Do I need to be in therapy first?
Answers
In most of the country, no. In five states, effectively yes, and no service can write around it.
The general position
Most states require a licensed clinician who has evaluated you. They do not require an ongoing course of treatment. A single thorough evaluation by someone licensed in your state, who forms a professional view and puts their licence number to it, satisfies the standard.
The five states where it is different
Arkansas, California, Iowa, Louisiana and Montana require a client-provider relationship of at least thirty days before documentation may issue. Louisiana additionally requires two evaluation sessions and excludes online letter services from the definition of a therapeutic relationship. In those states you effectively do need an established relationship, and nothing shortens it.
If you are in one of those states
- Ask an existing provider first. If you already see a therapist, a psychiatrist or even a GP who knows you, the requirement may already be met.
- Otherwise start now rather than when the letter is needed. The clock only runs forward.
- Treat any service offering a same-day letter in those states as telling you something important about itself.
What an evaluation is not
A form that records the diagnosis you typed in. If nothing you could answer would produce a no, nobody evaluated anything, and the resulting document carries the weight of the process behind it, which is none.
Common questions
- Can my GP write it?
- Often yes, where they know you and the judgement is within their scope of practice. For someone with an established doctor, this is frequently the easiest route.