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Friday, June 14, 2024

Help, My Therapist Is Also an Influencer!

Jeff Ayars didn’t like his therapist. Their sessions felt stilted and her mind seemed to be elsewhere. Ayars, a news producer from New York, wondered whether it was his fault—after all, she had good reviews online and he had found her through his work’s insurance. Then he found her TikTok account.

It wasn’t just her follower count—50,000 people—that caught his eye. It was the videos themselves. His therapist, it turned out, was also an influencer. Her bite-size videos helped people “make decisions quicker” or explained why people “don’t have to apologize” for their feelings. “Was she just thinking about her next post while we were in the session together?” Ayars says. “What’s her real goal?” Was she trying to help him, he wondered, or was she chasing social media clout?

During the pandemic, when the world’s mental health took a nosedive, the amount of mental health content on TikTok shot up; today, the #mentalhealth tag has 70.5 billion views. Add to this the explosion of the app’s popularity, with users more than doubling since Covid struck, and you get TikTok therapists broadcasting advice to their followers en masse.

As more and more therapists have started posting advice online, especially on TikTok, professional bodies have struggled to keep up. In the United States, the American Psychological Association (APA) published its first set of social media guidelines for psychologists only in October 2021. In the United Kingdom, the British Association for Counselling and Psychotherapy (BACP) refreshed its guidelines in March 2021. 

These guidelines call for the online and physical worlds to be kept separate as much as possible. With their IRL clients, psychologists should “consider the need to avoid contact with their current or past clients on social media, recognizing that it may blur boundaries of the professional relationship,” the APA suggests. Yet, as in Ayars’ case, an algorithm can quickly take this out of a therapist’s hands. If your therapist has tens of thousands of followers on TikTok, chances are they’ll pop up in your For You page. Does stumbling upon your therapist dancing to Hannah Montana when you’re scrolling on your lunch break cross a line? Ayars felt uncomfortable that his therapist hadn’t been transparent about also maintaining an online presence: “I think it’s just strange to find you’re working with someone who’s pursuing that—and it’s not upfront,” he says. 

A bigger problem is that when a therapist is posting online, there’s the temptation to use subject matter from sessions as inspiration for content—an absolute no-no. This happened to Michael, who lives in the US and asked WIRED not to use his real name for privacy reasons. He actually found his therapist through social media—he had a specific emotional issue he wanted help with, and he came across a therapist who made YouTube videos for about 12,000 subscribers, whose content specialized in psycho-education about this more niche issue. Michael realized this therapist was a practicing psychologist in the same state as him, so he reached out, and began sessions with him. 

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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 a 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.” 

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Today, 2.4 million followers watch his videos. The Biden administration asked Guenther to talk about the US president’s new economic plan to his followers, and he’s writing a book. Guenther loves being in the spotlight and being recognized on the streets. He says about half of his income now comes from his online presence. He sells merchandise, including a T-shirt that says “Favorite Client.” 

The content produced by Guenther and other therapists defies the traditional picture of therapy: that it be bespoke, tailored to your history and emotional needs—instead, it’s overtly general. And amid the love his followers show for him, some of Guenther’s videos have been called out for offering advice that is too one-size-fits-all or which borders on toxic positivity. In one video about feeling like a burden, he tells the viewer: “You’re not a burden on anyone … It’s not that you’re too emotional, it’s that you grew up around someone who couldn’t support your emotional needs.” Multiple users called out this advice for potentially offering narcissists or abusers an excuse for their behavior; what if sometimes a viewer who may feel exonerated by Guenther’s advice is indeed the problem, they argued? 

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“A lot of the content I make is not going to apply to everybody, because it’s vague, it’s not nuanced; it’s just 30 to 60 seconds,” says Guenther. “So I’m going to assume … that the people that are watching my content know what’s for them and know what’s not for them.” 

Guenther eventually hopes to leave TikTok, once he’s built a big enough following that he can take with him to a different platform. In an ironic twist, the platform is negatively affecting his mental health. “There’s this weird addiction that I have to the likes and to the views,” he says. “It feels toxic.” 

In an ideal world, people wouldn’t be getting their mental health advice from TikTok or Instagram—the support is generic, the credentials of its dispenser often unquestioned. But for reasons of cost or lack of practitioners, therapy is inaccessible to many. For some, social media may be the only way they can access help. If a therapist-influencer can give people basic tools rooted in evidence to help themselves, “then that’s really beneficial,” says White. The APA and BACP guidelines do extol the value of therapists using social media for these reasons, and note as well that it raises awareness of mental health and normalizes its discussion. Raquel Martin, a psychologist speaking to BuzzFeed News, said that she considers being on social media one of her “responsibilities.”   

Guenther sees his content as a backdoor way to fill the gaping mental health care void. “We’re all depressed, we’re all having a really hard time,” he says. “This is the best way that they can get therapy.”

For better or for worse, therapist-influencers are here to stay. They’re democratizing the barriered world of therapy, but the content’s lack of nuance and the murky boundaries between patients and professionals are breeding issues that the field is scrambling to reckon with. You may not want or need to see your therapist on TikTok, but as the borders between social media and the chaise longue get hazier, be prepared for them to pop up on your For You page. 

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