Is online therapy suitable for expats? 3 things to check first

Is online therapy suitable for expats?

Yes, for the vast majority of expats, online therapy is not just suitable, it’s often the more sensible option than trying to find someone local. The main things to check are whether your counsellor is properly insured to work with you abroad, whether the country you’re in has its own specific rules about who can practise therapy there (the US is the main exception to watch for), and whether you’re in a country where you’d need urgent local, in-person support if things got serious. Outside of those checks, there’s no good reason online therapy shouldn’t work as well for you abroad as it would at home.

I’ve lived in Madagascar, the Philippines, Greece, India, and Cuba, among other places, and I’ve done the whole “I don’t speak the language, I don’t know anyone, and I have no idea how anything here works” thing more times than I can count. I’m not writing this as a theory. I’m writing it as someone who’s sat with the specific kind of lonely that only shows up when you’re a stranger somewhere.

Key takeaways

• A 2024 Cigna Healthcare study of over 10,000 people found that 48% of globally mobile workers are lonely, and UK expats report noticeably lower overall wellbeing than the global average.
• Older research (Patel, 2014–2016, n=5,000) found expats were three times more likely to report feeling trapped, isolated, or depressed than people who hadn’t relocated, with loss of their support network cited as a top stressor by 42.8% of respondents.
• For most of the world, a UK-based counsellor can legally and ethically see you online, as long as they’re checking local rules, not just assuming it’s above board.
• The US is the clearest exception, since many states have their own licensing laws that specifically restrict who can provide therapy to residents there.
• A well-drafted contract that states which country’s law applies (this is called a governing law clause) protects both you and your counsellor if anything is ever disputed.
• Online therapy isn’t automatically the right call if you’re in a country with no accessible emergency mental health services and you’re at genuine risk, that’s a different conversation with a different plan.

If you’re weighing this up for yourself, I offer a free 20-minute consultation to talk through whether it’s the right fit before you commit to anything.

Why is loneliness so much worse for expats specifically?

Loneliness abroad hits differently because it strips away the stuff you didn’t even realise was holding you up. At home, your support network is invisible until it’s gone: the friend you text without thinking, the GP who already has your notes, the neighbour who’ll take a parcel in. Abroad, all of that has to be rebuilt from nothing, often in a language you’re still learning, in a culture where you can’t always read the room.

We’re social creatures, and that’s not a throwaway line, it’s the actual mechanism behind why relocation is consistently ranked as one of life’s more destabilising events even when it’s a choice you’re excited about. The 2024 Cigna study I mentioned above found that nearly half of globally mobile workers report lacking companionship in their new country, and UK expats specifically scored lower than the global average across almost every wellbeing category, not just social connection. That’s not a small or unusual experience. That’s the norm for a huge number of people living this life right now.

And the older figures back this up from another angle. One widely cited study found expats were three times more likely than people at home to report feeling trapped, isolated, or depressed, with the loss of their existing support network coming up again and again as the biggest single stressor. I’d argue that number hasn’t shifted much because the underlying cause hasn’t shifted; moving country is still, structurally, an isolating thing to do, no matter how many WhatsApp groups you’re in.

Here’s the bit that doesn’t get said enough, though: none of that means something is wrong with you. It means you’re responding normally to an abnormal amount of change. That distinction matters, because a lot of the expats I’ve worked with have spent months quietly assuming their flatness or their low mood is a personal failing, when actually it’s a completely expected response to losing your entire scaffolding at once.

Can I legally see a UK counsellor while living abroad?

In most of the world, yes, and this comes down to a principle a lot of counsellors quote, that therapy happens “in the mind of the client,” meaning your counsellor’s professional and legal home base generally governs the work. The UK’s professional bodies are honest that this area isn’t perfectly settled everywhere, but for the large majority of countries there’s no specific law preventing you from seeing a UK-based, UK-registered counsellor online.

The important part is what your counsellor does on their end, not what you need to arrange on yours. A properly practising counsellor should be:

• Registered and accredited with a recognised professional body (for UK counsellors, that’s typically BACP, UKCP, or an equivalent)
• Covered by professional liability insurance that specifically extends to online work with clients based overseas, not just insurance for UK-based clients
• Using a contract that states clearly which country’s law applies if there’s ever a dispute, known as a governing law clause

That last point is one I take seriously in my own practice. It’s not there to protect me at your expense; it’s there so that if anything ever needed sorting out, both of us know exactly what framework we’re working within, instead of guessing.

If you’re wondering whether online counselling holds up compared to in-person work more generally, not just for expats, I’ve written about that separately.

What’s different about seeing a counsellor while based in the US?

The US is genuinely the exception, and it’s worth knowing why. Many US states have their own licensing laws that determine who can legally provide therapy to a resident of that state, and these are enforced far more specifically than in most other countries. This is different from the general rule of thumb that applies almost everywhere else.

Practically, that means if you’re a UK national living in, say, California or Texas, a UK-registered counsellor may not be able to see you in the same straightforward way they could if you were living in Portugal, Kenya, or Thailand. It’s not that online therapy stops working as a format; it’s that the specific legal permission to provide it changes state by state. If this applies to you, ask directly; don’t assume it’s fine just because it’s fine almost everywhere else.

Online vs in-person: what actually changes when you’re abroad?

That last row matters more than any of the others. Online therapy is brilliant for the ongoing, weekly work of feeling less alone, processing what’s changed, and building an “acceptable level of okay” in a new life. It is not a crisis service. If you’re in a country with limited or no accessible emergency mental health support and you’re at genuine risk, that needs a proper local safety plan alongside anything online, and any counsellor worth working with should be having that conversation with you honestly, not glossing over it to get you booked in.

So is it actually worth it for you?

I think it is, for most people in most situations, and I say that having lived the isolated, don’t-know-a-soul, can’t-read-the-menu version of expat life myself. The research backs up what a lot of my clients describe to me anyway: that the isolation is real, it’s common, and it’s not a reflection of anything being wrong with them.

I’ve written more broadly about the specific mental health challenges that come with living abroad if you want the wider picture beyond just the therapy-access question. And if you’re still weighing up whether counselling in general is worth it as an expat, rather than specifically the online format, that’s a separate piece I’ve written too.

My own approach is integrative, which in practice means I’m not going to hand you a rigid framework and expect your very specific, cross-cultural, often quite lonely situation to fit inside it. I’d rather work with what’s actually true for you.

You can read more about my own background living and working across several countries here, and if any of this resonates, get in touch or book that free 20-minute call to talk it through properly.

Frequently asked questions

Is online therapy as effective as in-person therapy for expats?

For the ongoing, ordinary work of therapy, yes, the format itself doesn’t reduce how effective it is. What changes for expats isn’t the therapy, it’s the access and legal picture around it, which is what this whole post is really about.

Do I need to tell my counsellor which country I’m living in?

Yes, always, and any counsellor working ethically will ask you directly. It affects their insurance cover, and whether local rules apply, so it’s not a detail to skip over.

What if I move to a different country partway through therapy?

Tell your counsellor as soon as you know. They’ll need to check whether their insurance still covers you in the new location, and if you’re moving to the US specifically, that’s the one situation where the answer might genuinely change.

Can online therapy replace local support if I’m in a mental health crisis?

No, and this is worth being direct about. Online therapy is excellent for the sustained, weekly work of feeling less alone and more like yourself, but if you’re in crisis, you need immediate, local, in-person support as well, not instead of it.

Is it normal to feel more lonely abroad than I expected to?

Completely. The data backs this up consistently, and in my own experience of living abroad multiple times, the loneliness caught me off guard every single time, even when the move itself was something I wanted. It doesn’t mean you’ve made the wrong choice; it usually just means your support network hasn’t caught up with your new address yet.