Telehealth Best Practices for Therapists: Growing Your Practice Beyond Geographic Limits in 2026

Telehealth is no longer an emergency workaround. It is a permanent, powerful component of modern therapy practice. What began as a necessity during the pandemic has evolved into a strategic advantage for therapists who know how to use it well.

In 2026, the therapists thriving with telehealth are not simply replicating their in-office experience over video. They are leveraging virtual care to reach clients they never could have served before, building flexible schedules that support their own well-being, and growing practices that are not limited by the walls of a single office or the boundaries of a single state.

This guide covers everything you need to know to build a thriving telehealth practice, from clinical best practices and legal compliance to the growth strategies that set top-performing virtual practices apart.

The State of Telehealth for Therapists in 2026

The numbers tell a compelling story. According to recent industry data, approximately 60-70 percent of therapy clients have used telehealth at least once, and a significant portion now prefer it as their primary modality. Insurance payers have largely maintained telehealth reimbursement parity, and interstate practice through frameworks like PSYPACT continues to expand.

Key trends shaping telehealth in 2026:

• Hybrid models dominate. Most successful practices offer both in-person and virtual options, allowing clients to choose based on preference and need.
• Interstate practice is expanding. PSYPACT (the Psychology Interjurisdictional Compact) now covers over 40 states and territories, allowing licensed psychologists to practice across state lines.
• Technology standards have risen. Clients expect seamless, professional virtual experiences, not glitchy connections and awkward interfaces.
• Specialization drives virtual success. Therapists with clear niches attract clients from broader geographic areas who are willing to seek out the right expert rather than the closest office.

Understanding PSYPACT and Interstate Practice

One of the most significant opportunities in telehealth is the ability to serve clients across state lines. For psychologists, PSYPACT has been transformative.

What PSYPACT allows:

• Licensed psychologists in PSYPACT member states can provide telehealth services to clients in other PSYPACT states without obtaining additional licenses.
• You apply for an E.Passport (for telepsychology) or an Interjurisdictional Practice Certificate (for temporary in-person practice) through the PSYPACT Commission.
• The process is straightforward and significantly less expensive and time-consuming than obtaining individual state licenses.

Important considerations:

• PSYPACT currently applies to psychologists. Licensed counselors, social workers, and marriage and family therapists have separate interstate compacts in various stages of development, including the Counseling Compact, which has been gaining traction.
• Even with PSYPACT, you must comply with the laws and regulations of the state where your client is located during the session.
• Verify the current list of PSYPACT member states before marketing to clients in other states, as new states join regularly.

For non-psychologist therapists:

• The Counseling Compact (for licensed professional counselors) is expanding, with multiple states having enacted legislation.
• Social work and marriage and family therapy compacts are also in development.
• In the meantime, some therapists obtain licenses in multiple states to expand their geographic reach, particularly in states with high demand for their specialty.

Setting Up Your Telehealth Technology Stack

A professional telehealth setup is non-negotiable. Your technology is your office, and it needs to feel polished, reliable, and secure.

Essential technology components:

• HIPAA-compliant video platform. Use a platform specifically designed for healthcare. Popular options include the telehealth features built into EHR systems like SimplePractice, TherapyNotes, or Jane App, as well as dedicated platforms like Doxy.me. Avoid consumer video tools like regular Zoom (the Zoom for Healthcare version is compliant) or FaceTime for clinical sessions.
• Reliable internet connection. Invest in high-speed internet with at least 25 Mbps upload and download speeds. Consider a backup mobile hotspot for emergencies.
• Professional audio and video equipment. A quality external webcam, a dedicated microphone or headset, and proper lighting make a meaningful difference in how clients experience sessions. Ring lights or desk lamps positioned in front of you eliminate shadowy, unflattering video.
• Quiet, private space. This seems obvious, but it matters enormously. Your background should be clean and professional. Use a physical office, a dedicated home office with a lock, or at minimum a consistent, private space.
• Digital intake and consent forms. Ensure your telehealth consent form specifically addresses the unique considerations of virtual therapy, including technology failures, emergency protocols, and confidentiality limitations.

Clinical Best Practices for Virtual Therapy

Effective telehealth therapy requires some adjustments to your clinical approach. The therapeutic relationship remains paramount, but how you build and maintain it shifts in a virtual environment.

Building rapport through a screen:

• Make intentional eye contact. Look at your camera, not the screen, when speaking. This creates the sensation of direct eye contact for your client.
• Use verbal tracking more actively. Nonverbal cues are harder to read on video. Increase your use of verbal reflections, summaries, and check-ins to ensure clients feel heard.
• Address the technology directly. Normalize the experience by acknowledging when technology creates awkward moments. "It looks like we had a brief freeze there. I want to make sure I caught everything you said" goes a long way.
• Be mindful of fatigue. Both you and your clients may experience "Zoom fatigue." Consider offering 45-minute sessions or building longer breaks between appointments.

Safety and crisis planning:

• Obtain the client's physical location at each session. This is essential for emergency response. If a client is in crisis, you need to know exactly where they are.
• Maintain updated emergency contacts. Have local emergency resources for each client's location readily accessible.
• Develop a technology failure protocol. Decide in advance what happens if the connection drops. Most therapists establish a rule: "If we lose connection, I will call you at the phone number on file within two minutes."
• Know your limitations. Some presentations and crisis situations are better served in person. Have clear criteria for when you recommend a client transition to in-person care.

Adapting therapeutic techniques:

• Screen sharing for psychoeducation. Use screen sharing to walk through worksheets, diagrams, or educational materials together in real time.
• Digital whiteboards. Tools like virtual whiteboards can replace the physical whiteboards many therapists use in session.
• Asynchronous resources. Between sessions, share articles, worksheets, or guided exercises through your secure client portal.
• Creative adaptations. For expressive therapies, ask clients to gather materials before sessions. For EMDR, bilateral stimulation can be delivered through specialized apps or audio.

Growing Your Practice Through Telehealth

Telehealth is not just a service delivery method. It is a growth strategy. Here is how to leverage it effectively.

Expanding your geographic reach:

• Market to underserved areas. Many rural and suburban communities lack access to specialized therapists. Your telehealth services can fill that gap.
• Target niche populations nationally. If you specialize in a specific issue, such as perinatal OCD, clergy burnout, or physician wellness, telehealth allows you to serve a national client base rather than relying solely on local demand.
• Optimize your online presence for virtual care. Make it clear on your website that you offer telehealth, which states you serve, and how easy it is to get started.

Operational advantages of telehealth:

• Reduced overhead. A fully virtual practice eliminates or dramatically reduces office rent, one of the largest expenses in private practice.
• Increased scheduling flexibility. Without commute times or office constraints, you can offer sessions during hours that work best for both you and your clients.
• Lower no-show rates. Multiple studies have shown that telehealth appointments have equal or lower no-show rates compared to in-person sessions, likely because the barrier to attendance is lower.
• Scalability. Adding capacity to a virtual practice does not require finding a larger office. It simply requires managing your schedule and potentially bringing on additional clinicians.

Building a hybrid practice model:

Many therapists find that the ideal approach is a combination of in-person and virtual services. Here is how to structure this effectively:

• Designate specific days for each modality. For example, Mondays and Wednesdays in the office, Tuesdays and Thursdays virtual.
• Let client needs guide the modality. Some clients benefit from starting in person and transitioning to telehealth once rapport is established. Others prefer virtual from the start.
• Use telehealth as a continuity tool. When clients travel, relocate (within your licensed states), or face temporary barriers to in-person attendance, telehealth prevents disruptions to care.

Marketing Your Telehealth Services

Clients searching for virtual therapy use different search terms and have different concerns than those looking for in-person care.

SEO strategies for telehealth:

• Target location-specific telehealth keywords. "Online therapist in [state name]" and "telehealth therapy [state]" are high-intent search terms.
• Create content addressing telehealth-specific questions. Blog posts like "What to Expect in Your First Online Therapy Session" or "Is Virtual Therapy as Effective as In-Person?" build trust and attract search traffic.
• List yourself in online therapy directories. In addition to Psychology Today, platforms like Alma, Headway, and Grow Therapy connect clients specifically seeking virtual care.

Addressing client hesitations:

• Effectiveness concerns. Share that research consistently shows telehealth therapy produces comparable outcomes to in-person therapy for most presenting issues.
• Technology anxiety. Offer a brief "tech check" before the first session to help clients feel comfortable with the platform.
• Privacy concerns. Explain your HIPAA-compliant technology and give clients tips for finding a private space in their home.

Common Mistakes to Avoid

As you build your telehealth practice, be aware of these frequent pitfalls:

• Ignoring state licensing requirements. Practicing across state lines without proper authorization puts your license at risk. Always verify your legal standing.
• Using non-compliant technology. A HIPAA Business Associate Agreement (BAA) with your video platform is not optional. It is a legal requirement.
• Neglecting your physical setup. Poor lighting, distracting backgrounds, and bad audio undermine your professionalism and the therapeutic experience.
• Failing to update consent forms. Your informed consent should specifically address telehealth, including risks, benefits, technology protocols, and emergency procedures.
• Underpricing virtual sessions. Some therapists charge less for telehealth, assuming it is "less than" in-person therapy. The clinical value is equivalent, and your pricing should reflect that.

Looking Ahead: The Future of Telehealth in Therapy

The trajectory is clear. Telehealth will continue to expand and evolve. Therapists who embrace it strategically, investing in their technology, their clinical skills, and their online presence, will be positioned to grow their practices in ways that were not possible even five years ago.

The opportunity is not just about convenience. It is about access, reach, flexibility, and building a practice that works for your life as much as it works for your clients.

At Therapist Growth Partner, we help therapists build and optimize telehealth practices that attract clients, comply with evolving regulations, and scale sustainably. Whether you are launching a virtual practice from scratch or adding telehealth to an established in-person practice, our team can help you navigate the technology, marketing, and strategy to make it work. Reach out to learn how we can support your telehealth growth.