological Association. (2018). Telepsychology and the Psychology Interjurisdictional Compact. Retrieved from https://www.apa.org/members/content/interjurisdictional-compact-telepsychology (American Psychological Association)
APA. (2024, January). What’s ahead for clinical practice? APA Monitor. Retrieved from https://www.apa.org/monitor/2024/01/trends-telehealth-new-normal-technology (American Psychological Association)
ASPPB. (n.d.). E.Passport / practicing telepsychology under PSYPACT. Retrieved from https://asppb.net/credentials-related-records/epassport/ (asppb.net)
Galvin, E., et al. (2022). Patient and provider perspectives of the implementation of telemental health. Journal of Psychiatric Practice, 28(1). (ScienceDirect)
Picillo, B., Yu-Lefler, H., Bui, C., Wendt, M., Sripipatana, A. (2025). Telehealth-facilitated mental health care access and continuity for patients served at federally funded health centers. Telemedicine and e-Health, 31(7), 838–847. https://doi.org/10.1089/tmj.2025.0011 (PubMed)
PsyPact. (n.d.). Psychology Interjurisdictional Compact (PsyPact) – practice Overview, legislative resources, FAQs. Retrieved from https://psypact.gov/ (psypact.gov)
KPI Institute for Health Policy. (2025). Expanding access to mental health care through interstate compacts. KPI Institute. Retrieved from https://www.kpihp.org/blog/expanding-access-to-mental-health-care-through-interstate-compacts/ (kpihp.org)
