Accessing affirming and culturally competent therapy is a challenge many people face, but for communities like polyamorous individuals, kink practitioners, LGBTQ+ people, and sex workers, the struggle is often even greater. These groups frequently live in areas where local therapists lack understanding or even hold biases against their identities and practices (Kolmes, Stock, & Moser, 2006).
The Interstate Counseling Compact (commonly known as the Therapy Compact) is a new initiative that has the potential to change this landscape. Once fully implemented, it will allow licensed therapists to practice across state lines, offering services to clients in any participating U.S. state (National Center for Interstate Compacts, 2023). This could be a game-changer for underserved and marginalized communities, providing them with access to therapists who truly “get it” — even if they live far away.
Why Local Therapy Options Often Fall Short
For people in polyamorous, kink, LGBTQ+, and sex worker communities, finding a local therapist who is knowledgeable and non-judgmental can feel like searching for a needle in a haystack. In smaller towns and rural areas, options are especially limited. Many therapists are unfamiliar with ethical non-monogamy or kink and may pathologize these practices (Schechinger, Sakaluk, & Moors, 2018). LGBTQ+ individuals and sex workers often face similar stigma and discrimination in healthcare, including mental health services (Poteat, German, & Kerrigan, 2013).
Even when affirming therapists do exist locally, another barrier often emerges: dual relationships. In tight-knit or small communities, the few therapists who are aligned with these identities and practices are often part of the same social circles. They may know the client personally, be connected through mutual friends, or even have ties to other people in the client’s polycule, kink group, or community network. Ethical standards in counseling prevent therapists from working with clients when these overlapping relationships exist to avoid conflicts of interest (American Counseling Association, 2014). While this protects clients, it can further limit their already scarce options.
This lack of access forces many people to choose between educating an untrained therapist (often at their own expense), going without therapy, or turning to informal support networks that may not provide the same level of care. Even in urban areas, waitlists for affirming and competent therapists can be months long, leaving people without timely support.
How the Therapy Compact Can Help
The Therapy Compact aims to allow licensed professional counselors (LPCs) to practice in multiple states without needing to get a separate license for each one (National Center for Interstate Compacts, 2023). For clients, this means they can seek therapy from a provider in another state who specializes in their specific needs, without legal hurdles.
For example:
- A polyamorous person in a small town in Idaho could legally work with a poly-specialized therapist based in Texas.
- A kink practitioner in rural Alabama could receive affirming therapy from someone in California with years of experience in BDSM communities.
- A sex worker in a state with few supportive resources could access counseling from a therapist known for sex work advocacy in another region.
This not only increases access but also improves the quality of care. Rather than settling for someone nearby, clients can choose a therapist who aligns with their identities and values.
The Research: Why Affirming Care Matters
Studies consistently show that clients who belong to marginalized communities experience better mental health outcomes when they receive affirming care. LGBTQ+ clients, for example, report lower symptoms of depression and anxiety when their therapists are culturally competent (Israel, Gorcheva, Burnes, & Walther, 2008). Similarly, people practicing ethical non-monogamy benefit from therapists who understand their relationship structures and avoid pathologizing them (Schechinger et al., 2018).
Affirming care reduces minority stress, which is linked to mental health disparities in LGBTQ+ and sex worker communities (Meyer, 2003; Poteat et al., 2013). By enabling access to specialized therapists across state lines, the Therapy Compact has the potential to reduce these disparities in real, measurable ways.
A Step Toward Equity in Mental Health
While the Therapy Compact is still rolling out, its potential impact is clear: it can help bridge the gap between underserved communities and competent, affirming care. For polyamorous individuals, kink practitioners, LGBTQ+ folks, and sex workers — many of whom have been historically excluded from safe and effective therapy — this is more than a legal update. It’s a step toward health equity and justice.
By expanding the pool of available therapists, the compact empowers people to find providers who see them fully and respect their lived experiences. As more states join, we move closer to a future where affirming therapy isn’t a rare privilege — it’s a right available to everyone, no matter where they live.
References
American Counseling Association. (2014). ACA Code of Ethics. Author. https://www.counseling.org/resources/aca-code-of-ethics.pdf
Israel, T., Gorcheva, R., Burnes, T. R., & Walther, W. A. (2008). Helpful and unhelpful therapy experiences of LGBT clients. Psychotherapy Research, 18(3), 294-305. https://doi.org/10.1080/10503300701506920
Kolmes, K., Stock, W., & Moser, C. (2006). Investigating bias in psychotherapy with BDSM clients. Journal of Homosexuality, 50(2-3), 301-324. https://doi.org/10.1300/J082v50n02_15
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697. https://doi.org/10.1037/0033-2909.129.5.674
National Center for Interstate Compacts. (2023). Counseling Compact: Frequently Asked Questions. Retrieved from https://counselingcompact.org
Poteat, T., German, D., & Kerrigan, D. (2013). Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Social Science & Medicine, 84, 22-29. https://doi.org/10.1016/j.socscimed.2013.02.019Schechinger, H., Sakaluk, J. K., & Moors, A. C. (2018). Heteronormativity, sexual identity, and relationship configurations: A meta-analysis of associations with minority stress and mental health. Journal of Social and Personal Relationships, 35(5), 802-827. https://doi.org/10.1177/0265407517699474
