Here’s how to work online and travel as a mental health professional. I love, love, love to work online as a therapist and combine it with travel. If you’re a licensed therapist, counselor, social worker, mental health counselor, psychologist, or simply wish you could be a digital nomad, I’d like to share with you all my knowledge, experience, tips and tricks for mental health professionals about travel and working online.
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Dream your dream then live your dream
From 2018 to now, I’ve worked as a therapist in Poland, Italy and Mexico. From our home base in Poland, I got to travel to Jordan, Israel, France, Germany, Austria, Spain and around Mexico while I was there. Where do you dream of going?
Wonderful and challenging
To be honest, it’s both wonderful *and* challenging. The food is amazing, it’s often delicious but sometimes, not so much. It can be expensive or cheap, depending on your budget and whether you choose to eat at inexpensive restaurants or fancy ones or cook at home or wherever you’re staying. The logistics require work. Travel can be tiring and frustrating or exhilarating.
Short-term
You can stay within your vacation budget and still bring in income if you work while traveling for a week or a month. You can cover a lot of ground, visit the hot spots, find a place you like and stay, or follow an itinerary and move on.
Italian working vacation
Four weeks in Italy in September / October 2021. One week, I worked out of hotel rooms on a driving tour through the Masa Lubrense, traveling south during the morning and working in the afternoon and evening. Then, during a week off, I sailed the Amalfi coast, from Marina di Stabbia south of Naples to Capri, Ischia and the town of Amalfi. It is so cool how much easier it is to visit a town on the Amalfi coast from the water. No parking problems, kitchen and bathroom on the boat! And I have to say that anchoring to swim through a window rock off Capri was an exquisite experience.
Room with a sea view, meals included
For another week, I worked from Villa Sirena Hotel pensione on the island of Ischia on the Tyrrhenian Sea. Breakfast and dinner were included in the cost of the room and there was a price break for booking a full week. You get another price break if you book a room with a garden view. In the mornings before work we swam, hiked to the top of Monte Epomeo, visited Aragon Castle and Poseidon Hot Springs.
Long-term travel and work
It’s far more affordable if you rent a place for a month, or several months. You can often find a nice place in a historic location for 800 Euros a month through AirBnB or Booking.com.
You *can* travel and work
Yes, you can. It really is possible to fit in the travel you want to do and the clients you want to see. It can be heaven on earth, and it has been for me on many occasions. It allowed me to take a week off to charter a sailboat with family and friends and visit the Amalfi Coast, Capri, Sorrento from the water.
What you need
If you’re already working online, you probably have everything you need.
Liability Insurance
This is the one thing that requires a week or two of advance planning. If you want to accept clients in international locations, you need to be sure that your professional liability insurance covers you.
American Professional offers coverage for working with clients in international locations. If you read the fine print, you will discover that if someone wants to sue you, they must sue you in the USA. As far as I am aware, the USA is the most litigious country; it is highly unlikely that someone in a foreign country would sue you. Do good work within your scope of practice and you will be fine.
When I started working in Poland, in order be covered to work with people abroad, I switched from CPH to American Professional. I did it without tail insurance. It was a bit nerve wracking to let go of the agency that had covered me since grad school, but it turned out fine.
Destinations
Where do you want to go? If you’re thinking about Europe, check how many hours ahead they are and think it through. You might find yourself working 2 pm to 3 am with a nice dinner break. It’s not terrible, if you are the type of person who can wind down and get enough sleep before you start your next workday.
Work schedule
Should you work weekdays or combine weekdays with a weekend day? If your main source of income is your business, then you need to plan your travel around your work schedule and your clients’ preferences. Think it through. What days will you want to travel? Would you prefer to work on weekends and travel during the week when there are fewer tourists?
Caution
Avoid Transient Circadian Disorder, Desynchronosis aka jet lag. It’s best for your body, your mood and wellbeing if you keep a consistent sleep-wake schedule. You can get jet lag if you go to sleep late (e.g. 3 am) on workdays and go to sleep at a reasonable hour on days off.
Niche
Does your preferred work schedule fit for your niche? Maybe you could incorporate scheduling preferences in your niche. For example, it might be clients with anxiety who want appointments in the morning. Or expats in Asia and Australia. Entrepreneurs who have a flexible schedule. Do your best to build a niche that dovetails with the time zone of your travel destination. And a schedule that works well for you and your clients.
Fun mornings in Europe
Generally, it’s pretty easy to build a little of the international experience into your morning and work in the afternoon and evening. If you want to go out in the evening on your days off, the night life in many countries starts late, so you can enjoy that too.
North and South America time differences are easier
On the other hand, the time differences between Mexico or northern Central America and the US and Canada are pretty easy. Time differences are small to none. Look up if the country does a time change and the date; it varies. Once you cross the equator in South America, things flip 2 hours when our time change springs forward and their time change falls back.
Time Buddy
Time Buddy is my favorite app to manage time zones. You can also access it through your browser at Time Buddy. Basically, it’s crucial. It lets you look at days of the week, matches times of day across time zones, allows you to see 4 times zones at one time and shows different countries’ time changes. For example, the US time change is on the second Sunday in March and November and Europe changes the fourth Sunday in March and November. Time Buddy helps navigate that passage.
Tools of the trade
As mental health practitioners, we have a responsibility to provide HIPAA compliant, confidential services within our competency and scope of practice. What tools do you use and how portable are they?
Scheduling
Because it’s the only app that does a good job of scheduling with multiple international time zones, I use Acuity Scheduling. The Powerhouse plan is expensive. Unfortunately, it is the only plan that includes a Business Associate Agreement (BAA) for HIPAA compliant confidentiality and a Data Processing Agreement (DPA) for EU GDPR compliant confidentiality. It sends email reminders to clients, integrates with video platforms like Zoom and payment platforms like Square. Unlike Zoom, they do not have an affordable plan for solo businesses that want a BAA or DPA. I wish they did. It’s long overdue.
How do you store your notes?
Do you use an Electronic Health Record (EHR) or Electronic Medical Record (EMR) platform like Simple Practice or Doxy.me, etc.
There are other options, of course: you can use your laptop for sessions and take notes with an iPad with external keyboard. Or you can pack an iPad with stylus, if you prefer writing handwritten notes and storing them electronically.
Security, encryption of notes
For security, there’s a free encryption program, VeraCrypt, to protect notes stored on your laptop.
Double locking file box
I’m that therapist / counselor who does EMDR and takes process notes on paper. That’s so I can shuffle through my pages and find relevant notes from multiple sessions, while I have my client on the screen. So, I only use the clients’ initials on the notes. They are stored in a double locking file box that I keep with me when I’m traveling.
VPN
VPN stands for Virtual Private Network and enhances confidentiality online. It might be a good idea to access a VPN located in the US before client meetings. One place you can get a free VPN is at Proton.me.
Video Conferencing / Telehealth /
Zoom offers a Business Associate Agreement (BAA) for HIPAA compliant confidentiality and a Data Processing Agreement (DPA) for GDPR compliant confidentiality at a reasonable price. In 2021 they only offered confidentiality agreements if you bought 10 licenses. So many therapists clubbed together to form groups of 10 that Zoom saw the wisdom of offering reasonably priced individual plans with confidentiality agreements. There are multiple other platforms that offer services.
Another video conferencing alternative
Wire is favored by security conscious people who work in technology. They trust its encryption and business practices more than they trust Zoom’s.
HIPAA and GDPR compliant email
For email, I highly recommend ProtonMail. Choose a country and that will determine the website suffix / top level domains (TLDs) such as .com, .ch, .it, .es, etc. ProtonMail provides end-to-end encryption and does not collect your data. They offer free and paid accounts. It is so secure that journalists use it to protect their sources.
Communication Hardware
The minimum for providing confidential mental health services online is an unlocked phone with local SIM card and app for confidential video calls. A laptop is preferable, in my opinion.
Unlock your phone for use abroad
If you call your cell service provider and tell them you are going to travel internationally, they will send you instructions that will allow you to unlock your phone.
The basics for work and travel
I travel with a laptop, double locking file box with a clipboard and lined notebook paper and inexpensive ring light, these days. One night, I was alone outside on a balcony and the outdoor lighting failed, but my ring light still worked. With the stone wall behind me, I looked like I was in a cave. Despite the loss of balcony lighting, we were able to continue our session.
Wherever I stay, I make sure they provide good WiFi, but my phone and local SIM card with cellphone service is always my backup plan.
You can work anywhere
One time, I did a session in a field in the USA in Amish country, with my phone on a tripod. In the far distance, I saw a couple in traditional dress go into a store, come out with 10-pound sacks, load up the horse drawn buggy and drive off. Another time, I did a session with my phone on a tripod, sitting on a blanket in the grass on a large, meadow by a lake.
Furniture set up
Summer of 2021, I did sessions in the hotel bedroom most of the time. My preferred arrangement is sitting in a chair with my back to the wall, my laptop on a table, desk or ironing board with a ring light clamped to the ironing board. Yes, a number of digital nomads use an ironing board.
Confidential meeting space
You do need to have a space where you won’t be overheard. The worst place I’ve done a session is in a hotel bathroom. I put lots of towels all around to soften the surfaces and improve sound quality. You do what you have to do to maintain confidentiality.
Sound protection
Use a white noise app to block your sound from traveling out and outside sound from traveling in during client meetings. Place your phone or other device with the White Noise app near the door so no one can hear what your client or you say during sessions. Remember that sound travels through windows too; you will need to keep them closed.
Headphones
If you use headphones, only you will be able to hear the client’s voice.
Travel: Plan for visas
On a separate topic, you must take travel visas into consideration. Do not take them for granted. Many countries give travelers with a US passport a 90-day visa automatically. Prepare in advance for countries that do not.
Mexico visas have changed
Be forewarned that Mexico does not always give people from the US 90 day visas anymore. You might have to ask for 90 days and explain why you want to stay so long.
Automatic visa for Europe is only 3 months
If you travel to Europe on an US passport, you automatically receive a 90-day visa when you arrive. Heads up! Please be aware that European countries and other countries in the Schengen zone only allow people with US passports to stay 3 months out of 6 months. That means you have to leave and stay somewhere else for a whole 90 days every 3 months before you can return to Europe or any of the countries in the Schengen Area. The only way around this is to go through the process of getting a longer-term visa.
What countries are in the Schengen Zone?
In alphabetical order, per Wikipedia, the Schengen Area aka Schengen Zone includes Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Lativia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and Switzerland. In addition, Monaco, San Marino and Vatican City have open borders, with the countries around them, so they seem like Schengen countries as well.
Visas for Europe over 3 months
If you want to stay longer, do your research. Many countries have two pathways: you can apply from your home country or you can apply once you get there. But! Know before you go.
Estonia EU 1 year visa
You might want to start your European trip in Estonia because it offers a digital nomad visa that will allow you to stay in Europe one year. Portugal and other countries are also starting to offer freelance visas.
Is it legal?
That’s actually an ongoing question. Is it legal to be in any particular geographic location and earn money? Does the country have a right to tax you since you are earning an income while physically present in that country? Good question. To find out, it is likely that you will need to talk with a knowledgeable tax accountant in both the US and any country where you spend an extended period of time.
Foreign Earned Income Exclusion (FEIE)
Most digital nomads from the US decide from the start whether they want to be outside the US for 330 full days during any period of 12 consecutive months. You can’t come back for longer than 35 days a year, total. If you choose this route, you still have to file US taxes and Form 2555. You just don’t pay taxes on income under $108,700 (for the year 2021).
International directories
If you would like to find clients in international locations, I have two favorites.
The Location Independent Therapists website is helpful and if you are a therapist / counselor / psychologist, or other mental health professional, you might like to join the Location Independent Therapists Facebook group. There is also a Location Independent Therapists community that offers members the opportunity to list their practice on their directory.
Another place you might like to list your practice is in the International Therapist Directory.
Other Resources
Kim Tolson has a course that teaches how to work online and travel: The Traveling Therapist. Megan Barnes Zesati’s Pack Your Practice site has a number of useful resources as well.
Questions
Feel free to ask me questions. At some point, I will offer a webinar on how to combine therapy / counseling / psychologist / work and travel. Email questions to natwalterfisk@protonmail.com.