91×ÔÅÄ

‘Just shut down all of your social media profiles!’ The lecturer issued this blanket statement during a seminar on professional and legal issues during my first term of training as a counsellor. While my fellow students primarily in their 40s and 50s nodded their heads in apparent agreement, aged 23 this instruction seemed unfathomable to me. Perhaps because I grew up with social media as a teenager, or because I had just moved away from my friends and family, I perceived social media as an essential resource to keep in touch with those close to me. Suffice to say, I double-checked my privacy settings and continued posting on Instagram.

Fast-forward two years and I was once again sitting in a professional ethics seminar, now training as a counselling psychologist. I was eager to hear how to manage ethical issues around social media use, having noticed an increase in practitioners sharing mental health information online over the past few years with a further surge during the pandemic. The seminar covered a wide range of ethical dilemmas from the typical riskrelated issues through to the more obscure, ‘how to respond if a client brings you baby clothes as a gift before you go on maternity leave’. And still there was nothing on social media. 

I decided to find my own answers by researching (along with my supervisor, Terry Hanley) the ethical dilemmas experienced by therapists who use social media, resulting in three publications.^1,2,3 The systematic review we published in 2024 found that it is now almost an inevitability to experience an ethical issue on social media as a therapist. Due to the societal normalisation and accessibility of social media, the boundaries around communication between client and therapist have evolved. The growing public interest in mental health and therapy has resulted in a demand for information on these subjects, and increasing numbers of therapeutic practitioners have responded by setting up professional social media accounts. The blurred boundaries between client and therapist increase further if the therapist takes on the role of a mental health influencer.

Definition

Defined by Triplett et al, a mental health influencer is a qualified therapist, trainee therapist, or other mental health professional who uses social media to share psychoeducation and anecdotes from either their professional experience or own personal experience.⁴ Mental health influencers increase accessibility to psychoeducation through sharing knowledge that, prior to social media, would only have been accessible through therapy. 

Although some therapists may not self-identify as influencers, their motivation to use a social media account to share knowledge fits with the mental health influencer definition. Influencers are categorised into different size brackets, with a following size of 1,000 needed to classify as the smallest type of influencer. This resonates with one of the findings of our research, that therapists may not be aware that they meet the criteria of an influencer based on following size or content shared, and so may not have considered how to manage ethical issues on social media with a professional presence.^2Ìý

Many therapists either set up in private practice straight after qualifying due to lack of available employed roles, or do so after leaving work in the NHS or another service for reasons such as burnout, feeling undervalued at work and feeling restricted in how they practise.⁵ They soon learn that to survive in a competitive marketplace they need to promote their practice. For a growing number that includes posting on a social media platform such as Instagram, and in the process – either intentionally or by accident – becoming a mental health influencer. 

This is often new territory for practitioners who have not had previous business experience. One of the themes that came out of our latest research, which explores psychologists’ experiences of using Instagram as a mental health influencer, is ‘I didn’t train as a marketer or social media expert’.³ We found that practitioners were uncertain of how to maintain therapeutic boundaries while also using their social media presence to market their private practice and related products such as books and online courses. The ethics become particularly murky when practitioners also use their accounts for social justice advocacy to explain the impact of social inequalities on mental health, and yet place some content behind paywalls, which reduces accessibility. 

Wild West 

Social media and the influencer industry in general have been described as the ‘Wild West’ due to the apparent ‘lawlessness’ of what is deemed appropriate behaviour online.⁶ In this context, it is no surprise that mental health influencers experience great uncertainty about what constitutes ethical practice online. Although key professional bodies have published ethical guidance for therapists’ social media use in recent years, including BACP⁷ and the Health and Care Professions Council,⁸ most of the guidance focuses on practitioners’ personal social media use rather than their professional online presence, covering subjects such as contracting with clients around social media and maintaining client confidentiality. Overall, the emphasis is on the importance of privacy settings, when, conversely, mental health influencers want to increase accessibility to their content. The standard advice to keep personal and professional identities separate online stands at odds with those therapists who want to share their authentic human selves to reduce mental health stigma and increase engagement with their posts. 

Therapy Today, April 2025

µþ´Ç³Ü²Ô»å²¹°ù¾±±ð²õÌý

Another paradox we came across in our latest research is that despite aiming to be wide-reaching with their public profiles to attract potential clients, many mental health influencers still felt surprised if a client knew information about themselves that they had disclosed online but not in sessions, such as if they had children.³ Some practitioners in the study acknowledged that they probably self-disclosed more on social media than they would in therapy sessions due to the context, albeit with information that they had intentionally chosen to share with the public. 

Information shared online is often designed for potential clients to learn about a therapist’s values and practice, to decide if they would be a good fit for therapeutic work together. However, this particular form of marketing opens the possibility for new clients to develop a parasocial relationship with the therapist and have expectations of how they will be in sessions, which could impact the therapeutic relationship. Research has found that after viewing their therapist’s personal social media profiles, 74.1% of clients held more positive beliefs about their therapist’s expertise, and 68.2% had more positive overall feelings about their therapist.⁹ Concerningly, some people may develop a parasocial relationship where they perceive the mental health influencer as their own therapist, and so choose not to access individualised therapy, despite posts being generalised and not intended as a replacement for therapy.¹⁰

While some mental health influencers specifically contract with clients around social media, such as stipulating that the practitioner will not follow any of the client’s social media accounts, others do not acknowledge their professional presence at all with clients. It is vital that mental health influencers consider how their clients would feel viewing their content and the impact this may have on the therapeutic relationship.³ Therapists may need to forewarn a client if they will be posting potentially triggering content, or inversely, light-hearted content while they are having a difficult time. Some therapists described being inspired by their client work to create content, either from a specific client or from across multiple clients. This may create a rupture in the therapeutic relationship if a client feels that their private and personal issues are being shared online, even if they are not identifiable or are in fact composite or fictionalised examples. 

¸é±ð²õ±è´Ç²Ô²õ¾±²ú¾±±ô¾±³Ù¾±±ð²õÌý

Our most recent research found that practitioners using social media as mental health influencers felt a responsibility to share their professional training and knowledge online.³ Many were concerned that if qualified health professionals did not share mental health resources, then people may turn to less reliable sources for support during a time of increased demand for mental health services and widening social inequalities following the COVID-19 pandemic and cost of living crisis. However, they also felt pressured to market themselves as ‘experts’ to promote their accounts, which could risk stepping outside their competences.

Cederberg noted there is competition between different professionals to distinguish themselves online and so they may exaggerate their credentials.¹¹ The general public are unlikely to check that the practitioner is speaking from an informed position based on their professional training and work experience, and so it is the professional’s responsibility to adhere to working within their competences. Smith et al advise mental health influencers to clearly state what training they have and what services they can provide, as many people may not understand the role of a therapist and so make assumptions about their competences.¹² This is particularly important in the context of the titles ‘therapist’, ‘psychotherapist’, ‘counsellor’ and ‘psychologist’ being unregulated in the UK, and giving no indication of level of training. This means that legally an individual with no mental health training could state they were a therapist on social media, which would create a false credibility and increase the public’s trust in their content. 

There is uncertainty around how much responsibility mental health influencers hold for the wellbeing of the people they interact with online. If perceived in the same way as clients, this would place great pressure on the therapist about how to respond and what responsibility they held if they saw an individual expressing, for example, suicidal ideation online. The therapist would likely have no knowledge of the context of the individual, what support systems they currently have in place, or even what country they live in, and so have great difficulty in providing support. This has led many mental health influencers to include disclaimers as pinned posts at the top of their profiles stipulating that the boundaries of their role are not to provide individualised support, and for followers to instead access offline support with signposting options provided. Our most recent research also found mental health influencers were unsure of their responsibility to support individuals who become distressed in response to a post they have shared, particularly regarding trauma.³ Despite inputting boundaries, there can still be a sense of invalidation that the therapist cannot do more to support people online, and there are difficulties in offering empathy without slipping into a therapeutic relationship. 

³§³Ü±è±ð°ù±¹¾±²õ¾±´Ç²ÔÌý

The role of a mental health influencer is still perceived as taboo by many practitioners working in more traditional roles, with concerns around earning money from using their therapeutic expertise in different ways from their conventional training. This can lead many mental health influencers to feel judged by other practitioners, and so feel unable to turn to others for support with any issues they experience online. 

This lack of support also extends to supervision, as it is not currently mandated to receive supervision specifically for social media work. An additional issue is the mental health influencer themselves may have a greater knowledge of ethical issues experienced on social media than their supervisor, and so not receive knowledgeable support.² Appropriate supervision can support therapists with the decision-making process of how to present themselves online and engage with followers while also guarding their personal safety and the representation of their profession. Supervision can also be used to check in on the therapist’s wellbeing, as they are at increased risk of burnout from the additional workload and from receiving distressing messages around risk and trauma (see box, ‘Red flags’). 

±Ê´Ç²õ¾±³Ù¾±±¹±ð²õÌý

Despite the current uncertainties and anxieties around how to use social media as a mental health influencer, those currently working online also report many positives to this role. Many of the mental health influencers we talked to for our research said they greatly valued the online community they had created with both other mental health influencers and the general public. Some also said they found social media a fun way to use their creativity when planning content, and felt they could learn new tools and theories from other professionals that they could use in their practice. They additionally found social media rewarding as it allowed them to work in line with their values, such as by sharing content about social justice, and felt a sense of validation from hearing direct feedback of how they had helped others. The practitioners worked hard to produce social media content in addition to their offline therapeutic work, and so believed they should be financially compensated for this work. 

Has the time come for the identity of a therapist to expand from exclusively traditional therapeutic roles to also encompass social media work as a mental health influencer? This reconceptualisation of the therapist identity to include social media work may normalise the use of specialised supervision for this work, and the introduction of more nuanced ethical guidelines for professional social media use as a mental health influencer to protect both the general public and the therapist. As social media platforms continue to develop, the role of a mental health influencer will also evolve, and so ethical guidance will need to be regularly updated as new ethical issues occur. 

While interviewing practitioners for my research I was asked by multiple participants if I would set up a professional account myself as a mental health influencer. Right now I am still hesitant to give a firm answer. I feel proud of the resourcefulness and hard work shown by my fellow mental health practitioners to utilise social media as a free and accessible platform to provide the general public with psychoeducation and mental health support during a time of growing social inequalities. I am excited by the opportunity to bring social justice advocacy into my practice through social media, either from my own account or through setting up a social media account for the service I work in. I feel hopeful that the future of mental health care will normalise these new ways to support the wider population beyond the therapy room. However, I am also aware of the complexity of the ethics involved, and that the informed support needed to protect both the public and the practitioner around social media work is still not widely available.