When you practice therapy from abroad, two tax systems potentially apply to your income: your home country's (which may tax you regardless of where you live) and your host country's (which may claim you as a resident taxpayer). Getting this right isn't optional — getting it wrong means double taxation, penalties, or both. This guide covers the concepts; for your specific situation, one session with a cross-border tax professional is worth more than any article.
The 183-day rule
In most countries, spending more than 183 days in a calendar year triggers tax residency. As a tax resident, you generally owe income tax on your worldwide earnings in that country. Move every few months and you may stay under this threshold everywhere — but you also may have no tax residency at all, which creates its own problems.
US therapists: you're taxed on worldwide income regardless
This is the most important special case. US citizens and green card holders are taxed on worldwide income regardless of where they live. Moving to Portugal doesn't exempt you from the IRS. What it does change is:
- You may qualify for the Foreign Earned Income Exclusion (FEIE) — up to ~$126,500 excluded from US tax (2026) if you pass the physical presence or bona fide residence test
- You may get a foreign tax credit for taxes paid abroad
- You still file a US return every year
US therapists abroad must file in the US and potentially in their host country, then use treaties and credits to avoid double-paying.
EU therapists: it depends on your country
EU tax rules vary by member state. France taxes residents on worldwide income; some other countries have more favorable treatment for overseas income. A key principle: registering as a non-resident in your home country before leaving can change your tax exposure significantly, but it also changes your social security contributions, healthcare access, and pension accrual. This is a decision to make carefully.
What to sort out before you leave
- Your home country's rules on non-resident taxation — does it follow you?
- Tax treaties between your home and destination countries — these prevent double-taxation
- The self-employment tax angle — as a self-employed therapist, you pay both halves of social contributions in the US (15.3%); this continues abroad unless a totalization agreement applies
- VAT/GST — some countries require self-employed service providers to register for VAT above a certain income threshold
Practical first steps
- Research your home country's rules on citizens/residents working abroad
- Check if a tax treaty exists between your home and destination country
- Find an accountant who specializes in cross-border self-employment — not a generalist
- Set up a separate account for tax reserves (25–35% of income is a conservative estimate for most self-employed therapists)
The bottom line
Taxes abroad are solvable, but they require proactive planning — not reactive catching-up. The therapists who have most regrets about the nomad life are often the ones who ignored taxes for two years and then faced a painful correction. Do the work upfront.
For the payments side (currencies, transfer fees, invoicing), see How to Get Paid as a Nomad Therapist.