How to Access Mental Health Counseling/Therapy Abroad: A Resource Guide for US Foreign Service Officers and Their Families.
Introduction
Below you will find information about therapy in general as well as a deep dive into the multiple avenues you can use to access therapy as a member of the Foreign Service Family. This information is very specifically targeted for US Foreign Service Officers and their families. I have gathered this information over time as I have attempted to help my Foreign Service (FS) community. Help is out there! A lot of help actually! You can access high quality healthcare anywhere. I hope the information contained within helps to demystify the process. If you have questions or additional resources, you can contact me using the form HERE.
Unfortunately, as we all know, there is no one size fits all in FS. This guide is simply a resource. I am not stating that any one insurance provider is better than the other, nor am I claiming any one mental health provider is better than another. We all have different needs. As things change constantly, I can’t guarantee this information will be correct in your specific location/circumstance. If your questions/concerns are related to insurance - always check your specific coverage/plan. Disclosure- I am a therapist and an EFM. I am not employed by State Department. I do have an online therapy practice that is listed alongside multiple resources in this article. This guide has not been reviewed or approved by State Department.
Jump to Section
How long is therapy going to take? What will therapy look like?
What mental health resources are available within State Department?
How do I get reimbursed if I pay for therapy “out of pocket” while overseas?
What is therapy?
Therapy/Counseling/Psychotherapy is a safe space with a professional who is trained in the complexities of the mind. It can be helpful for those who are feeling a bit lost/low as well as for those who are intensely suffering. Therapy empowers people through helping them understand who they are (not who they were told to be), how they got here, and can even help people figure out where they’re going. Therapy is a resource for people who don’t know what to do next, who need to make a decision, or could use some help understanding and/or making the most of a new situation. The therapist’s job is to teach you new skills and help you to reflect on problems that you may not be able to see clearly or objectively because you are too close to them.
The folks over at Good Therapy wrote a great general definition as well as some excellent follow up questions. Their article is HERE. I’m pasting the text here for your convenience but feel free to check out their page to read more.
“Therapy, also called psychotherapy or counseling, is the process of meeting with a therapist to resolve problematic behaviors, beliefs, feelings, relationship issues, and/or somatic responses (sensations in the body). Beginning therapy can be a big step toward being the healthiest version of yourself and living the best life possible—no matter what challenges you may be facing. Through therapy, you can change self-destructive behaviors and habits, resolve painful feelings, improve your relationships, and more.”
HERE is a list of the different types of therapists and here is an article I wrote called, “What type of therapy do I need?”
Do I need therapy?
Therapy isn’t just for people experiencing severe symptoms. Therapy can assist individuals in meeting their goals, skill building, decision making, and self/other awareness. For example, I specialize in existential concerns/questions and value alignment. These are topics that can reduce stress and increase resilience for any phase of life, and are especially helpful in times of stress. In my opinion, therapy is a flexible service that changes to provide the assistance needed, whatever that may be. So in the end, you can decide if you need therapy. If you want to read more, I wrote an article here called, “Should I go to therapy?”.
If you still aren’t sure, you can meet with a therapist once and see if it feels right. If you’re not sure if you could benefit from speaking to a psychiatrist (MDs who can prescribe medication) or a psychologist (PhD/PsyD – cannot prescribe in most cases) or a master’s level therapist (MA/MS/LCSW/LPC/LMHC/etc.), you can speak to any one of them and ask their opinion. MED employs psychiatrists (RMO-Ps). You can contact them directly to schedule an appointment.
How long is therapy going to take? What will therapy look like?
Therapy can be one session, 10 sessions, or 100+ sessions. It depends on what you want/need. For example, many of my clients come in weekly to resolve their most painful symptoms and then decrease session frequency until they terminate completely or only come in as needed. My hope is that therapy can be a preventative service and people can come in to get tools, get back to the “real world”, and repeat as needed.
Generally, you will meet for an intake/consultation appointment to see if you and the therapist are a good fit/understand each other. You should be interviewing them as much as they are interviewing you! If you decide to start working together you can discuss with your therapist how often you would like to meet and work with them to see how their schedule works. Then, hopefully, you and the therapist will set the treatment plan/goals for therapy to establish your direction. Don’t worry, your therapist should guide you through every step of the way, but never hesitate to ask questions!
On the technical side, each therapists’ practice looks different. This is something else you might want to ask about if it isn’t clear on their website. For example, my practice is in-person and online. I have the ability to see clients in my home office and through HIPAA compliant online software/client portal - Simple Practice - which includes encrypted video/messaging/document storage as well as secure payments. This means ALL your data will be secure, not just your therapy notes. Not all video platforms/versions are secure/meant for therapy use (e.g. Skype is NOT HIPAA compliant). Make sure your therapist is using a secure video service/platform.
Will therapy impact my job/security/medical clearance?
Here is some excellent guidance passed on to me in January 2022 by an incredibly helpful Department of State Regional Psychiatrist (RMO/P), Dr. Thomas Mak.
·The State Department is clear that, “The act of seeking help from a counselor, psychotherapist, or other mental health professional to address stress, depression, grief, anxiety, family or marital issues, or other concerns is not derogatory in a (DoS) security clearance determination.”
RMO/Ps assigned overseas are medical providers and not involved in the medical clearance or security clearance adjudication process
The State Department security clearance is a completely separate process from a State Department medical clearance process and is administered through Diplomatic Security.
If you are not a State Department employee, please check with your agency’s Human Resources Office for guidance. The RMO/P office is here to assist you.
Medical Clearances:
Employees and family members eligible for a State Department clearance will still be asked to report counseling on the DS-3057 Medical Clearance Update form and may be asked to provide supplemental information. However, due to recent changes from The Department of State’s Bureau of Medical Services (MED), counseling for grief, bereavement, marital difficulties, family therapy, parenting issues, situational stress, pandemic stress, phase of life transitions, adjustment problems, coaching for attention deficit disorder, pastoral or spiritual needs, and other supportive services will no longer require any further review by the State Department Mental Health Clearance team.
Additionally, the expansion of MED’s free Employee Consultation Services (ECS) to be available 24/7 means employees always have support available. ECS services and USAID’s
Staff Care are Employee Assistance Programs and strictly excluded from clearance review and should not be reported on the DS-3057 Medical Clearance Update form.
Security Clearances:
Key Points for DoS employees from ALDAC DTG: 310146Z JUL 19 Subject: Mental Health and Security Clearances
If employees need mental health care, they should get it. They should not neglect their mental health for fear that seeking treatment will negatively affect their security clearances
The act of seeking help from a counselor, psychotherapist, or other mental health professional to address stress, depression, grief, anxiety, family or marital issues, or other concerns is not derogatory in a security clearance determination.
From 2016-present, only approximately .001% of security clearance suspensions and revocations were based on significant concerns about an employee’s judgment, reliability, or stability stemming from mental health issues such as irresponsible, violent, paranoid, manipulative, impulsive, chronic lying, deceitful, exploitative, or bizarre behaviors.
This is something State has been working on changing for more than a decade. Here’s an article quoting former Secretary Clinton from 2010 on the clearance issue.
What mental health resources are available within State Department?
A lot of these are SharePoint links - which are inaccessable to EFMs/MOHs not working for State Department. This highlights a major issue in accessibility, but unfortunately, it’s not one I can fix. Please ask your lovely FSO to help you out here.
Your MED unit can help screen for potential mental health concerns and they may have a referral list on file. They can also provide you the current contact information for your RMO/P and/or help you schedule an appointment. Some MED unit providers are able/willing to screen for things like depression/anxiety and perscribe medication. You can walk-in or email.
Your DOS Regional Psychiatrist (RMO/P). RMO/Ps offer medically confidential consultations, evaluations, and brief counseling to employees and family members under COM authority. Psychiatrists are mainly perscribers and due to the number of people they serve, they are usually unable to meet for regular talk therapy sessions and may refer to a therapist.
Deployment Stress Management Program - provides information, education, referrals, initial assessment and brief treatment for problems related to the stress of deployment to high threat posts, overseas crises, and other stressful situations encountered by Foreign Service Officers, family members and State Department employees overseas. Phone: 703-875-4828; Email: MEDDSMP@state.gov; Intranet Website: http://med.m.state.sbu/mhs/dsmp/default.aspx
Employee Consultation Services (ECS) - free, confidential counseling with clinical social workers to Department of State employees and family members. They can assist with job stress, marital and relationship problems, parent and child problems, single parent and blended family concerns, school adjustment problems, elderly parent concerns, separation, loss and grief, financial concerns, life transitions, career/ retirement issues, and pre-post departure and reentry concerns. Phone: +1 703-812-2257; Email: MEDECS@state.gov.
Military Onesource – Support for Military Personnel & Families
USAID Staff Care - (password USAID) Programming for USAID employees. More information HERE. Staff Care Call Center (Available 24/7): 877-988-7243; Direct Dial: 919-645-4960; Reverse Charge: 44-208-987-6200 E-Mail: support@usaidstaffcarecenter.net
TalentCare - supports and promotes the integration of the Department’s workforce resilience initiatives. More information HERE.
Diplomatic Security Peer Support Group - provides immediate & confidential Peer Support to our Diplomatic Security employees and their EFMs during and/or in the aftermath of incidents or periods of high emotional or physical stress. Assists with coping skills, recovery strategies, follow up, referral services and being there for each other. Members of DSPSG are not medical professionals.
Victims' Resource Advocacy Program (VRAP) - VRAP is committed to assisting aggrieved individuals in overcoming difficulties that result from crimes investigated by the Bureau of Diplomatic Security. VRAP assists by providing resources to counter the realities that follow traumatic experiences and guidance on the judicial processes surrounding criminal offenses. Every effort is made to specifically tailor resources to meet the needs of the victim and may include counseling, assistance attaining reimbursements for medical payments and lost property, accompaniment to judicial proceedings, relocation support, etc. If you ever feel unsafe or experience violence at Post (from your spouse or anyone else), please speak to your RSO. They are very supportive folks who will believe you and help you get safe.
Tele-health for FSBP members (scroll down for overseas options)
A list from Foreign Service Youth Foundation - also includes outside resources
I was unable to find a good resource for BCBS. Here is an Overseas FAQ, but if you find anything better, please let me know!
Is therapy covered by Foreign Service Insurance - Foreign Service Benefit Plan (FSBP) Blue Cross Blue Shield (BCBS) or TriCare?
Generally speaking, YES! You can either find a provider who takes your insurance up front or pay for services “out of pocket” and file for reimbursement. If you use your insurance (upfront or reimbursement), you will likely need a diagnosis. Please read the section above on the (non)impact of diagnoses on security/medical clearance. Be sure to talk about diagnosis with your therapist - they can help explain diagnoses and their meaning (or the lack thereof). You may not need a diagnosis if you are using your flexible spending account/arrangement (FSA). I encourage you to be clear on the documentation you may need and chat with your therapist to make sure we get everything done in the right order. Some insurance providers may need a referral letter from the RMO or RMO-P, which is a fairly simple process.
How do I find a therapist while posted/serving overseas?
Individuals should be able to access care with local providers, an online provider of their choice, or someone assigned/available to them through insurance providers or State Department programs. If you’ve this far, you might want to revisit these resources. HERE is a list of the different types of therapists and here is an article I wrote called, “What type of therapy do I need?” Don’t worry too much about picking the right type, as long as you feel your therapist understands and helps you, you should be okay.
Find a therapist through State Department or your insurance
You can refer yourself to services through several of the State Department programs listed above.
Log on to your insurance providers website or give them a call to ask about coverage and covered providers.
Theoretically, your RMO-P and MED can BOTH provide referral lists (ideally they will have lists of local and State resources). They can also provide referral letters for insurance if needed, although this seems to depend on the Post.
Find your own therapist
Individuals can reach out to therapists directly and can start immediately if self-pay, this may also be true for some types of insurance. You may be able to be reimbursed for these services through your insurance provider.
1. If you are looking for an in-person/local therapist, you can try googling phrases like “therapy in CITY” “counseling in CITY” “expat therapy in CITY” or “psychotherapy in CITY”. You can also ask in local social media groups. For example, the expat Facebook groups in Vietnam are where EVERYONE goes to ask questions. If you aren’t comfortable asking, you can use the search function in these groups and see if someone else has asked in the past.
Be sure to interview the therapist and make sure they are well qualified for the work they are doing. HERE is a guide for that.
2. If you are looking for an online therapist outside of State Department who works with, understands, and/or specializes in US Foreign Service life, here are a few common recommendations. I am not saying any of us are better than anyone else, I only know these people have the proper credentials and often work with FSOs/EFMs.
• Dr. Fae Frederick - That’s me. Adults only.
• Therapy Solutions Group – All ages.
• Active Connected– In VA and employees some EFMs. All ages and couples.
• Truman Group– All ages and couples.
3. If you want more options and are open to online possibilities, you can try the following places. You might have to expand your search to other countries/regions. In the end it’s up to each therapist to decide what regions they serve due to possible liability/licensing issues.
Psychology Today - one of the biggest directories in the world
Families in Global Transition- remember to search for multiple key words “therapy” “psychologist”
How do I get reimbursed if I pay for therapy “out of pocket” while overseas?
If using insurance
Your insurance will likely require a “superbill” (invoice with a diagnosis code and service provided) from the therapist that you will need to submit to your insurance. If your local therapist cannot or does not diagnose, you may need a referral letter with a diagnosis from an MD (or MED).
It is highly recommended that individuals speak with their insurance company prior to starting services so they are clear on their options and what is needed for reimbursement and what is covered.
Some insurance providers sometimes require a referral from an MD before they reimburse. You may want to check with them before starting services.
Individuals should get any necessary referrals before their first paid session with therapist, as sessions dated prior to MD referral letter may not be covered/reimbursed.
Here are some instructions for reimbursement from the three main insurance providers.
◦ FSBP
◦ BCBS
◦ Tricare
If using FSA/HSA -
You use your FSA by submitting a claim to the FSA (through your employer) with proof of the medical expense and a statement that it has not been covered by your plan. You will then receive reimbursement for your costs. Ask your employer about how to use your specific FSA.
Often no diagnosis is needed for this route. Also for those who have a copay, the copay may be able to be charged to the FSA. At the time of this article (and from my understanding) only "psychologists" are covered (PhD or PsyD), not Master's level clinician (MA, MS, LPC, LMHC, LCSW, LPCC, etc).
More Resources
If you want more resources, feel free to browse my collection HERE. There’s a lot in there like:
Specific resources for those with marginalized identities
Issue specific resources (stress, depression, anxiety, relationships, values, etc.)
Resources for therapists/clinical supervisors
You can find my recommended reading lists for self-help and beyond HERE.
I hope you found these writings and resources helpful. If you have more/different/updated information, please let me know through the contact form. Good luck out there!
Dr. Fae
has a Ph.D. in Counseling Psychology. She lives abroad and offers online therapy & clinical supervision. In her individual therapy practice, she specializes in value alignment, existential questions, decision making, and general coping to increase overall life satisfaction. Her online self-study course Deepening & Developing Connections is always available.
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You can learn more about her in all these places.
drfae.com | facebook | instagram | linkedin
*The content on online-therapy.net is not intended to be a substitute for professional medical/therapy advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical/mental condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.