Work Online and Travel: LMFT LPC LCSW PsyD EdD Travel

I love, love, love to work as a therapist / counselor online and travel. Would you like to work and travel too? If you’re a licensed therapist, counselor or psychologist, other online practitioner, or simply wish you could be a digital nomad, I’d like to share with you all my knowledge, experience, tips and tricks.

Dream your dream and 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. Yes, you read that right. 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 all the travel you want to do and all the clients you want to see. It can be heaven on earth, and it has been for me on many occasions. Let me tell you, 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.

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.

Work schedule

Work days? Or weekends? If you’re like me and you depend on your business for your income, then you need to plan your travel around your work schedule. 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? Does that work for your niche? Do your best to build a work schedule that is good for you and your clients.

Time differences

Where do you want to go? If you’re thinking about Europe, you might find yourself working 2 pm to 10 pm. It’s not terrible, so long as you can wind down and get enough sleep before you start your next workday. 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, the night life in many countries starts late, so you can enjoy that too, even while you’re working days with people back home.

On the other hand, the time difference between Mexico or northern Central America and the US and Canada are pretty easy. The time differences are small to none. Once you cross the equator, things flip 2 hours when our time change springs forward and their time change falls back.

Notes: 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 carry a double locking file box and keep it with me when I’m traveling.

Hardware and supplies

The minimum for providing confidential mental health services online is an unlocked phone with local SIM card and app for confidential video calls.

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 require 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, unoccupied lot by a lake.  When an owner from a neighboring property a long ways away saw that I was packing up the car and was getting ready to leave, he tromped into sight and asked if I was interested in buying land.

Set up

As I mentioned, last summer, I spent a month in Italy and worked two weeks of that month. Most of the time, I did sessions in the bedroom, 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, seriously, lol.

Confidential meeting space

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 need to have a space where you won’t be overheard.

Automatic visa for Europe is only 3 months

If you’re traveling on an American passport, you automatically receive a 3 month visa for Europe 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 3 months every 3 months before you can return to Europe or any of the countries in the Schengen Area unless you 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)

However, 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).

Resources

Megan Barnes Zesati’s Pack Your Practice site has a number of useful resources.

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.

Apps

TimeBuddy is essential. Even with a time difference app, you need to be super careful with your scheduling.

Scheduling

Because it’s the only app that does a good job of scheduling with multiple international time zones, I use Acuity Scheduling. Sadly, I have to pay for a Powerhouse plan because it’s the only one that includes a Business Associate Agreement (BAA) for HIPAA compliant confidentiality and a Data Processing Agreement (DPA) for GDPR compliant confidentiality.  It includes email reminders to clients,  and integrates with a number of video platforms like Zoom for video calls and multiple payment platforms like Square for payments. 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.

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 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.

VPNs

In addition, when working with clients in the US from abroad, I recommend using a Virtual Private Network (VPN) through ProtonMail or other provider to route your connection through the US.

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.