But Michael quickly noticed that a couple of days after a session, his therapist would upload a video that contained content uncomfortably related to what they discussed. “You’re like, ‘God, is this person using me for inspiration?’” he says. “It makes you second-guess yourself when you’re going to the next session.” He never confronted his therapist about it, and stopped seeing them after six months.
Therapists are also facing negative consequences of being open about their work online. In August 2022, one licensed counselor, Shabree Rawls (or @unusuallybree on TikTok), posted a video in response to an article on the rise of single men, in which she told men to go to therapy. The video went viral and she was terminated from her job the same week. Another therapist, Ilene Glance (under the handle @sidequesttherapy), was on the receiving end of backlash after she posted on TikTok in which she complained about a client “trauma-dumping”—where a person overshares traumatic details without the other person’s consent. After a wave of negative comments, harassing phone calls, and one-star reviews for her private practice, she deleted her TikTok account.
Ella White, a counseling psychologist in training at the University of Manchester, kept waiting for social media ethics to come up in her training—but it never did. So she decided to study it herself, using her doctoral thesis to interview other therapists about their attitudes toward using social media.
In her opinion, the guidelines aren’t comprehensive enough—leaving too much interpretation down to therapists themselves and not addressing what counts as inappropriate use. The guidelines also aren’t suited to the ever-shifting realities of Being Online. “This creates a difficulty in creating guidelines that are not as vague as current recommendations, but also not so specific that they feel like rules, which then become outdated,” she says. Plus, be too strict and you risk therapists being scared off from using social media at all. That therapists are having trouble navigating boundaries online perhaps isn’t surprising, says White—it’s a new demand for the profession, and the guidance on this is newer still. It is also just that—guidance, not a set of explicit rules, meaning that if therapists don’t adhere to it, there won’t necessarily be repercussions.
White is conducting research on what better guidelines might look like and how they might be better disseminated. She thinks they could include types of ethical dilemmas therapists may encounter on social media, to increase awareness of issues they may face, and guidance on what they could do in these situations. To this end, White thinks those designing the guidelines should spend more time actually speaking with psychologists, to hear their experiences and where their concerns and fears lie. This, hopefully, would get therapists to adhere to guidance more closely.
One of the most successful therapist-cum-influencers is Jeff Guenther, better known on TikTok as @TherapyJeff. Eighteen months into the pandemic, Guenther, a licensed counselor based in Portland, saw that the topic of mental health was “really trending,” he says. A passion for fighting mental health stigma, combined with a feeling that content creation seemed like fun, prompted him to start posting on TikTok in September 2021. His first three videos—where he tried to be too funny and weird, he says—bombed. But then his fourth—“5 questions you should ask your therapist right now”—went viral. “And the rest was history.”