Can An American Therapist Do Therapy With Expats Living Abroad? Or Citizens Of Other Countries?

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?)

(Updated July 2025)

One of the questions that sometimes comes up is about American clients who don’t have a fixed residence. Maybe they’re digital nomads staying in different countries or U.S. states every few months. Or maybe they use a U.S. address on paper, but haven’t actually lived there for a while. So what does that mean for therapists? Are you allowed to work with them?

Here’s what I’ve learned: in most U.S. states, what matters is not where the client claims to live, but where they are physically located at the time of the session.

That means: if someone is physically in a certain state or country while receiving therapy, then the laws of that place usually apply. It’s their current physical location that determines which licensing board (or country) has jurisdiction not their official residency or where they pay taxes.

For example, in California, CAMFT (California Association of Marriage and Family Therapists) has said that if a client is physically in California during the session, they fall under California’s rules, even if they’re just visiting from somewhere else. So a therapist would need a California license to see them at that time. Source: CAMFT Telehealth Questions & Answers

This same idea is shared by Person Centered Tech, an organization that supports therapists in navigating telehealth and ethics. They explain that “location at the time of service” is the main legal factor when determining if therapy can happen across state or national lines. Source: Person Centered Tech – Teletherapy Across State Lines

So what does this mean in real life?

• If a U.S. citizen is living in Thailand for six months, you’re probably OK to work with them as long as your licensing board permits therapy with international clients and Thailand doesn’t prohibit it.
• If a client is temporarily in California, even for a week, you may need to be licensed in California to legally provide therapy during that time.
• If a client is nomadic and moving constantly, it’s important to ask them where they are during each session and document it. You’re responsible for knowing the rules that apply in that moment.

Just to clarify, it’s not that a client’s legal residency never matters, it can still come up in specific cases. For example, it might affect whether a client can use insurance, how taxes are handled, or what your liability coverage does or doesn’t cover. But when it comes to licensing and jurisdiction, the client’s physical location during session is what usually counts.

This is one of those areas where risk management is important. If there’s any uncertainty, the best move is to:

• Ask the client where they are physically located during each session
• Consult with your licensing board or an attorney who understands telehealth laws
• Keep documentation of client location in case you need it later

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.