Help, My therapist is Also an Influencer

Imagine you find yourself once a week at your therapist's office in the hope of guidance or coping mechanisms for a traumatic event you survived, only to scroll through TikTok to find your therapist on the ‘For You’ page with a follower count—of 50,000 people! What do you do?

There are minimal ethical guidelines for therapists when it comes to using social media. Consequently, much is left open to professional interpretation, an openness that could place professionals and the public at risk. It’s become more apparent as therapists increase social media usage as many professionals seek the role of mental health influencers, whether purposefully or without realizing.

However, for clients, these developments could raise numerous critical ethical issues, including influencer integrity, competency, and confidentiality, not to mention risk management. This article briefly touches on these issues parallel to related research.

Practice and Policy Implications

• Therapists increased work engagement as mental health influencers by sharing professional advice through social media - sometimes without realizing they are influencers. These professionals must be mindful of this work's vast array of consequences.

• The literature has recognized ethical issues surrounding integrity, confidentiality, risk management, and competency. Professionals must keep good practice guidelines around these issues and stay updated on responses to any new technological developments.

• Research has identified that several professionals must stick to the promoted good practices around social media. Such guidance should be communicated proactively and rooted within the therapy training programs.

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• Further research is required to support professional bodies in creating more specific and distinctive ethical guidelines on social media usage for therapists acting as mental health influencers.

Social Media and The Therapist

Since the COVID-19 pandemic, telepsychology has proliferated. Telepsychology refers to psychological services delivered through telecommunication technologies, including videoconferencing,  telephone, and social media platforms.

There are various levels of influencers on social media ranging from nano influencers (1,000-5,000) followers to macro-influencers (100,000+) followers to mega influencers who everyone knows about, such as Henderson (2020) and Triplett et al. (2022).

Several therapists have Instagram accounts, such as: 

• US-based psychologist Dr. Nicole LePera (@the.holistic.psychologist) = has five million followers

• UK-based clinical psychologist Dr. Michaela Dunbar (@myeasytherapy) = has one million followers

 

However, the question on the minds of many is whether a mental health influencer on social media should participate in brand deals and, within the consent process with clients, including having a social media platform. A professional may include self-disclosure to create a personal presence their followers can relate to, such as family photos which clients might use to gather information about the therapist’s life and views. The self-disclosure might be unintentional. The clients could gain a wealth of knowledge without the therapist's awareness, which can create a power imbalance.

Influencer Confidentiality

Where is the respect for client confidentiality regarding a mental health influencer? The public raised questions about a client’s privacy on social media, which the psychologist could access.

DiLillo and Gale (2011) found that although 76.8% of psychology doctoral students training in the USA and Canada believed that searching for a client on social media was entirely or usually unacceptable, 94.4% of the students reported searching for at least one client on social media. 

 Professionals have reported using social media to investigate risk issues such as substance misuse and self-harm to better understand the client’s life, however, whether the client provided informed consent or was informed retrospectively. 

 Another side of the coin is that a professional uses topic discussions from client sessions on their social media platform. Even though the client’s personal information is not disclosed, the possibility of the client being aware that the topic discussion is influenced by one of their sessions could cause mistrust in the client and therapist relationship.

 Ella White is a Counselling Psychologist in professional training at the Manchester Institute of Education at the University of Manchester. Her thesis focuses on good practice for psychologist use of social media as a mental health influencer.

According to White, there are too many grey areas in the guidelines, leaving too much interpretation in the therapist's hands and not addressing inappropriate usage.

“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 become outdated,” stated Ella White.

 White is researching better ways guidelines can be addressed and communicated. She feels that some of the ethical dilemmas that therapists face on social media should be addressed to create awareness and give guidance on how to handle these situations.

Those who design these guidelines could spend more time talking with psychologists to discuss their experiences, concerns, and fears, and it could help therapists adhere to guidance more closely.

Final thoughts

The article has considered numerous core ethical issues related to social media usage by therapists. Even though social media is a platform that can have the potential for mental health influencers to share helpful messages, it could also come at a risk. 

Professional wisdom and research are starting to shed light on the consequences professionals should avoid. However, more exploration and research are still urgently required to minimize the risk to therapists and the public.

Social media platforms continue to evolve and change; therefore, continuous research is required to monitor and identify all ethical issues that arise for mental health influencers. Ongoing research information can support good practice guidelines for the evolution of social media. Social media usage for future therapist research findings should be included in therapist training programs to promote morality.

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