This is not legal advice. I’m not a lawyer, I’m just a American expat living abroad who researched some stuff about getting therapy and I’d love to share what I found.
You see, although I was born and raised in California, I haven’t lived there for over 13 years.
And over the past 13 years, I’ve done some of the deepest and most important healing work of my life.
That healing work was (1) completely online and (2) completely with American therapists. So I am enthusiastically supportive of both online therapy and globally-accessible-therapy – and I’m proof that it works.
Many therapists who know of me have asked, “so can therapists who are in the USA provide therapy services to American expats or citizens of other countries outside of the USA?” And the answer is…
Yes! Usually Therapists Can Do Therapy With Expats Residing Abroad Or Citizens Of Other Countries
And that’s because the USA doesn’t regulate residents of other countries.
Therapists based in the USA can do telehealth with people residing abroad. Being licensed in the USA is not what would limit your ability to see clients internationally.
USA licensing only regulates USA residents, not global residents. Which makes sense right? Those boards protect USA residents, not every existing human residing anywhere in the entire world.
How To Confirm You Can Provide Therapy To Someone Living Abroad
Just because the USA doesn’t regulate residents internationally doesn’t mean you should go wild and do whatever you want outside of national borders.
The regulations of the country in which your potential clients reside are still of concern. It is recommended to research them so you can be aware of them and respect them.
According to my research so far, most European countries and Asian countries do not block their residents from getting mental health care from professionals abroad. As for other countries, I have not done research on them. And generally, you shouldn’t just take my research as fact.
Please do your own research, here’s how:
The driving question ought to be, “Does this country that my potential client resides in have laws around their residents getting mental health care from abroad?“
The easiest way to get an answer to that question will be to check with the therapists or therapists train therapists (professors, EMDR trainers, etc) that live in that country. Once you find someone, ask if they’d be willing to help you understand that countries’ regulations and particularly regulations around residents getting therapy services from other countries.
So far, I have yet to hear of a country that regulates this. But it’s still good practice to research, be aware, and respect any regulations you discover.
Even If It’s Not Regulated, There Are Still Risks You Need To Know About
If you discover that it’s OK to provide mental health services to clients abroad according to the regulations of that country, you should know that there are still risks. Here are the risks to know about:
- You won’t be as easily able to guide a client to crisis support if they ever needed it
- If client dies or suicides, you may risk a lawsuit from client’s family
- Your liability insurance would not cover your expenses if you got into trouble
Depending on the potential client and your own risk adversity, these risks may land as higher or lower risk.
For instance, I’m fortunate not to have been suicidal or in need of crisis support over the last 13 years. But if I was, it may have been risky for me to do online therapy and not have direct connections to local support would it have been needed.
You’ll want to weigh things out for you and for the unique client you are considering helping.
Ambiguous Residency Could Be A Risk For Serving US Nomadic Types (Maybe?)
Additionally, in the case of US citizens who have become nomadic, there may be risks if there is any ambiguity of the client’s residency status.
If the client lives in, I don’t know, Germany, but only for six months, are they a resident of Germany? Or are they just in transit and their actual residency is still the state of NY?
Or if an American is truly nomadic but has not established residency in another country because they move every few months, does that mean they are still technically a “resident” of the last US state in which they resided?
Transitory or residenceless expats could also be a risk as it could be unclear where their true residence is. Unfortunately, outside of tax definitions, I don’t know of any other guidelines that might clarify some of the more complex residency situations.
If someone’s true residence is, in fact, still in a US state though, I would imagine that risk is significantly reduced or eliminated if a therapist is licensed in the state of the client’s last residence (or future intended residence if domicile was established in the state prior to being abroad).
The potential client may have clarity on what their situation is and if not, or if there are any questions, I would recommend consulting with attorneys through your board to avoid unnecessary risk.
Also, Clients Abroad Will Probably Not Be Able To Use Insurance
This is probably obvious but worth mentioning: clients abroad will not be able to use their health insurance to cover the fees. Or at least, I have yet to see a health insurance policy with such international coverage for mental health care.
If the client would like to use their insurance, or be reimbursed by their insurance, it’s unlikely to work. They will need to be prepared to pay out of pocket.
Hope This Helps Spread the Support!
Therapists are doing such important work. Hope this post sheds some light on how therapists can expand their help beyond US borders. To learn more about ethics, I highly recommend courses and consultancy from Person Centered Tech where I learned much of what I know.