Can Mental Health Clinicians Work Internationally?

If you’re a licensed clinical social worker (LCSW) or mental health clinician dreaming of working abroad, you’re not alone! More and more therapists are exploring international opportunities and successfully making the move.

As an American LCSW who has built her virtual, private-pay practice while living in France since 2022, let me share some of what I’ve learned.

Can a US therapist work abroad?

Yes. With a very important caveat. Being licensed in the US is not what limits your ability to see clients internationally. What determines legality is where your client is physically located at the time of the session, not where you are.

When you make the move to a new country, you will want to know in advance: are you hoping to maintain your US based practice virtually or are you hoping to take on clients in the country you are moving to? These are two very different paths, so let’s dive in.

1. Running your US based practice from abroad:

With this path, you keep your US licensure active, you maintain your US LLC (or equivalent), and you continue seeing clients in the states you’re already licensed in while also living abroad. This is what I have done, and it’s the easiest way for American therapists, LCSWs, psychologists, etc. to live abroad and keep working. There are some important things to consider:

• Confirm with your carrier that your policy covers care delivered while you are physically located abroad. Not all malpractice policies extend beyond US borders.

• Medicare does not reimburse for telehealth services if the provider is located outside the United States and many insurance companies require the clinician to be in the US.

• Keep time-zones in mind when scheduling. I’m from Philadelphia, and all my clients are on the east coast, so there is 6-hour time difference I am factoring into my schedule.

• Make sure you’re all set up tech-wise. Check your EHR and payment processing platforms and confirm they work from the country you’re looking at. I use Simple Practice. It’s also worth checking out VPNs, especially if you’re planning on being in multiple countries.

• Remember to stay on top of updates, trends, laws in the places your clients are. Even though you’re not in the US, your clients are, so ethically, you need to be on top of what’s going on back home to ensure you are providing the most ethical, updated and competent care.

• Even if you are maintaining your US based business, you must check the visa requirements of the country you are hoping to move to. For example, if you’re hoping to move to a European country, you can only stay in Europe for 3 months at a time without a visa permitting you to stay longer.

Here are some websites/resources to learn a bit more or check for the latest updates:

• CCHP (Center for Connected Health Policy) — cchpca.org — the most comprehensive tracker of state telehealth laws, updated regularly

• Telehealth.HHS.gov — federal government resource on cross-state licensing

• Person Centered Tech — personcenteredtech.com — CEUS, resources specifically designed for therapists navigating telehealth ethics and compliance

• Your state licensing board — always the first call before making any decisions

• A healthcare attorney — for anyone serious about this, especially around malpractice coverage and international practice

• APA's telehealth guidance — apaservices.org for psychologists

2. Work as a licensed mental health provider in your new country:

Honestly, this one is much trickier! Not all US clinical credentials have equivalents in other countries. For example, I am an LCSW and in France, they do not have an equivalent to my license. It is possible to get approved to provide services, but not without great expense and significant additional education, supervision, and jumping through regulatory hoops, including getting a visa that allows you work here.

Getting licensed to practice in a European country as a US-trained clinician is possible but again, it's a lengthy, expensive process with no guarantees. Most countries will require:

• Credential evaluation — your US degree gets assessed against local standards, and is often considered insufficient without additional training

• Further education — many countries require additional coursework or even a full local master's program

• Language proficiency — professional-level fluency in the country's primary language, not just conversational

• Supervised clinical hours — completed within that country, which means finding local supervision, often for little or no pay

• Local licensing exams — typically in the local language, testing knowledge of that country's mental health system and legal framework

• Understanding of local insurance and regulatory systems — how care is funded, what's covered, and how to navigate a completely different bureaucracy

For most US therapists, this path is not practical. The more realistic option (and the one I chose) is maintaining your US license and seeing US-based clients remotely while living abroad.

If this is something you are still hoping to do, I recommend reaching out to US therapists who are currently in the country you hope to move to and who have an established local practice. There are many amazing Facebook groups for expat therapists where you can connect!

I've been building my US practice from Paris since 2022. If you're considering doing the same and want to talk, reach out here.

A note: the legal and licensing landscape changes frequently. I always recommend verifying current requirements with your state licensing board, checking the CCHP tracker for state-specific telehealth laws, and consulting a healthcare attorney before making any major decisions. What I can offer is the lived experience of building a practice from Paris and the practical, emotional, and logistical reality of what this actually looks like day to day.