Continuing Therapy After a Client Relocates Across State Lines
Your client, a 34-year-old graphic designer, has attended weekly video sessions from an apartment in Richmond, Virginia, for eight months. You hold a Virginia LPC license and a Virginia-only malpractice policy; you have never been licensed in Maryland and have not practiced under any interstate privilege. The client has accepted a job in Baltimore and will move in three weeks. She plans to stay in Maryland at least nine months and wants to continue your Thursday 6:00 p.m. sessions. She says, 'It is just video, so location should not matter,' and notes that her depression has been stable: PHQ-9 of 6, no suicidal ideation, and no recent self-harm. She has a history of recurrent major depression and one psychiatric hospitalization five years ago. She will return to Virginia only for holidays. She asks you to keep seeing her without interruption and says she does not want to start over with a new therapist.
1. What licensure and legal issues must you resolve before the next session, and how should you respond to the client's belief that video therapy makes location irrelevant?
Read the worked answer
The threshold issue is the client's physical location at the time of each session, not the modality. Telemental health practice generally falls under the jurisdiction where the client is located, so a Virginia license does not automatically authorize sessions with a client sitting in Maryland. Before the next session I would verify the Maryland board's current requirements, including independent licensure, any telehealth registration, temporary practice provisions, and whether both states have implemented an interstate compact and whether I actually hold a privilege under it. I would also confirm malpractice coverage and insurance-panel credentialing for Maryland. I would explain to the client that 'video' does not create an exception: practicing without authorization can expose her to interrupted care, expose me to board action, and may affect reimbursement. If authorization is unavailable, I would not conduct the Thursday session with her in Maryland. Instead, I would begin a planned transition, including referrals and a records-release plan. I would document the licensure check, the client's location, the informed-consent discussion, and the transition plan.
2. Assume Maryland authorization is unavailable. What should your transition plan include, and what should you avoid doing?
Read the worked answer
I would avoid abrupt termination and avoid 'one more session' after she moves, because good intentions do not create legal authority. The plan should start before the move: identify three to five Maryland-licensed providers, preferably with telehealth availability and experience with recurrent depression; offer a warm handoff with the client's written authorization; provide a treatment summary and records; and confirm the new provider accepts her insurance or discuss self-pay options. I would update the safety plan with Maryland-specific resources, including 988, local mobile crisis, and the nearest emergency department, and confirm her emergency contact. I would clarify that I can continue sessions only while she is physically in Virginia, such as during a documented holiday visit, if my license and policy cover that session. I would set a termination date, review progress and relapse-prevention skills, and document the referrals, authorizations, and client's response. If she deteriorates during transition, I would arrange urgent local evaluation rather than extend unauthorized care.
3. What should be documented about the location-verification and informed-consent process, and why does that documentation matter?
Read the worked answer
Documentation should show that I verified the client's physical location at the start of each session, checked the licensing rules for that location, and discussed the limits of confidentiality and emergency response in the new state. It should include the dates of the licensure inquiry, the names of board representatives or written sources consulted, the malpractice-coverage confirmation, and the client's understanding of why sessions cannot simply continue. I would record the updated informed consent, including emergency contacts, local crisis resources, technology risks, and the possibility that a session may need to be rescheduled if she is traveling. If a session occurs while she is in Virginia, I would document that location specifically. This record matters because it demonstrates that the decision was based on jurisdiction and client safety, not convenience, and it creates a defensible account if a board, insurer, or licensing authority later questions the care.