Have you been feeling unsure about complying with the laws and regulations as a location independent therapist?
Some of these questions may have crossed your mind or are holding you back:
Can I work with a client in this specific country?
Can I keep working with a client who moves to a new country?
What happens if I am the one moving?
How can I work AND travel at the same time?
Those are just some of the questions we get asked every week. And sadly, the answer is:
It’s complicated. Or: It depends.
Now, we know this isn’t the answer you are looking for and we are really sorry, we know how frustrating this can be. But, here at LIT we are all about being transparent and honest about what it means to be a location independent therapist.
And this aspect of it, is indeed probably the most frustrating for most colleagues – that and the difficulty to market your virtual practice when you are trying to reach the whole world in a system that is still so often based on a physical location!
So, how do we navigate all those questions and manage to run successful businesses as location independent therapists while helping clients all over the world?
We start by doing our research and asking the right professionals: lawyers, accountants, our licensing board and malpractice insurance to name just a few.
Although we get asked these questions all the time in our Facebook group, the truth is – a Facebook group is usually not the right place to figure out those complicated details of running your own business!
We also plan for worst case scenarios and are aware of what might happen. For instance,did you know that a GDPR breach can lead to a fine of up to 200.000€ or 4% of your gross income?
We are also aware that no matter how much research we do, it might be difficult or even impossible to get a definitive answer on some of the questions we have.
At some point we will need to decide what type of risk or grey area we are willing to navigate and to be honest, this is really an essential part of running your own business and being self-employed!
Now, even though we won’t be able to give you the definitive answers you might have hoped for, let’s take a closer look at the main areas in which you will need to make sure you are compliant when working online as a location independent therapist:
Privacy/Data Protection Regulations as a Location Independent Therapist
Which regulations do you need to follow?
Are all your programs HIPAA and/or GDPR compliant?
Are you following all necessary procedures?
You’ll need to consider both the video platform you use and any programs where you store client notes and information. Also, make sure that you do your research on the regulations you’ll need to follow that apply to you, and also to your clients depending on their location.
If you’re looking for a digital system for managing client information and note-taking, here are some recommendations from our LIT Community Members:
- Owl Practice: This program is available in Canada and the US and offers a comprehensive and compliant practice management service and an embedded video platform.
- Simple Practice: This practice management software handles everything from messaging, electronic health record, scheduling, payment, and the video platform.
- WriteUpp: This GDPR-compliant software allows you to schedule your meetings, message clients, keep track of your notes, and even host video conferences. It has great customer service and a free 30-day trial to test it out and see if it meets your needs.
As with any tools, we recommend you do your own research and compare the options available to you. Don’t forget to look into the privacy policies and small print to ensure it will suit your needs. And make sure to comply with all the relevant legislation (which can vary from country to country).
Immigration Regulations as a Location Independent Therapist
Immigration regulations are especially relevant if you are the one travelling or moving to a new country. If you are considering a permanent move, you might want to get your licenses recognised in your new country.
However, many location independent therapists find that if they only want to work online, they can practice in their new country of residence while keeping their business registered in the country they are licensed in. It’s important to make sure that this is permitted by your licensing board.
You would also want to consult with an immigration attorney in your new country of residence to see if this is permitted, as well as with an accountant in your new country of residence and in the country your business is registered in.
Short-Term Stays & Digital Nomad Visas
If you are visiting on a shorter term basis, you will want to check what type of visa you will be on and what those allow you to do while in the country. If you’re travelling on a tourist visa, it’s likely that you won’t be covered to work while in the country – even if you’re working online.
But as remote work becomes much more mainstream, many countries are introducing digital nomad visas. You can find a pretty up-to-date list of digital nomad visas here.
You might also need to check how long you can stay in a country before being considered a tax resident or figure out what those implications might be. If your situation is complicated and you’re unsure about it, the best advice we can give you is to consult with a tax accountant who works with expats. They will be in the best position to advise you and ensure that you meet all your tax obligations, so you can continue to work and travel worry-free.
The immigration regulations will vary a lot depending on where you’re from and which passport(s) you hold. So, it’s best to do your research before you set out.
If you plan to move around rather than having a home base, you’ll need to stay on top of the visa requirements in each of your destinations. For example, the EU 180-day rule applies to people from countries such as the USA and the UK. It means you can only stay within the EU for 90 days out of every 180 days, and then you’ll need to move on to a non-EU country.
Licensing Regulations as a Location Independent Therapist
This one is usually the biggest challenge for many colleagues, but it’s also the one that will vary the most from country to country.
The regulations vary depending on where you’re licensed and according to the specific title and education you have. And as they’re such a big challenge for location independent therapists, we’ll focus mostly on licensing regulations for the rest of this blog post.
We can’t talk about every location as the laws and regulations vary so much and also change frequently. We’ve given a brief overview of the regulations in the US and Europe – but please do your own research, too.
US Regulations – An Overview
In some highly regulated countries like the US, you’ll need to be licensed in the state where your client is physically located at the time of the session. As you can imagine, that can get complicated if you have a client who lives in one state but goes to university in another state.
And these kinds of scenarios are becoming more and more common in the post-Covid world, where remote work is the norm for many people. If you have a client who travels or decides to move to a different state, you won’t be able to continue working with them if you’re not licensed in that state.
For example, we recently received a request from someone looking for a therapist. But the catch was that they were moving around between four US states to figure out where they would like to live permanently – so they would need a therapist who is also registered in all four states.
As you can see, the USA is especially restrictive when it comes to the laws around working with clients in a different location.
If you’re based in the U.S., you may be interested in looking into The Psychology Interjurisdictional Compact (PSYPACT) which was created to improve the practice of telepsychology across state lines.
European Regulations – An Overview
In contrast, in many European countries, the focus is more on where you as the mental health professional is based. So, if you wanted to work with a client living in Germany, the rules would be different based on whether you were in Germany or not.
If you were in Germany yourself, you would need to have a German license to provide psychotherapy (among other requirements). It can also depend on whether there is any public or private insurance involved, and what their requirements would be.
But these rules and regulations vary a lot depending on where you are. So, you’ll need to look into the laws of the country where you live, where your business is registered, (and possibly also the country where you hold a passport) to find out what regulations you’ll need to follow.
We hope that telehealth laws will change in light of the world we live in, where location independence and remote work are becoming much more normal. But in the meantime, we need to work within the existing systems.
What to Do if Your Client Moves Abroad?
Imagine this scenario: You’re working with a client, but they decide to move abroad (for work/family/etc) and they’d like to continue working with you.
What do you do? Are you allowed to continue working with this client, or could it cause problems for you?
Normally, the most important factor in this situation is where your client is physically based. So, the first step is to find out what the laws state in the country where your client is moving to.
One thing worth noting is that the terms and specific job titles often vary from country to country, too. So, counselling in Germany might not mean the exact same thing as counselling in the UK or the US and may not be regulated in the same way.
Many mental health professionals feel more comfortable providing a service that isn’t regulated in the client’s country. That could mean the exact service (such as therapy, counselling, psychotherapy, etc) isn’t regulated, or that their job title doesn’t exist in this country (for example, a Licensed Clinical Social Worker or a Marriage and Family Therapist).
We recommend doing a search for the country + “psychology regulatory board” to see whether you can find the relevant organisation. And if that doesn’t provide any results, you can try to contact a therapist licensed in that country and see whether they can shine any light on the situation.
How We Navigate Rules and Regulations as Location Independent Therapists
We, the LIT Community co-founders, both know from first hand experience that this can be a very daunting undertaking and we have had to adapt our businesses along the way.
We want to share our own stories and experiences to show you that it’s possible to find your way as a location independent therapist. But we also don’t want to sugarcoat anything or pretend that it’s easier than it really is.
Navigating the rules and regulations around the world is a challenge. But it doesn’t have to be a barrier to working as a location independent therapist.
We hope that by providing our stories, you can get some inspiration for how you can make it work for you, too. However, you will need to be open to exploring different ways of working, depending on where you are in the world, where your clients are, and the services you provide.
Sonia’s Experience as a German Psychologist Working Around the World
Sonia is licensed as a psychologist and psychotherapist (Psychologische Psychotherapeutin) in Germany. But when Sonia wanted to open her online practice in 2015, she had to make the transition to providing counselling instead, as psychotherapy online just wasn’t legal in Germany back then.
Some of the rules changed in 2018, but there was (at least pre-pandemic) still a requirement for an in-person assessment and diagnostics before you could offer online psychotherapy sessions.
As this would have been really complicated to implement with clients all over the world, Sonia decided to stick to her counselling offer. In Germany, counselling (Beratung) isn’t really regulated at all. But it does mean that Sonia can’t work with clients with a mental health diagnosis for example.
For Sonia, this has affected her marketing and the financial side of her business more than her actual work as her target audience has always been people who are a great fit for “counselling” according to German laws and regulations.
But, counselling isn’t exempt from VAT in Germany (whereas psychotherapy is), so she has to charge 19% VAT on all her counselling services!
Melissa’s Experience as a Location Independent Psychologist in Europe and the USA
Melissa is based in the U.S. and has her Master’s and PhD in Clinical and Health Psychology. However, Melissa has also lived and worked abroad (both online and offline) in both Spain and the Netherlands as a psychologist. So, she has a good insight into navigating the transitions that come with moving and working abroad as a mental health professional.
Melissa grew up in the U.S. but received her master’s and PhD in Spain. Even then, it still took two years (and some extra exams) to get her undergraduate degree recognised so she could work as a psychologist in Spain. Later, she moved to the Netherlands and had to go through a similar process.
Moving Back to the USA
When Melissa decided to move back to the U.S. in 2019, she had to do a lot of reflecting to decide if she wanted to go through this process once again to have her graduate studies recognized in the U.S. so she could get licensed there.
At that time all of her clients were expats living outside of the U.S. and she knew that being licensed in the U.S. would require her to contact regulatory boards around the world each time she took on a new client.
However, Melissa also knew from firsthand experience that even when you are registered as a therapist in a country it is hard to get your questions answered about telehealth laws. She knew she would face numerous obstacles if she needed to do this for countries where she wasn’t even registered. Factor in language barriers, and it would have been time-consuming, difficult, and potentially inconclusive.
She looked into having her qualifications recognised in the US so she could ultimately get licensed there, but no one could provide her with a specific response as to how long this would take.
It likely would have taken at least two years, and required thousands of hours of supervision. This was pre-pandemic and supervision would have been entirely offline. After 2 years of working entirely online and being able to take her office on the road, she didn’t like the idea of being tied down for years of offline supervision!
It Can Depend on Your Clients/Niche
The biggest deciding factor were the clients that Melissa was working with. Although her clinical training was in the treatment of eating disorders, this wasn’t the type of client she was working with at this point in her career.
Instead, most of her clients were expats struggling with cultural adaptation, work-life balance, navigating big life decisions, and other non-clinical concerns. When she came across a Facebook group dedicated to therapists who were switching to coaching (led by another former expat) she knew she’d found her answer – she’d switch to coaching!
Making the Switch from Therapy to Coaching
In making this decision, Melissa read several books, and took some courses in order to better understand the differences between coaching and therapy. She uses Acceptance and Commitment Coaching (an established approach adapted from Acceptance and Commitment Therapy) and her coaching is goal-focused and short-term, as opposed to therapy which may involve a more longer-term relationship.
Last year she switched from providing transition coaching to expats to providing mindset coaching for business owners. This has allowed her to separate her coaching from therapy even further.
As a coach, Melissa needs to choose the clients she works with very carefully. For example, she doesn’t work with anyone with an active diagnosis (unless they are also working with a therapist separately).
Melissa doesn’t believe that switching to coaching is the right decision for everyone, but it’s what made sense for her. She does miss diving as deep with clients like she did as a therapist, but overall she appreciates the flexibility and freedom that coaching provides her to take her business on the road and work with clients around the world.
And as the LIT co-founder, Melissa appreciates having the community of mental health professionals at her fingertips. Not only does it allow her to feel more connected with the mental health world, but it also provides plenty of colleagues if Melissa needs to refer someone for a service she doesn’t provide.
Navigating the Laws & Regulations as a Location Independent Therapist isn’t Impossible!
As you can see, the rules and regulations around working with clients around the world as a mental health professional aren’t always clear, and in many places, they are outdated.
We hope to see some updates to these laws as location independent life and remote work becomes the norm. But for now, we hope you find a solution that works for you, depending on where you are and where your clients are based.
Although navigating the privacy, immigration, and licensing laws can seem confusing and difficult at times, it’s definitely possible!
There are so many different ways that you can make the location independent lifestyle work for you. All it takes is a little research, imagination, and determination.
Overcoming the challenges of the legal licensing restrictions is well worth it, as it will open up the freedom to work with clients around the world. We’ve found that having an international community of therapists in the LIT Community is invaluable when navigating these laws. We can ask questions, share our experiences, and get inspired by each other.
Feel free to share your own experiences with the licensing rules and regulations below! We’d love to hear how you manage this complicated topic.