Quick answer: Americans living in Italy have three realistic options: keep a US therapist online, where the limit is usually their state licence rather than the technology; use the Italian public system, which is inexpensive, slow and in Italian; or work privately with a licensed therapist in Italy who practises in English. Private sessions here typically cost less than the US out-of-pocket rate, and the professions are organised differently from what you are used to.
Therapsy is a multilingual psychotherapy service in Italy that connects expats, international students and Italians with licensed therapists in their own language, online across the country and in person in 24 Italian cities.
Key takeaways
- Your US therapist is usually licensed by a single state, so continuing from Italy is a licensing question, not a technical one. Ask them, not the platform.
- Italy separates psicologo, psicoterapeuta and psichiatra, and only the psichiatra, a medical doctor, prescribes.
- Private therapy in Italy starts from EUR 70 a session, which is generally below the US self-pay range.
- Insurance works the other way round here: you usually pay, receive a proper invoice and claim afterwards, if your policy covers it at all.
- Video sessions hold up on outcomes: a noninferiority meta-analysis found symptom reduction no worse than face-to-face delivery, while the working alliance came out somewhat lower.
- Therapsy works in 14 languages, and the first conversation with the Clinical Director is free with a reply within 12 hours.
Can you keep your therapist in the United States?
What actually decides it?
Their licence. US licences are issued by state boards, and whether a clinician may treat a client who is physically abroad depends on their board, their malpractice cover and, in some cases, on local rules where you are sitting. It is a question for your therapist and their board, and it is worth asking before you move rather than after the first missed session.
Does the format itself weaken the work?
Not according to the research. A systematic review and noninferiority meta-analysis of videoconferencing psychotherapy examined 12 studies and found target symptom reduction to be noninferior to face-to-face delivery, while the working alliance came out somewhat lower. Specific treatments have been tested the same way in randomised noninferiority trials of telehealth delivery.
What does not work well?
A six or nine hour time difference over a long period. Evening sessions in Italy mean a working-day slot in the US, which is usually the first thing to break, and a therapist who cannot refer you to anything local if something escalates. Continuity is worth a lot; a fragile schedule is not.
How is therapy in Italy different from therapy in the US?
Who is who
A psicologo is a licensed psychologist registered with the Ordine degli Psicologi. A psicoterapeuta has completed a further four-year specialisation and delivers psychotherapy. A psichiatra is a medical doctor and is the only one of the three who prescribes. There is no direct equivalent of the LCSW or LMFT structure you may be used to, so match on the register and the specialisation rather than on the acronym.
What about the culture of therapy itself?
Two differences Americans notice. Therapy is less normalised in everyday Italian conversation, so you will hear it discussed less casually. And sessions tend to be somewhat more formal at the start, with the frame, fee and boundaries stated explicitly. Neither reflects on quality; both surprise people who expect the American register.
Is medication handled differently?
The prescribing route is different: a psychologist cannot prescribe, so medication involves a psychiatrist, and continuing a US prescription generally means a consultation here rather than a transfer. Bring the name of the molecule and the dose, not only the brand, because brand names differ between the two countries.
What does it cost, and what about insurance?
What are the fees?
At Therapsy individual sessions start from EUR 70, couples from EUR 100 and a psychiatric consultation from EUR 110, with the same fee online and in person; the pricing page lists the rest. That is generally below the typical US self-pay rate, which surprises most people who arrive expecting the opposite.
How does insurance work here?
Usually as reimbursement rather than co-pay: you pay the session, receive an invoice from a licensed professional and submit it. Whether an international or US policy accepts a foreign provider varies a great deal, so ask your insurer for the exact wording before you start and ask the therapist what documentation they can issue.
Is there a tax angle?
Psychological care is generally deductible as a health expense in the Italian tax return. If you are filing in both countries, this is worth raising with whoever prepares your US return as well, since US expat filing has its own rules. Keep every invoice.
What about the public system?
If you are enrolled in the SSN you can access public mental health services through the local CSM. It is free or nearly free, it works in Italian, and waiting times are long. It is the right route in severe cases and emergencies, and many people use it alongside private care rather than instead of it.
How do you find an English-speaking therapist in Italy?
What to verify
Ask for the full name and the Ordine degli Psicologi registration number and check it; the register is public. Ask whether they are a psicoterapeuta or a psicologo, and what they work with most. Ask the fee and the session length together. A professional who answers all four without hesitation is telling you something useful.
Does the therapist need to understand American context, not just English?
It helps more than people expect. The things that come up, distance from family, a spouse whose career paused for the move, healthcare anxiety in a system you cannot read, guilt about an ageing parent eight time zones away, are easier with a clinician who has heard them before. Our therapists work with international clients daily.
Online or in person?
Both are available: online across Italy and in person in 24 Italian cities. Online keeps the same therapist if you move city or spend a period back in the States, which for expats is the part of care that most often breaks.
How do you start?
At Therapsy the first conversation is free and happens with the Clinical Director, who proposes a therapist and explains the reasoning. You get a reply within 12 hours, and you can change therapist later without starting your history over.
Frequently asked questions
Can my American therapist treat me while I live in Italy?
It depends on their state licence, their insurer and in some cases on local rules, not on the technology. Ask your therapist to check with their licensing board before you rely on it.
How much does therapy cost in Italy compared with the US?
At Therapsy sessions start from EUR 70 for individual therapy and EUR 100 for couples, which is generally below the typical US self-pay rate. Public care through the SSN is free or nearly free but works in Italian and has long waits.
Will my US health insurance cover therapy in Italy?
Sometimes, usually as reimbursement against an invoice from a licensed professional rather than as a co-pay. Confirm the wording with your insurer before the first session and ask the therapist what paperwork they provide.
Can I get my medication prescription continued in Italy?
Through a psychiatrist rather than a psychologist, and normally after a consultation here rather than by transferring the prescription. Bring the molecule name and dose, since brand names differ between the two countries.
Do I need to speak Italian to see a therapist in Italy?
Not in private multilingual care. Therapsy works in 14 languages, including English, online across Italy and in person in 24 cities.
Is therapy in Italy as good as in the US?
The training route is different and the regulation is strict: psychotherapy is reserved to professionals who complete a four-year specialisation after their degree and register with the Ordine. Verify the individual on the public register, as you would at home.
