Seeing international patients as a psychologist from Spain opens an interesting market (expats, Spanish-speakers in countries with no clinical offer, patients who want therapy in their language) but it requires clarifying three fronts: legal, tax and technical.

This guide covers how to set up your practice for international online therapy without breaking your college's code of ethics, without tax surprises and with a stack that respects patient data.

Jurisdiction and ethics: where you can practise

As a psychologist registered with the Spanish college, you can practise in Spanish with patients resident in any country as long as:

  • The patient's country of residence does not require a local licence for online psychological therapy (some US and Canadian states do).
  • You comply with your code of ethics (COP) and Spanish law.
  • You inform the patient, in writing, that Spanish regulation applies.

For the USA, Canada, Australia and some Nordic countries, it is wise to consult the college. The safe option: only patients in the EU, LATAM, UK and Iberoamerican residents.

VAT and invoicing to patients outside Spain

Clinical psychotherapy is VAT-exempt in Spain (art. 20.One.3 LIVA). For B2C services:

  • EU patient: invoice without VAT (healthcare exemption); identify the patient with their address.
  • Non-EU patient: invoice without VAT; the service is not localised in Spain.
  • Form 349: only if you invoice companies, not individuals.

There are nuances by country. Consult your accountant; cheap bills get expensive at audit time.

International payments: Stripe, Bizum and banks

Bizum doesn't work outside Spain. For international patients:

  • Stripe: charge cards in EUR/USD/GBP with automatic conversion. Fees 1.5-3.5%.
  • Wise / Revolut Business: multi-currency accounts to avoid the Spanish bank's exchange rate.
  • SEPA transfer between EU countries for long therapies with a reliable patient.

More in online payments for psychologists.

GDPR with non-EU patients

If the patient resides in the EU, GDPR applies with all its guarantees. If they reside outside the EU:

  • GDPR still binds you as the controller established in Spain.
  • You cannot transfer data to non-secure providers (check that your video and clinical software are EU-based or use standard clauses).
  • Inform the patient of the legal framework in the informed consent.

Language, time zones and tech stack

  • Explicitly announce the languages you work in (ES/EN/CAT/PT) and mark it on your site.
  • Limit the time zones served: GMT-3 to GMT+3 is manageable; more is exhausting.
  • Bilingual clinical software (My Psico Agenda is in ES/EN/CAT) and consents in the patient's language.
  • End-to-end encrypted video platform with EU-hosted servers.

Common pitfalls when seeing international patients

  1. Charging cash or without an invoice «because they're abroad»: illegal and expensive.
  2. Mistakenly charging VAT on exempt sessions (complicated refunds).
  3. Accepting patients in US/Canadian states without a local licence.
  4. Forgetting to declare income in the quarterly 130 form.
  5. Using free «consumer» video platforms without a data-processing agreement.

Frequently asked questions

We answer the most frequent questions on seeing international patients as a psychologist in Spain.

Do I need a licence in the patient's country?

It depends on the country. EU, LATAM and Iberoamerican residents: usually no, your Spanish membership and a clear informed consent are enough. USA and Canada: most states/provinces do require a local licence for online therapy with residents.

What if the patient has a crisis in another country?

Your crisis protocol must cover it: have local references (hospital, emergency number, family contact) and put it in writing in the frame and consent.

Can I charge in USD if the patient is in the US or LATAM?

Yes, with Stripe or multi-currency gateways. Remember to convert to EUR for your income tax and declare the revenue in euros at the day-of-payment rate.

Can I charge differently by country of residence?

Yes. Some colleagues apply local rates (lower for LATAM, higher for Switzerland/Norway). It is legal as long as you do it with a public, consistent criterion.

Does my professional liability insurance cover patients in other countries?

Only if the policy says so. Check the «territorial scope» section and, if missing, take out an extension. More in professional liability insurance.

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