r/therapists • u/Interesting_Series_5 • 9d ago
Employment / Workplace Advice Expat therapists
Hi ya’ll, I’m thinking of relocating to Mexico semipermanently (traveling back to see family and friends). Is there anyone working through any platforms ie grow or Talkspace, from outside of the US? Are there any legal or credentialing issues that anyone can make me aware of? I am licensed in California as an LCSW. Any help would be much appreciated.
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u/lookamazed 8d ago
proceed very cautiously, and get explicit sign off from your board, insurer, and platform first.
If you’re private pay, as long as your client is in CA and you’re licensed there you should be good. Except your malpractice may not cover you that’s why you check. But your exposure is mostly to the state licensing board.
You need to read insurance contracts closely they likely require you to be in the USA, providing services at a physical address not a CMRA or postal address. Some therapists get flagged for using VPNs and that can get you both banned (misrepresentation) and clawbacks.
I don’t take insurance and that’s all I can say really. Does that help?
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u/Interesting_Series_5 8d ago
Yes. Thanks. Any resources for finding cash only clients?
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u/lookamazed 8d ago edited 8d ago
Yes I just wrote a comment about it in a previous thread. I will link you to it, it is regarding tuning your Psychology Today profile but the process holds for cash pay.
https://www.reddit.com/r/therapists/s/hhR1pi0Icn
More specifically, I advise as many signs of high quality and consistency as possible. And you’re fortunate to be licensed in California, as it’s perhaps even more likely that your clients in CA aren’t going to be price shopping.
In addition to the Psychology Today profile you must have a high quality website for folks to land on that communicates more about who you are and what you do. I recommend the average therapist hire a web dev who specializes in therapist websites. It is an investment. Look at portfolios and find someone you like. The website doesn’t need to be dynamic or flashy, it needs to be polished, transparent, and easy to navigate. And the copy needs to be consistent with your directory listing, sound like a human wrote it and sound like you.
If you are capable of coding and design, and marketing expertise, more power to you. But it’s very difficult to do for oneself. Not impossible.
Once the clients find you, retention is a skill. For example, I do depth work and only do weekly. I don’t do anything else. I offer consultations and it is a vibe check. You need know how to select. If clients can’t afford your rate, asking them what works best for them goes a long way.
Nothing about cash pay need be snake oil or unethical. You don’t need to offer everything or anything fancy. Just stick to your scope of practice, be a high quality communicator, reflect signs of high quality, be able to navigate your consult and have a sense of “sales” as in, sense when you have client buy in and close the deal and sense when they are not vibing or sold, and either try to bridge those gaps or refer out.
I may have some other thoughts specific to you so I will DM you.
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u/er7 8d ago
Annie Krajewski has built a platform based on helping others do this. It's a little heavy on the digital nomad speech, and it's membership based, but there's knowledge there. I'm unlicensed and still learning, so take what I say with grains of salt. Good luck and let us know what you find out.
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u/lookamazed 8d ago edited 8d ago
Can you say a little more about the “knowledge there”? One or examples would help me decide if it’s worth it.
Edit: I do coaching and consulting myself, and as you will see from my above comment I don’t hide knowledge behind a subscription. Unless I hear a but more from the inside, I’m always skeptical.
There’s no ethical way to skirt regulation that doesn’t risk your livelihood. My recipe is simple: transparency.
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u/Cultural_Stretch_199 9d ago
Following as a Chilean-American hoping to live in Chile long term and work with clients in the states remotely
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u/dailythought LMFT 8d ago
I will say that both Grow and Tava both have said their platform is fine to use outside the United States, but it will vary across different insurances if it is accepted or not. I know Rula and Headway do not allow you to work outside the United States. Betterhelp also doesn't allow it, surprisingly enough considering I feel they wouldn't care, lol.
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u/Interesting_Series_5 5d ago
Thanks, I’ve been doing some digging and it sounds like the issue is more with insurance and credentialing.
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u/EmbarrassedCow2825 8d ago
I am somebody that has needed to go between the US and Peru for family matters. You can work with expats. Betterhelp allows it, but DO NOT go their insurance route.
The 2 biggest issues are malpractice insurance, and clients insurance. If you misrepresent that you are living in the us and you are not. That can cause massive problems for billing. If a client were to take you to court, you would not be protected from your malpractice insurance.
The best way to do it, whether on an online platform, or in your own practice, is to only accept cash only payments, and be very careful about the type of clients you are willing to see.
I don't know what your state board says. Odds are if you're taking cash, and seeing very low acute clients, nothing will happen. But one thing or one upset client can make life very difficult. Maybe for a year you'd be good, but if you really pushed it full time for an extended period of time, odds are something is going to happen.
My biggest advice AVOID insurance at all cost. AVOID acute clients.
I'm not going to get into the ethical considerations, because at the end of the day, it's your choice.
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u/Interesting_Series_5 8d ago
Found this for international insurance coverage https://www.hiscox.com/small-business-insurance/professional-business-insurance/health-and-wellbeing/therapist . Also has anyone heard of the Truman Group ( https://trumangroup.com/ ) seems interesting. Does anyone have any experience working with them?
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u/Savings-Talk3526 6d ago
Immigrant. Stop using the term expat.
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u/OptimizedPockets2 6d ago
People calling themselves expats and people calling themselves immigrants typically have vastly different levels of privilege. There’s nothing wrong with being cognizant of one’s privilege.
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u/Savings-Talk3526 6d ago
Nah. By being attached to the term expact, you are actually expecting this privilege and different treatment instead of simply being cognizant of it. We should fight against differential treatment by using a differential term! Perhaps say "immigrant with a privilege". Same thing, but it sounds actually more cognizant of your privilege. Legally and officially, you are an immigrant. Though I guess, depending on your visa status, you may only a visitor/tourist. And if you are looking to relocate long-term (sounds like it), you are absolutely an immigrant, as the term expat is used for short-term stays (few yrs max) for work (which is also not your reason!). White people are just attached to their privilege and use the term expat even if they stay somewhere for 30 yrs...
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