I could already work with clients across Arizona. Getting licensed in other states would let me reach more people looking for the kind of trauma therapy and EMDR services I offered. It would also help with scheduling: an afternoon appointment for me could be an after-work appointment for a client farther east.
I’d been following the Social Work Licensure Compact and hoped it would make it easier for clinical social workers to practice across states. But I didn’t want to wait, so I pursued individual licenses in Oregon, Washington, and Massachusetts.
Being licensed in a state does not mean you have a practice in that state.
A license gives you legal authorization. It doesn’t give you visibility, referral relationships, or a sense of the local care landscape.
Federal telehealth guidance says behavioral health providers generally need to be licensed or otherwise legally permitted in the state where the client is located, and there are several ways to get there, including full licensure, compacts, and reciprocity. But once you’re authorized, you still have to figure out how clients and colleagues there will find you.
The referral network I had in Arizona came from years of living and working there. I knew other therapists, agencies, prescribers, treatment programs, and community resources. People had seen my work over time. They understood my specialties and knew when I might be an appropriate referral. I didn’t have any of that history in a newly licensed state.
Multi-state practice requires a multi-disciplinary network
I also realized I didn’t just need to meet more trauma therapists. I needed couples and family therapists, child and adolescent therapists, prescribers, testing psychologists, and specialists for concerns outside my scope.
A client might need help with a co-occurring concern, or couples therapy alongside individual treatment. Sometimes that means transferring care. Other times it means an adjunct provider, with consent and coordination. Either way, a referral network made up only of people who do what I do won’t work. It needs different disciplines, specialties, and levels of care, with people who understand one another’s roles.
The need multiplies with every state. Each one means finding out who does couples therapy, who sees children, who prescribes, who does evaluations. Multi-state practice doesn’t just expand the number of potential clients. It multiplies the professional relationships required to support them responsibly.
A state license didn’t make me part of the professional community.
I tried joining local listservs and Facebook groups. Some welcomed me, but others limited membership to people who lived or worked in the area. A license there didn’t make me part of the professional community.
Visibility was another problem. Google leans heavily on physical location, so an online therapist with no office in a state can be legally able to work there and still not show up when clients search. The directories I looked at had the same limit. Being visible in several states could mean separate listings, each with its own cost, and most let clients search only one state or location at a time.
That missed something important: clients who need one provider licensed in more than one state. Think of a college student who lives with family in Arizona but attends school in Massachusetts, or a seasonal resident who splits the year between two homes. They don’t need one therapist in an Arizona search and another in a Massachusetts search. They want one provider authorized in both places, and a directory that searches one location at a time makes that person hard to find.
This experience changed how I understood multi-state practice. The challenge was not only obtaining more licenses.
Providers also needed:
- A way to show all the states where they could provide care
- A way for clients to search several relevant states at once
- Professional relationships in places where they had no local history
- Referral partners who understood their specialties and scope of practice
- Multi-disciplinary connections with professionals who could address needs outside their own services
- Visibility that did not depend on maintaining a physical office in every market
Clients needed a clearer way to search for fit and continuity, not simply proximity.
While I was authorized to work in multiple states, my practices wasn’t visible and I didn’t have a network there.
That gap eventually became one of the central reasons we built Therapy Expanded.
Continue the series
Next: Convenience, Control, and the Changing Business of Online Therapy