Therapists Shouldn’t Be Posting About Clients On Twitter

Photographed by Paola Vivas
In many ways, therapist Kristina Virro’s short, snappy content unpacking pop psychology topics is typical of #TherapyTok. From coping with burnout to setting boundaries and "combating perfectionism", her videos tap into today's relentless pursuit of self-optimisation and are regularly met with praise from her 56,800 followers. 
Her account is not just a space for neatly packaged advice; it’s for entertainment, too. In a recent TikTok video, watched over 148,000 times, Kristina shared her "most awkward moments in therapy". These included the "end-of-session bomb drop" (when a client shares a big piece of information when time is almost up) and "asking for self-disclosure" (when a client asks the therapist to draw on their own experience). The caption: "Fellow therapists, I NEED to know yours 😂." 
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Of course, it’s not just therapists viewing Kristina’s content. Given that clients are rarely offered such candid insight into a therapist’s inner thoughts, it’s unsurprising that this particular clip went viral. But not everyone welcomes such insight, particularly those who are currently undergoing therapy. "Now I’m scared to go to therapy because I don’t want my therapist to feel awkward," commented user @lainey on Kristina’s video. "Omg I’m embarrassed," read another comment from @lruth.art.
Last year, when a therapist posted a now-deleted video to TikTok complaining about her clients' "trauma dumping", it elicited a similar response. Amid the furore from people pointing out that the idea of trauma dumping on a therapist represents a misuse of the term, there were also people left feeling uneasy and questioning whether there is a limit to how much they should share in a session. The incident also pointed to a wider phenomenon: how the growing number of therapists posting about their clients is shaping people’s perception of – and relationship to – therapy. 
P.E. Moskowitz, an author who runs the Mental Hellth newsletter about capitalism and psychology, sees this as a cause for concern. "I would be mortified if I went on TikTok and saw my therapists doing a thinly veiled video about me," they say. "If you’re in therapy, it should be centred on you and your struggles. The therapist should not be part of that, and to see therapists online complaining – even if it’s not your own therapist – could lead people to not essentially trust a therapist."
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Twenty-one-year-old Miriam* says that seeing a therapist complain about a client online left her deeply unsettled. "If a client runs into their information online like that, it makes them feel like a poster child, or like an example of a train wreck that the therapist is using for clout and personal gain," she says. She decided to talk to her own therapist about these feelings. "I was apprehensive at first but he reassured me he’d never post about my life on social media so now I trust him." Miriam's therapist doesn’t have an online presence and she says it would be harder to maintain this trust if he did. 
Therapists might defend the decision to talk about clients on social media by saying it’s important for people within the profession to connect with one another. "While being a therapist can be incredibly rewarding, it can also feel quite isolating," Kristina tells me. "After all, our job is to make sure that someone feels completely and utterly tended to, and this naturally means putting our own needs and feelings on the back burner during the session. Having other therapists share that something resonated with them [on TikTok] has allowed the therapist in me to feel really seen."
There are, however, therapists who hold a very different opinion. Psychotherapist and counsellor Erin Stevens argues that therapists should not be talking about their clients outside of supervision (the formal process whereby a qualified or trainee psychotherapist or psychotherapeutic counsellor regularly presents their client work to a supervisor). "It’s a longstanding culture that needs to be tackled; social media has just made it more visible," she says. The problem is particularly rife on anonymous subreddits such as r/askatherapist and private Facebook groups, where therapists tend to discuss their casework with each other more freely. According to Erin, if therapists are choosing to discuss casework online in public forums, they might be lacking formal supervision. "It is really useful to have [supervision] to unpack the client work and if you don’t, then it's going to probably seep out in other areas," she says.
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Therapists are also discussing clients online in order to provide guidance to their followers. Divya Robin, a therapist with 208,000 followers on Instagram, thinks this is justified as long as the client can’t be identified. "For example, it might be a client struggling with perfectionism," says Divya. "Most people have struggled with perfectionism so it makes the client unidentifiable." She adds that sharing this kind of information is important as it "​can make people​ feel less alone in their situation".
Erin criticises what she calls the "arbitrary rules" – such as a client being "unidentifiable" – that therapists use to justify posting about what happens in their sessions. After all, a client may be unidentifiable to others but that doesn’t mean that they won’t recognise themselves in their therapist’s content, or worry that it might be about them. Erin says she knows of clients who have identified themselves in such posts. "I’ve heard clients talking about it on social media, where they've recognised themselves in a therapist’s post – even if the therapist might have done something like switch their gender [to try to conceal their identity]." 
These ethical grey areas have led professional bodies such as The British Psychological Society (BPS) to issue specific guidance about social media use. A BPS spokesperson told Refinery29: "[BPS] members should follow this guidance and behave appropriately on social media, upholding the principles of privacy and confidentiality. Members should be reminded that social media sites are not appropriate places to discuss work-related issues. We acknowledge every situation is different and nuanced and complaints made to the BPS regarding member conduct on social media will be looked at on a case-by-case basis."
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This all raises questions about how therapists should be using social media, if at all. For Divya, it depends on whether the therapist is willing to have open conversations and establish boundaries with clients around social media. She says that having a social media presence has allowed for better client-therapist relationships, with her posts sometimes acting as prompts for discussions during sessions. "I don’t think I've ever had a time where my Instagram has been something that's been harmful to a client or caused a rupture in our therapeutic relationship," says Divya. "If anything, it's only made it stronger, but you have to be open about it."
Erin – who has around 11,000 followers on Twitter – feels that therapists should be able to have an online presence and that it’s about being responsible with that platform. "The more followers you have, the more scrutiny you come under, which I think is justified because you are representative of the profession in a bigger way," she says. "But I think even if you have 50 followers, or 100,000 followers, you need to be really considerate and mindful of your audience."
Many therapists claim to want to use their platform for the betterment of others but it can be hard to discern who is acting in good faith. Miriam would rather therapists didn’t have an online presence but says: "If their tone is helpful and they truly want to spread a message, that’s different." However, she adds: "A majority seem to be online for the wrong reasons." Moskowitz points out that therapists are as likely as anyone else to fall prey to the attention economy. "[Therapy] is about your place in the world and your traumas, your past. To turn it into this thing that's used for virality is kind of disgusting." It is not hard to imagine a situation where the desire for clicks drives a therapist towards more dubious practices, such as referencing a client on their social media. 
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Moskowitz continues: "I think in the same way that going to the doctor should be private, therapy is a sacred thing that is not for public consumption." An even bigger concern for them than the compromised relationship between a therapist and their client is the way in which therapy content tends to simplify and universalise psychoanalysis. "That’s dangerous because it’s not really the point of therapy. Therapy is about the individual experience." They add that addressing this problem means providing affordable mental healthcare so that people aren’t relying on social media in the place of actual therapy.
It’s perhaps unrealistic to expect therapists to stay off social media, particularly when there is so much of an appetite for therapy content. But when it comes to what they should and shouldn't post, therapists should be subject to higher standards than the average social media user. Otherwise it’s the clients who will suffer. 
*Name changed to protect anonymity

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