Legally Practicing Across Borders: Interstate and International Mental Health Practice, During and Post-COVID

Course Materials

Unit 1: Why Worry?
Unit 2: COVID and the States
Module 1 Wrap Up
Module 2: Interstate Temporary and Emergency Practice
Unit 3: State of Confusion
Unit 4: COVID Concerns
Module 2 Wrap Up
Module 3: Legal-Ethical Issues and Risk Management in International Practice
Unit 5: When in Rome, Tokyo, Sydney...
Unit 6: Specific Examples
Module 3 Wrap Up
Course Wrap-up


  1. Why do we even have to worry about cross-border/interjurisdictional practice?
    • The role of licensing boards in the US.
    • When and how foreign licensing board rules come into play.
    • Concrete risks in illegal cross-border/interjurisdictional practice.
  2. Changes to interstate practice due to COVID-19
    • The cascade of executive orders.
    • Where emergency practice allowance stands now.
    • A survey of a few states’ executive orders which impact out-of-state practice.
  3. Getting answers about practice in foreign jurisdictions
    • The info items a therapist needs to know about practice in a foreign jurisdiction to determine if it is legal to work from there or with clients there — even after COVID-19 ends.
    • A process for getting these answers from US states during and after COVID-19.
    • A process for getting these answers in nations outside the US.
    • PSYPACT and similar efforts to reduce jurisdictional barriers during and after COVID-19.
  4. Legal-ethical issues arising when the COVID-19 emergency ends
    • Taking new clients in jurisdictions where your allowance to practice is only temporary.
    • Changes to the practice landscape after declarations of emergency lapse.
  5. Working with clients in foreign nations
    • The difference between practice being permitted and practice not being forbidden.
    • Some risks and benefits of Roy’s telepractice in Japan.
    • A demonstration of finding potential information sources in nations where government websites are not written in English, or where information about practice licensure/registration is not findable.
  6. Working with clients in US states where one is not licensed
    • Some specific state boards without any temporary practice allowance of any kind, and how we discovered that fact.
    • Some specific state boards with temporary practice allowance rules that goes back to pre-COVID times, and how we discovered that fact.
    • Some specific states with emergency temporary practice allowance as a response to COVID, and how we discovered that fact.
    • Some specific state boards that restrict the ability of therapists to work with clients while the therapist travels out of state.

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