Wendy Boring-Bray :
The rise of social media has made nearly everything quickly and easily accessible to the public. As it turns out, this is even true within domains where privacy and confidentiality are considered foundational principles, such as psychotherapy.
In keeping with these times, the field of psychotherapy has begun adapting itself to the online world. A couch in an office has become a Zoom screen, emails to providers are being replaced by text messages, and providers are taking to social-media platforms themselves to boost their practices and share information about mental health.
This shift has increased exposure to conversations about therapy and mental illness, which has subsequently led to a growing acceptance of mental-health challenges. The result? Younger generations are now far more likely than previous generations to not only seek mental health treatment, but to openly discuss it with others.
So, we now have a generation of individuals who are educating themselves about mental health, seeking treatment for their mental health in a more technology-centered culture, and perfectly comfortable discussing personal aspects of their lives on a public forum.
It should be no surprise that there are few qualms about sharing a therapy session online for others to see.
Since the start of COVID-19, most traditional talk therapy sessions have been held via tele-health, where clients can meet a therapist without leaving home.
At the same time, social media apps like TikTok have blown up as a way for people to post and look through countless quick videos of, well, just about anything.
Casually scrolling through these apps, you may come across a video clip of someone sitting in front of a computer and having a conversation with their therapist, or a screenshot of another person and their psychiatrist texting back and forth.
There are plenty of motivations for this kind of content. On the one hand, individuals post clips of their therapists to raise awareness of mental health, and to share their story.
On the other hand, a person might put up a video of their provider giving valuable insight or helping them talk through a difficult issue, hoping to help someone else who might have needed to hear it.
And of course, many creators use interactions with their therapists to get laughs from their audience. Some Gen Z posters are notorious for their darker, often self-deprecating sense of humor, and quite a few therapists have been able to adapt to this. This makes for therapeutic discussions that are just as sarcastic as they are empathetic, and that a lot of younger viewers can get a kick out of, if not also relate to.
So, what kind of affect might this sort of content have, not only on the person sharing, but the therapist, the viewer, and beyond? Like any other field, mental health will evolve and grow as society does. When shifts occur, they aren’t inherently positive or negative; it just means that there are new things that must be considered.
There are certainly benefits that could come from this phenomenon. For one, mental health treatment isn’t always accessible for everyone due to cost, waitlists, etc. These social-media posts can help to spread knowledge to people who wouldn’t have gotten the chance otherwise.
 It also normalizes the therapy process. Seeing a favorite creator chatting with a professional about their mental health might encourage someone to seek treatment themselves, especially if that person was anxious or uncertain about getting started.
Confidentiality and privacy are key factors in psychotherapy. Laws and guidelines have been developed to best protect what a client discusses in treatment as much as possible, as well as the relationship between therapist and client in general. If clips of therapy are being put up for hundreds, thousands, even millions to see – even brief clips – that is opening the door into that space.
The client is allowing aspects of their therapeutic relationship to be both appreciated and scrutinized in the public eye. Even if the creator typically feels comfortable sharing personal details of their lives, it’s difficult to predict what kind of effect this kind of vulnerability might have on one’s healing journey.
The therapist is also being exposed to the world. Even if the content only contains their voice or their name, there is a chance they could be identified by other clients or colleagues.
If you are a client thinking about putting your therapy journey online, be mindful of how much/what you are sharing. Consider the potential pros and cons of letting others into the room with you, and definitely have a conversation with your provider about it first.
If you are a therapist whose client approaches you about sharing bits of your sessions, be thorough about thinking through the ethics. Technology has opened an entirely new ethical grey area that needs to be waded through.
For added guidance, the APA has written up guidelines for using social media as a therapist. These, plus ample discussion with peers, supervisors, and of course clients themselves, should help to keep everyone as safe as possible.
(Wendy Boring-Bray is the assistant director of the Doctor of Behavioral Health program at the Cummings Graduate Institute for Behavioral Health Studies).
