Online Therapy for Expats: How It Works Across Countries and Time Zones

Online therapy can make it possible for expats to work with a qualified therapist by secure video, in the language they think and feel in. For many people living abroad, it solves the biggest barriers to getting support: local therapists who don't speak your language, don't understand relocation, or have long waiting lists. And research suggests it works: a 2022 meta-analysis of randomized trials found no significant difference in outcomes between therapy by video or telephone and therapy in person.

One important point before anything else: therapists are registered with a regulator in a particular place, and the rules about which clients they can see online vary between provinces, states and countries. Always check that a therapist is permitted to work with someone where you live.

This guide explains how online therapy for expats works in practice, what the evidence says, and what to look for in a therapist.

Why expats choose online therapy

Language. Talking about feelings is hard enough in your first language. Doing it in your second or third can feel impossible. Online therapy lets you work with someone in the language where you feel most yourself.

Understanding. A therapist who knows what relocation, cultural adjustment and family transitions involve doesn't need everything explained from scratch.

Continuity. If you move again, travel often, or split time between countries, you don't have to start over with someone new each time.

Privacy. In a small expat community, seeing a local therapist can feel exposed. Sessions from your own home are more discreet.

Access. In some places, therapists are scarce, expensive or booked for months. Online therapy widens your options.

Is online therapy as effective as in-person therapy?

For many people and many concerns, the evidence is encouraging. A meta-analysis published in Clinical Psychology: Science and Practice (Lin, Heckman and Anderson, 2022) pooled 20 randomized clinical trials comparing teletherapy (video or telephone) with in-person therapy. It found no significant difference in treatment outcomes after treatment or at follow-up, and no significant difference in dropout rates. The authors concluded that client outcomes in teletherapy do not differ from in-person versions of treatment.

That doesn't mean online therapy is right for everyone or every situation. It is not suitable as crisis care, and some people simply prefer being in a room with someone. But for ongoing support through relocation, transition, low mood, anxiety, grief or relationship strain, it is a well-supported option.

What online therapy can help with

People living abroad often seek support for:

• Relocation depression and a hard first year
• Loneliness after moving abroad
• Identity loss after moving for a partner's job, sometimes called trailing spouse syndrome
• Grief for someone back home
• Language barrier anxiety
• Relationship strain after a move
• Supporting children through a move

How online therapy works in practice

Sessions

Sessions happen over a secure video link. You join from wherever you have privacy and a stable connection. At The Home Bench, therapy is available to clients located in Saskatchewan, and transition coaching to clients everywhere else. Individual sessions are 50 minutes, and couples and family sessions are 75 minutes. Most people meet weekly or every two weeks.

Time zones

If you work with a therapist in a different time zone, appointments are usually arranged in your local time. A few tips:

• Pick a regular time that fits your week, such as a lunch hour or after the children are in bed
• Watch the clock changes: Europe and North America switch to and from daylight saving time on different dates, so check your appointment time in the weeks around those changes
• If your schedule shifts with work or travel, plan sessions a few weeks ahead

Language

At The Home Bench, sessions are in English and French.

Setting up your space

• Use headphones so you can speak freely without being overheard
• Let people at home know you need uninterrupted time
• Keep water and tissues nearby
• If privacy is hard at home, think creatively: a parked car, a walk with your phone, or a booked room at a co-working space

How to choose a therapist when you live abroad

Look for:

• Professional registration you can check. For example, I am a Registered Social Worker (RSW) with the Saskatchewan Association of Social Workers, which means I can offer therapy to clients located in Saskatchewan.
• Permission to work with you where you live. Rules for seeing clients in other provinces, states or countries vary. Ask before you start.
• Relevant experience, such as relocation, identity changes or family transitions.
• An approach that makes sense to you. I work with cognitive behavioural and solution-focused approaches. You can read more about how I work.
• Clear information about fees, cancellation and privacy. See my services and fees.
• A free first conversation, so you can see how it feels before committing.

It also helps when a therapist has lived something close to your experience. I trained as a counsellor before moving abroad with my own family, and that lived experience shapes how I understand this work.

Therapy or coaching?

Some therapists who are registered in one place offer coaching to people who live elsewhere. Coaching can help with adjustment, goals and practical next steps after a move, but it is not therapy: it does not assess, diagnose or treat mental health conditions. If you need therapy, look for a therapist who is registered where you live.

At The Home Bench, therapy is available to clients in Saskatchewan, and transition coaching to clients everywhere else.

When online therapy isn't the right fit

Online therapy is not emergency care. If you are in immediate danger or need urgent support, please contact local emergency services in the country where you are, or find a free helpline at findahelpline.com.

What a first online session looks like

If you have never had therapy by video, it can help to know what to expect. Before the session, you receive a link. A few minutes beforehand, you find a private spot, put on headphones and join. There is no questionnaire or intake form to fill in. The conversation is the intake.

We start with what is bringing you here and what has been hardest. You decide how much to share. Toward the end, we talk about what you would like to focus on and how often to meet. Many people are surprised by how quickly the screen fades into the background once the conversation gets going.

If you would like to know more before booking, my guide to what to expect from a free therapy consultation walks through the first conversation step by step.

Privacy and confidentiality online

Confidentiality works the same way online as in person. At The Home Bench, sessions are private, notes are kept securely, and nothing is shared without your explicit consent, with the standard legal exceptions for safety. You can help protect your own privacy by joining from a space where you can't be overheard, using headphones, and making sure your device is not shared with others.

Frequently asked questions

Does online therapy work for expats?

For many people, yes. A 2022 meta-analysis of 20 randomized trials found no significant difference in outcomes between teletherapy and in-person therapy. For expats, online therapy also removes barriers like language, availability and finding a therapist who understands relocation.

Can I see a therapist from another country?

Sometimes. It depends on the therapist's regulator and on the rules where you live. Ask any therapist where they are registered and whether they are permitted to work with clients in your location before you begin.

How do time zones work for online therapy?

Appointments are set in your local time. Pay attention around daylight saving changes, since Europe and North America change clocks on different dates.

Is online therapy covered by insurance abroad?

It depends on your plan. Many people pay for sessions and claim reimbursement themselves. See my guide to paying for online therapy abroad for questions to ask your insurer.

Talk it through

Sometimes the move is for everyone else. You're learning the rhythms of a new place, holding family life together, and trying to recognize yourself in the middle of it all.

I offer therapy to women and families in Saskatchewan, and transition coaching to clients living elsewhere. Wherever you're joining from, our conversations can make room for what this season has brought up and help you find your footing again. Sessions are virtual, in English or French.

Not sure what kind of support you're looking for? A free 30-minute consultation is a gentle place to start. We can talk about what's been weighing on you and whether working together feels like a good fit.