While scrolling TikTok in 2022, Kaylen came across something unexpected: a video about relationships and anxiety, made by her therapist. She wasn’t sure how it found her, since they didn’t have each other’s numbers. But what was most remarkable about this experience was that it had happened before. She had come across her previous therapist online on YouTube in 2022 and had been uncomfortable then, too.
“That was actually part of the reason why I was like ‘I think I’m going to stop therapy for a while,’” the Los Angeles-based 29-year-old says.
The stars of TherapyTok, as it’s called, pull in numbers not dissimilar to the artists and influencers who found mainstream fame on the app. A video about suicide warning signs has more than 9 million views. So does another about whether or not you’re in “freeze mode.” Those posts are among the tens of thousands of contributions psychologists have made to the platform. However, despite their popularity, and the rise of things like “therapy speak,” users have conflicted feelings about seeing their own mental health professional in front of the camera.
“It’s like when you’re a kid and you see your teacher at the supermarket,” says Ashley, who is 30 years old and from Brooklyn. Ashley started getting served her own therapist’s content after sending her a TikTok that was relevant to their sessions. “You’re like, ‘You’re not allowed to be here,’” she jokes.
It would be a Health Insurance Portability and Accountability Act (HIPAA) violation for a psychologist to discuss their private sessions with others. But with life now lived significantly online, a rising number of therapists are using social media tools to grow and promote their practice — and the normal boundaries are blurred.
“There isn’t a lot of information of how to navigate it,” says Ernesto Lira de la Rosa, Ph.D., clinical assistant professor at New York University’s Department of Applied Psychology. “[But] we do spend a lot of time in our introduction to the profession and ethics class talking about this.”
Broadly, students are advised to protect both themselves and the field’s reputation by disclosing their social media presence to their clients and to be mindful of the potential impact of the information they’re sharing online, knowing it might be received inaccurately.
“I see clients come in saying ‘I have ADHD or I have anxiety,’” he says. “And as I start asking more — ‘When were you diagnosed?’ — [they say] ‘Oh, well I saw on TikTok someone said these are the symptoms.’”
Some therapists are motivated to create content that counteracts what they feel is a widespread misunderstanding of mental health information. Bay Area psychotherapist Meg Josephson began posting online in hopes of doing just that, but her TikTok account, which now has 250,000 followers, ended up becoming a vital way to promote her practice. Now, she says, most of her clients say they came to her from her social media, and it recently landed her a book deal.
The weirdest part, for some clients, is seeing the therapist they know from their sessions inhabit this entirely different persona online. “I’m not talking to my clients in a way of like ‘Here’s the top 10 reasons you should break up with your boyfriend,’” Guenther says with a laugh.
Jeff Guenther, a marriage and family therapist who posts on TikTok to 2.8 million followers as TherapyJeff, had been practicing for more than 15 years before he started making content in 2021. He says he was bored by the pandemic and wanted to be part of the community of other therapists he had seen posting online.
“The fourth video that I posted went viral, and four of my clients that I was seeing at the time saw it before I could even tell them that I was doing it,” he says. “It felt really jarring to them, and I felt embarrassed.”
Generally, he says, the reaction was one of “shock and surprise” to see him on their phones. They talked it through in their respective sessions and ultimately came up with a list of social-media boundaries he includes in his informed consent form today. “If they do leave a comment, I will ignore [it]. I’m not going to acknowledge that we have any sort of relationship, because that would actually be breaking confidentiality,” he says.
Therapists’ content is not a substitution for therapy, something Guenther makes sure to state in a disclaimer pinned to the top of his TikTok page. It’s simply self-help entertainment, and the weirdest part, for some clients, is seeing the therapist they know from their sessions inhabit this entirely different persona online. “I’m not talking to my clients in a way of like ‘Here’s the top 10 reasons you should break up with your boyfriend,’” Guenther says with a laugh.
“I guess it was just surprising to me because I didn’t think of her as a ‘TikTok therapist,’” Ashley says of her own therapist’s videos. “I feel like that has a connotation.” While many mental health professionals who join TikTok are well-meaning, the app’s inextricable tie with the pursuit of viral fame can cause viewers to be skeptical of their real motives — that they’re unqualified or unethical.
“If I saw my therapist on tiktok I would simply ✨ pass away ✨,” a typical X post reads. “If I saw my therapist giving advice on tiktok I would kill her,” another declares.
This knee-jerk distaste might be because the search for virality can end up harming clients. In 2021, trauma expert Ilene Glance went viral for a now-deleted video in which she used a cutesy trend to call out clients who want to “trauma-dump” during their first session. “Not on my watch,” the caption reads, 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 from the ordeal.
Twenty-eight-year-old Megan* is a tarot reader and content creator from Brazil. She had been seeing her therapist for three and half years when an incident on Instagram caused her to abruptly terminate their relationship. She opened her messages one day to find her therapist had shared a post with her — one that was an exact copy of a post Megan had made earlier, swapping the word “tarot” for “therapy.” She was asking Megan to “like” it.
“I didn’t go back to any sessions after that,” Megan says. The therapist updated the post to credit her, but this experience made her see how unethical her entire practice was. They had followed each other on Instagram before Megan became a client, for instance, and Megan later learned her therapist would spend time with other patients socially.
She began seeing a new therapist that same week. “We discussed boundaries when it comes to our social-media interactions, and with her, I feel like our relationship is 100% just professional,” she says.
On the whole, these stories are anomalies. Some clients aren’t that bothered by online encounters with their therapists. Emma was particularly sympathetic, having previously worked in mental health care herself. “That made me very well aware of how much [they’re] really just people,” she says.
“I’m not talking about our sessions. But these sessions influence me, and they might subconsciously influence the content that I’m creating.”
But not all patients are as understanding. Kaylen says she has “mixed feelings” about it. “There was one [YouTube] video where we had kind of discussed what he was talking about,” she says of her former therapist. “I thought to myself, ‘Well, is he kind of using my information to create content out of it?’”
Naturally, many of the clients I spoke to had combed through these accounts to look for the same thing: “I was like, ‘Is she talking about me?’” says Olivia, a 23-year-old from New York.
Therapists say this isn’t the case. “I’m never thinking of one specific client when I’m making a video,” says Josephson. “I’m just thinking of like, ‘Oh, it’s so interesting how seven clients were feeling the same thing this week. Maybe other people are feeling that, too.’” If a patient sees themselves in the content, she says, it’s not necessarily that the video is about them.
“What ends up happening is people may think a video is about them because they feel so seen and they thought they were so alone in it,” Josephson adds. “But the fact that thousands of people liked it or are commenting on it shows that maybe this is actually a human experience and you feel seen because it’s so universal.”
Guenther agrees. “I’m not talking about our sessions,” he says. “But these sessions influence me, and they might subconsciously influence the content that I’m creating.”
Any discomfort someone has with their therapist’s social media presence should be brought up right away, Guenther says. Sometimes, however, the rupture is beyond repair. While Kaylen attempted to continue her sessions with the therapist on YouTube, her personal background in social-media marketing ended up getting in the way. The therapist “actually asked me if I could help them,” she says. “After that, I was like, ‘Yeah, this is my last session. I can’t do this.’”
But for Josephson, social media has been instrumental in connecting her with potential clients. She’s found a digital-first introduction can be helpful. “Not that it’s the same, but they can get a sense of the therapist’s speaking style and mannerisms and just their general essence, which is a cool glimpse into that person,” she says.
However, clients have boundaries, too, and many draw the line at knowing whether or not their mental health professional owns a ring light. In other words, to borrow a phrase that might not be therapist-approved: Ignorance is bliss.
Experts:
Ernesto Lira de la Rosa, Ph.D., clinical assistant professor at New York University’s Department of Applied Psychology
Meg Josephson, psychotherapist
Jeff Guenther, marriage and family therapist
