In 2022, Karen was browsing TikTok when she discovered something unexpected: a video about relationships and anxiety made by her therapist. She wasn't sure how it found her because they didn't have each other's phone numbers. But what's most striking about this experience is that it's happened before. In 2022, she met her former therapist on YouTube and also felt uncomfortable at the time.
"That was actually part of the reason why I thought, 'I think I'm going to stop treatment for a while,'" said the 29-year-old patient from Los Angeles.
TherapyTok stars have attracted a crowd not dissimilar to the artists and influencers who have achieved mainstream fame on the app. A video about the warning signs of suicide has been viewed more than 9 million times. So does another question about whether you are in "freeze mode". These posts are just one of tens of thousands of contributions psychologists have made to the platform. Yet despite their popularity and the rise of things like "therapy talks," users have ambivalent feelings about seeing their own mental health professionals on camera.
"It's like when you were a kid and saw your teacher in the supermarket," said Ashley, 30, from Brooklyn. Ashley started getting content from her own therapist after he sent her TikToks related to their therapy sessions. "You'd say, 'You're not allowed here,'" she joked.
It would be a violation of the Health Insurance Portability and Accountability Act (HIPAA) for psychologists to discuss their private therapy with others. But with people's lives now largely conducted online and more and more therapists using social media tools to develop and promote their treatments - the lines of normal are blurring.
"There's not a lot of information about how to navigate it," says Ernesto Lira de la Rosa, Ph.D., clinical assistant professor in the Department of Applied Psychology at New York University. "[But] we do spend a lot of time talking about this issue in career introduction and ethics classes."
In general, students are advised to protect themselves and the reputation of the field by disclosing their social media presence to clients and to be aware of the potential impact of the information they share online, knowing that it may be received inaccurately .
"I see clients come in and say 'I have ADHD or I have anxiety,'" he said. "When I started asking more questions — 'When were you diagnosed?' — [they said] 'Oh, well, I saw someone on TikTok saying these were the symptoms.'"
Some therapists are motivated to create content to counteract what they believe are common misconceptions about mental health information. Meg Josephson, a Bay Area psychotherapist, started posting online hoping to do just that, but her TikTok account, which now has 250,000 followers, ended up becoming an important way to promote her practice. Now, she says, most of her clients say they found her through her social media, and she recently landed a book deal through social media.
For some clients, the strangest part is seeing a therapist they know in therapy take on a completely different persona online. "I don't talk to my clients in a 'Here are the top 10 reasons why you should break up with your boyfriend,'" Guenther said with a laugh.
Jeff Guenther, a marriage and family therapist who posts to his 2.8 million followers on TikTok as TherapyJeff, had been practicing for more than 15 years before starting producing content in 2021. He said he was tired of the pandemic and wanted to be a part of it. He had seen communities of other therapists online.
“The fourth video I posted went viral and four of the clients I was seeing saw it before I even told them I was doing it,” he said. "It was really uncomfortable for them and I felt embarrassed."
Generally, he said, people's reaction to seeing him on his phone is one of "shock and surprise." They discussed the issue in their own meetings and ultimately came up with the list of social media boundaries he included in the informed consent form today. "If they did make a comment, I would ignore [it]. I would not admit that we had any kind of relationship because that would actually breach confidentiality," he said.
Therapist content is not a substitute for therapy, something Guenther makes clear in a disclaimer at the top of his TikTok page. This is just self-help entertainment, and for some clients, the weirdest part is seeing a therapist they know from therapy appear online in a completely different persona. "I don't talk to my clients in a 'Here are the top 10 reasons why you should break up with your boyfriend,'" Guenther said with a laugh.
"I guess it surprised me because I didn't think of her as a 'TikTok therapist,'" Ashley said of the video of her own therapist. “I think there’s substance to it.” While many of the mental health professionals who join TikTok have good intentions, the app’s inextricable ties to the pursuit of viral fame may make viewers question their true motives — their Unqualified or unethical.
“If I saw my therapist on TikTok I would ✨die✨,” reads a typical X post. "If I saw my therapist giving advice on TikTok I would kill her," another declared.
This knee-jerk aversion may be because the pursuit of virality may ultimately harm customers. In 2021, trauma specialist Ilene Glance went viral for a now-deleted video in which she cutely addressed clients who wanted to "dump their trauma" in their first session . "Not on my watch," the caption read, twisting the knife.
In response, one TikTok user said, "You are dangerous to your patients and dangerous to the mental health field." Glance deleted her account and told BuzzFeed News she lost two clients during the ordeal .
Twenty-eight-year-old Megan* is a tarot card reader and content creator from Brazil. She had been seeing a therapist for three and a half years when an incident on Instagram caused her to abruptly end their relationship. One day, she opened her messages and discovered that her therapist had shared a post with her that was identical to Megan's previous post, replacing the word "tarot" with "healing." She asked Meghan to "like" it.
“I didn’t take any more classes after that,” Megan said. The therapist updated the post to praise her, but the experience made her realize how unethical her entire treatment was. For example, they followed each other on Instagram before Megan became a client, and Megan later learned that her therapist spent time socializing with other patients.
That same week, she started seeing a new therapist. "We discussed the boundaries of social media interactions and I feel like our relationship is 100 percent professional," she said.
Overall, these stories are anomalies. Some clients aren't bothered by meeting with a therapist online. Emma was particularly compassionate as she had previously worked in mental health nursing herself. “It made me very aware that [they] are just human beings ,” she said.
"I'm not talking about our sessions. But those lessons influenced me, and they probably subconsciously influence what I'm creating."
But not all patients are so understanding. Karen said she had "mixed feelings" about it. "There's a [YouTube] video where we discuss what he said," she said of her former therapist. "I thought to myself, 'Well, is he using my information to create content?'"
Of course, many of the clients I spoke to scrutinized the accounts for the same thing: "I was like, 'Is she talking about me?'" says Olivia, 23, from New York.
Therapists say that's not the case. "When I make a video, I never have a specific client in mind," Josephson said. "I just thought, 'Oh, it's so interesting that seven clients this week felt the same way. Maybe other people feel this way, too.'" If patients see themselves in the content, the video doesn't necessarily have to be, she said. about them.
"What ends up happening is that people may think the video is about them because they feel seen and think they are so alone in it," Josephson added. "But the fact that thousands of people liked it or commented on it shows that maybe this is actually a human experience where you feel seen because it's so common."
Gunther agreed. "I'm not talking about our conference," he said. “But these lessons influence me, and they may subconsciously influence what I’m creating.”
Gunther said any discomfort a therapist has with social media should be raised immediately. Sometimes, however, a rupture cannot be repaired. While Karen tried to continue therapy sessions with a therapist on YouTube, her personal background in social media marketing ultimately got in the way. The therapist "actually asked me if I could help them," she said. "After that, I thought, 'Yeah, this is my last practice. I can't do this.'"
But for Josephson, social media plays a big role in connecting with her potential clients. She found a digital-first introduction helpful. "Not that they're the same, but they can feel the therapist's speaking style and demeanor and their general essence, and it's a cool glimpse into that person," she said.
However, clients also have boundaries, and many don't know if their mental health professional has a ring light. In other words, to borrow a phrase that may not be recognized by therapists: ignorance is bliss.
expert:
Ernesto Lira de la Rosa, Ph.D., Clinical Assistant Professor, Department of Applied Psychology, New York University
Meg Josephson, psychotherapist
Jeff Guenther, Marriage and Family Therapist
