What To Do To Offer Therapy To International Clients

Telehealth is capable of expanding therapy beyond borders. With a video link forming the connection, a therapist can conduct sessions with clients both across the country and around the world.

But before you offer your therapy services on the international market, there are several necessary steps to take. Some countries require therapists to have a local license before working with residents. Learn more about what you need to do to offer therapy to international clients below.

Check The Regulations In Both Locations

When offering therapy to international clients there are two locations involved: the location of the client and the location of the therapist. For the most part, it’s the client’s location that takes precedence. But you should take the regulations of both locations into account before you start practicing.

The Client’s Location

The location of the client is primarily seen as the location of the therapy session. A client in Italy is seen as receiving therapy in Italy, whether the therapist is in Rome, Wisconsin, or Kyoto.

If you plan on working with clients in several countries, you’ll need to know the rules for each area.

For the most part, international locations do allow residents to receive therapy services from professionals based in the U.S. However, this isn’t a blanket rule. You need to be aware of the exact laws for the country you plan on (remotely) working in.

Your Location

Presumably, the state that you’ll be conducting teletherapy from is the state that you are licensed to practice in. USA licensing boards don’t have jurisdiction over other countries. This is why the primary concern is the location of the client.

With that said, it’s worth double-checking the regulations your state has in place. As you will still be based in the state, they may have some say over how you run the practice.

Seek A New License

Some foreign jurisdictions require therapists to be licensed in the location they intend to practice in. In these cases, the therapist would need to be licensed and registered in the same country as the client.

 However, it’s likely to be a long and potentially even expensive process. Think seriously about whether it’s worth pursuing before you commit.

Speak To Your Insurance Provider

The next step is to speak directly with your insurance provider. Being legally allowed to work with international clients doesn’t mean your liability insurance will offer coverage.

There are inherent risks involved with international clients. The significant distance will make providing support in a crisis situation harder. In addition, time zones and internet connections might make it difficult to provide quality care.

These risks might leave you vulnerable to malpractice lawsuits. And your insurance won’t necessarily cover international work. Contact them before you take on any clients, so you know the protections they can provide.

Ensure You’re HIPAA Compliant

HIPAA might not have an international presence, but in the event of a lawsuit, it’s worth ensuring your communications are HIPAA-compliant beforehand.

As the majority of your communication will happen online, you must be using secure systems. These should be in place anyway for telehealth, but if you’re working with international clients, you’ll have to take different data laws into account.

In addition, you need to have a clear and consistent line of communication. A poor video connection can damage the service you offer. Upgrading your internet connection might be necessary.

Familiarize Yourself With International Resources

Providing clients with local resources is helpful in many situations, but telehealth can make it difficult. This happens even when both the client and therapist are in the same state—resources in one part of Oregon won’t be the same in another.

When dealing with an international client, the problem is even more pronounced. In a crisis, do you know the local services to contact?

When you start offering international teletherapy, you need to familiarize yourself with the area your client is contacting from. It will help you understand their life better, and so provide a better service, and ensure you can act responsibly in a crisis situation.

Consider The Logistical Issues

When you feel comfortable that you have the financial and legal protections to proceed with international clients, it’s time to consider the fine details.

Time Zones can have a significant impact on your ability to offer international services. You’ll need to find a schedule that works for you and your practice, as well as the client. You might be tempted to work late/early to accommodate their needs, but watch out for burnout.

You’ll also need to consider payment. Although international money transfers are relatively easy nowadays, you might find it takes longer than usual for the money to clear. Additionally, if you use payment software via an EHR, an international client might need to use a different method.


Telehealth with an international client is a valid option for therapists, but not necessarily an easy one. While many countries do allow US-based therapists to work with residents, some areas will have tight restrictions. Research the regulations before working with any international client.

When you understand the licensing regulations, the next steps are standard when setting up a practice. Do you have the right insurance? Is your system HIPAA compliant? Can you provide the best care possible?

Expanding your practice across borders can have many rewards! Just make sure you’re properly prepared before committing.

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