I haven't seen a therapist for over a year (by choice). But thanks to US therapy licensing laws, I'm no longer allowed to.
My partner and I left the States in December 2021 on our first-ever adventure as digital nomads. And though I did have some bad mental health days, I was too absorbed in my new life to reach out to my therapist. Once we returned to the US after an amazing (but stressful) year of nomading, back-to-back work, depression, and COVID, I knew it was time.
I'd played around with BetterHelp since I knew I'd need a remote option, but was a little put off by the "pay now, connect later" approach. Before I left though, I did get one match who was based, coincidentally, not too far from me.
Okay, I'll admit it, I did a little digging around and got in touch with this person off-platform (sorry, BetterHelp!).
We seemed like a good match and I crossed my fingers as I joined our introductory phone call. But five minutes in, when I mentioned I needed online therapy because I'm a nomad, I heard crickets and then "Well, you see..."
Turns out US therapist licensing laws still require clients to be physically present in the same state that the therapist is licensed in.
I'd vaguely remembered this being "a thing" in the early days of COVID, but had naively assumed this had all changed for good. Ha. Nope.
So that sucked.
After some digging into digital nomad subreddits, international health insurance companies, and brightly-coloured "digital nomad therapist" sites, the results were a bit depressing:
- Platforms like BetterHelp (and health insurance companies) will pretty much always match you with a mental health professional in your physical location unless you're in a country where therapy is unregulated.
- A few reasons many of us don't think about location restrictions are: A) many therapists using online platforms to connect with clients think the platform has it covered and they're in the clear (they aren't), B) they're willing to look the other way, or C), nomadic clients establish a residential address and then just don't say anything about their actual location.
- Hilariously, therapists don't have the same location restrictions as their clients, so those "digital nomad therapists" aren't catering to wanderers, they're literally travelling the world while seeing clients stuck at home.
Do I sound bitter? I feel like I sound bitter.
So...what do I do about therapy now? The way I see it, I have a few options. And no hate, please, these are just the options I've seen:
- I could stay put in my state.
- I could keep a low profile (cash pay + fake residential address).
- I could persuade my therapist to offer location-independent sessions.
- I could work with religious leader who also offers counseling (Pastors/ministers and other members of the clergy are often exempt from state-based licensing laws).
- I could work with a therapist from another, less regulated country.
- I could move to a country with fewer therapy regulations and see a US therapist.
#1 is not really an option for me. And #s 2 and 3 put the therapist in potential danger of losing their license, so I'm really stuck with the last three. I'm a practicing Christian, so #4 could technically work, but I don't have a lot of faith (ha) in the benefits of religious counseling without psychological credentials.
So this is going to be a journey! In the meantime, don't worry, I am seeing my former therapist while I'm in the area.
Feel free to join me as I work to (legally) find a new therapist in or outside of the US as a digital nomad. I'll keep you updated on my research, the resources I'm using, and what works/doesn't.
Wish me luck!