Navigating Cross-Border Work With Clients

I have been working online with clients since 2001 as an insurance broker and since 2017 as a counsellor and therapist.

Even prior to the COVID-19 pandemic many therapists worked online, even though it hasn’t been spoken about much. Since the COVID-19 pandemic, there has been a global shift towards online therapy as we continue to minimize in-person interactions and move as much of our work as possible onto online forums. 

One possibility that opens up as we shift online, is the potential to work with clients who reside in other cities, other parts of the province (or state), and in other countries. Naturally, questions arise as to whether we are permitted to work with clients in other provinces, states and countries. 

When you are considering working with a client in another state, province or country, there are 3 important things to know:

Is the client suitable for online work?

Not every client is well suited to working online. If the client has a moderate or severe mental health disorder, is prone to panic attacks or significant emotional dysregulation, working with an in-person therapist may be a better option. Also, if the client is experiencing suicidal ideation, they may also be better suited to in-person work. 

Ideally, you have received appropriate training prior to working online and know how to screen your clients properly.

Are you properly insured?

Next, you’ll need to contact your insurance company. You’ll want to ask them two things: 1) are you properly insured to counsel clients online?; and 2) are you insured to work with a client in their jurisdiction. 

Many insurance companies in Canada do cover you for online therapy as well as working with clients in both Canada and the U.S., but not worldwide. It is important that you confirm what your insurance company covers you for.

Are you permitted to work with the client?

Even if you are properly insured, you’ll still need to check with the governing body where the client resides. Even with insurance, it’s possible you could be violating the regulations in another province, state or country by working with a client who resides there when you’re not registered with them. 

Generally speaking, you need to be registered, certified, licensed or approved by the governing body in counselling/therapy/social work (whichever applies to you) where the client lives. The easiest way to discover whether you meet the requirements is to contact the governing body where the client lives and ask. 

Sometimes, governing bodies don’t actually regulate the practice of counselling or therapy and you’ll be good to go. Other times, like at the beginning of the COVID-19 crisis, certain governing bodies may make exceptions in order to best serve the public. More commonly, governing bodies won’t permit therapists from other provinces, states, or countries to work with a client in their jurisdiction unless they are registered with them. 

Whether you choose to get registered/licensed in another jurisdiction besides your own, is completely up to you. It may be worth looking into the cost of licensing and the amount of time required to get and maintain licensure in that jurisdiction.

If you would like to grow your practice, consider looking into our BYPP Grow Your Practice Program.