Practicing While Abroad

As a psychotherapist who occasionally travels or lives abroad for extended periods, I’ve received many questions—sometimes from colleagues, sometimes from clients—about the legality, ethics, and logistics of practicing Telehealth while outside the U.S. There’s a lot of confusion and misinformation out there, and I believe clarity is essential for both therapists and the people we serve.

I’m sharing this not only to demystify the process, but also to model transparency in clinical practice. For fellow therapists, I hope this post offers helpful guidance and encouragement to navigate global mobility with professionalism and care. For clients, I want to offer reassurance: it is absolutely possible to receive ethical, confidential, and high-quality therapy—even if your therapist is temporarily practicing from another part of the world.

Can Therapists Legally and Ethically Practice Telehealth While Abroad?

Short answer: Yes—licensed therapists can ethically and legally practice Telehealth while traveling or living abroad, as long as they meet specific legal, clinical, and ethical requirements.

There’s a common misconception that therapy must be delivered from within the same state or country as the client. In reality, Telehealth regulations are based primarily on where the client is located—not the therapist. With the right protocols, therapists can maintain high-quality, compliant care from virtually anywhere in the world.

Common Myths About Practicing Telehealth from Abroad—Debunked:

Let’s clear up some widespread misunderstandings:

❌ Myth 1: Therapists can’t practice legally from outside the U.S.
✅ Fact: As long as the therapist is licensed in the state where the client is located and complies with relevant laws, international Telehealth is legal and ethical.

❌ Myth 2: It violates HIPAA or professional ethics.
✅ Fact: Therapists can maintain full HIPAA compliance and ethical standards while abroad by using secure platforms, encrypted networks, and maintaining confidentiality.

❌ Myth 3: Insurance won’t cover sessions conducted from abroad.
✅ Fact: Many insurance plans do reimburse Telehealth sessions conducted by therapists abroad, as long as documentation, coding, and licensure align with payer guidelines.

How Therapists Ensure Compliance While Practicing Abroad

Ethical international Telehealth requires more than just a laptop and Wi-Fi. Here are the key steps therapists take:

1. Follow State Licensing Laws Based on Client Location

Therapists must be licensed in the U.S. state where the client is physically located at the time of each session.
Some states require additional registration for out-of-state or Telehealth providers.

2. Maintain HIPAA Compliance and Secure Technology

• Use HIPAA-compliant platforms like Therapy Notes,Zoom for Healthcare, or SimplePractice.

• Access PHI only through encrypted devices and secured networks

• Use a VPN when needed to enhance data security and comply with U.S. standards

3. Ensure Malpractice Insurance Covers International Telehealth

Therapists must:

• Confirm that international practice is not excluded from their policy

• Verify that their Telehealth services are fully covered under existing terms

4. Update Informed Consent and Notify Clients

• Clearly communicate that your practice is conducted remotely, and that sessions may take place while you are located in a different city, state, or country. Emphasize that your focus remains on maintaining continuity, professionalism, and high standards of care regardless of location.

• Inform clients of any relevant time zone differences, communication expectations, or logistical changes that may arise due to your location. Set clear guidelines for scheduling, response times, and availability to support a seamless therapeutic relationship.

• Provide clients with a clearly written emergency plan, including local crisis resources based on their geographic location. Ensure they understand how to access immediate support if needed and how to proceed in the rare event of technical disruptions during a session. Therapists abroad cannot respond in-person to client crises—but that’s also true domestically for remote therapy.

5. Verify Insurance Reimbursement Policies

• Use appropriate “place of service” codes (usually “02” for Telehealth)

• Confirm that the therapist’s location won’t affect client reimbursement

• Check with individual insurance plans for international restrictions

6. Maintain a Confidential and Consistent Workspace

• Sessions must be conducted in private, sound protected environments

• Avoid shared or public spaces (e.g., cafes, coworking spaces)

• Use white noise or sound barriers as needed to protect client privacy

A Personal Note: How I Practice Ethically and Responsibly While Abroad

Here’s how I stay fully compliant:

• I only work with clients located in states where I am licensed

• I use encrypted, HIPAA-compliant platforms and secure networks

• I proactively update informed consent to reflect my availability, relevant safety protocols, and emergency procedures

• I verify that my liability insurance covers Telehealth sessions conducted internationally

• I ensure a consistent, confidential environment—no matter where I’m located

• I provide clients with emergency plans and resources that would apply whether I’m in the U.S. or abroad

Remote therapy is still remote—whether I’m sitting in my home office or a quiet, secure space overseas. The safeguards, structure, and quality of care remain the same.

The Benefits of a Global Perspective in Clinical Work

Spending time abroad keeps me grounded, creative, and connected to the world beyond my screen—qualities that enrich my clinical presence. My travels deepen my cultural awareness, sharpen my adaptability, and renew my commitment to showing up with clarity and care for my clients.

Cross-cultural experience also enhances my attunement to issues related to identity, belonging, values, and dynamics of power, privilege, oppression, trauma, and resilience—all important aspects of my work with clients.

Final Thoughts: Ethical Telehealth Is Not Bound by Borders

Practicing ethically and legally while abroad is not only possible—it can also reflect a therapist’s high level of intention, professionalism, and care. With clear communication, proper planning, and a commitment to best practices, therapists can offer secure, ethical, and compassionate care from anywhere in the world.

Therapists don’t need to choose between travel and clinical integrity. With diligence and structure, we can do both—and continue to support clients with the depth and consistency they deserve.