Finding therapy as a digital nomad just got way, way worse.

Finding therapy as a digital nomad just got way, way worse.
Turns out teletherapy isn't all that accessible. Photo by Elisa Ventur on Unsplash

Being a digital nomad is a huge privilege. I just wish it came with affordable mental health care.

If you've been following my posts recently, you'll know that I'm on the hunt for a new therapist. Unfortunately, being a digital nomad and US resident make that extremely difficult.

Quick recap: US clients have to physically reside in the same state that a therapist is licensed in. Platforms like BetterHelp match you based on location and even therapists who specialize in helping expats/nomads are restricted by who they can serve where.

Before we go any further, I feel like I should share a bit more about my lifestyle and situation:

  • My partner and I have been nomads since Dec 2021 and are currently US residents for work reasons
  • We live in a high cost of living (HCOL) area near family (necessary but hopefully temporary)
  • We are not insured and pay cash for checkups and procedures, including therapy
  • I'm currently the sole earner while my partner works on a career change
  • I have multiple mental disabilities that currently limit my work capacity and income

On the upside, we have the privilege of living and working from pretty much anywhere (within our budget). The downside is that we need affordable, mobile options for mental health.

Now in case you're wondering, a high deductible health plan (HDHP) in my area costs about $600 a month for two people with a $10k deductible. That means at minimum, I'm paying at least $17,000 a year before my insurance kicks in, which doesn't include extra costs associated with pre-existing conditions.

This isn't just a question of finding therapy as a nomad, but affordable healthcare as well.

These posts are focused on my search for a new therapist. But it's worth noting that this is just part of a much larger conversation many Americans are having right now. If you're worried I'm left with no options, don't be! My former therapist graciously took me on again twice a month while I'm in the area.

Digital nomad therapy update

Okay, enough with the intro! In an earlier article, I narrowed my therapy options down to three:

  1. Finding counseling with a religious leader who is exempt from therapy licensing laws
  2. Searching for a therapist outside of the US (in a country with fewer or different mental healthcare regulations)
  3. Leaving the US so I can access better international health/mental health care options

I have several mental health disabilities (depression, anxiety, PTSD/C-PTSD) and a complicated faith background, so the first one is out for now.

Now, I could theoretically find a US-based therapist and just not tell them every time I move. Ethically questionable? I agree. But I'm looking for someone I can build a relationship with who understands how my lifestyle plays into and affects my mental health.

Ironically, finding a therapist would be a lot easier if I were living outside of the US.

But that's just not an option right now. So I was left with Option #2: looking for a non-US-based therapist. Here we go.

The search continues...

I started my search with a few sources some LinkedIn contacts had been kind enough to leave in comments or share with me. One was Therapy In Barcelona, a very SEO-friendly named collective of English-speaking expat therapists who offer in-person and virtual services.

Another option I came across was UK Therapy Guide, which I stumbled on when I was trying to get a sense of how "safe" it was to work with a therapist in a less-regulated country (it depends). Now all this time, a concern was nagging at me. If therapists can only see clients in states they're licensed in, what sort of restrictions do international therapists face when working with a US client?

So I decided to stalk a few of my digital nomad Facebook groups and see what I could find. Luckily (or rather, unluckily for me), the answer came pretty quickly.

I stumbled across a Facebook post where a therapist, April Benney of Wonder Haven Counseling, was getting ideas for her next nomad destination. I popped in to ask some nosy questions about restrictions as an expat therapist and whether I could interview her. She graciously agreed, and here's what I learned:

"The general rule is that a therapist is required to follow the licensing restrictions of the client's location during sessions. If the client is located in a U.S. state or territory, the therapist is required to follow those licensing restrictions, even if they themselves are outside the U.S." She went on to say that even an international therapist would need to be licensed in every single state I travelled to as a nomad.

In other words, location-based restrictions for therapy are based on the global location of the client, not the therapist. Which leaves me...where, exactly?

Honestly, SOL at the moment. Right now, I'm still trying to process this new info and my stomach drops whenever I think about it.

I never thought I'd be facing a choice between my nomadic lifestyle and healthcare. But here we are.

Hopefully I'll have next steps worked out in the next few weeks, but I won't lie, it's a little hard to stay positive.