The TikTok Therapist

Before 2020, Micheline Maalouf had never dreamed of having a million anything, let alone that many followers on social media. After all, she wasn’t famous. Or an expert in her field, having just finished graduate school to become a therapist three years earlier. And with her experience in self-promotion amounting to a handful of goofy home movies made back in the ’90s and the occasional inspirational quote on Instagram, she wasn’t exactly a marketing savant, either.

But that January, following a friend’s casual suggestion, she signed up for an account on TikTok—a social media platform featuring short video clips—and threw together a quick, 15-second recording. In it, Maalouf sits in her office, wrapped in a cardigan, nodding intently as if listening to a client. Suddenly, she tosses her notebook aside and jumps from her seat, fists pumping in the air as words appear across the screen: When my client finally has a breakthrough during a therapy session. Maalouf raises both arms triumphantly, dances on her sofa chair, and spins in circles as glitter rains down.

By the time she woke up the next morning, the video had accumulated tens of thousands of views. Her inbox on TikTok was overflowing with exuberant messages. People wanted more. They wanted to know what it was really like to be a therapist.

Maalouf’s mind began to race. What am I supposed to do now? she wondered. And how the heck am I supposed to condense something as complex as therapy into 15-second videos? “I was freaking out,” she recalls. “There was definitely a feeling of impostor syndrome.” Eventually, once she’d collected herself, she had another thought: I’ve got to learn how to do this.

Week by week, she kept posting videos. Some leaned humorous, like her first video. Others were more educational, like one that breaks down depression—and has 2.4 million views to date. To a thumping techno beat, Maalouf spends another 15 seconds playing the role of client, acting out symptoms like reduced appetite, insomnia, poor concentration, and irritability. It looks different for everyone, reads a line of text in the last frame.

And yes, there are plenty of videos of Maalouf dancing.

Today, it’s safe to say Maalouf has hit her stride. She posts several times a week, amounting to hundreds of videos, covering everything from getting better sleep to spotting unresolved trauma to setting boundaries. Her account has garnered over a million followers and more than 19 million likes.

Of course, Maalouf’s TikTok fame comes with more than a few professional benefits too, including a full caseload and hordes of people who want to see her for therapy. “It’s the number one way I get clients now,” she says. “People say ‘Hey, I saw your video on TikTok and I’d really like to work with you.’”

Overnight success. It’s every therapist’s dream, right? But is it really that easy? And what is Maalouf doing, exactly, that makes her such a hit?

Rules Unspoken

Compared to other fields, psychotherapy has offered few guideposts for professionals looking to cultivate a social media presence. Some say the American Psychological Association (APA) Ethics Code and HIPAA provide guidance enough, as both say their regulations apply to internet and other electronic transmissions. But both were developed in the late ’90s, and neither contains amendments or language specific to the use of social media.

The APA began drafting social media guidelines for psychologists in 2019, but nothing has been made public so far. A still-active page on APA’s website, originally published in 2016, says its Committee on Professional Practice and Standards is seeking input from therapists as it creates social media guidelines.

Perhaps the most explicit institutional direction on therapists’ social media usage comes from the Association of State and Provincial Psychology Boards (ASPPB), which manages the licensure and certification of psychologists in the United States and Canada. In 2017, the ASPPB established its Social Media Task Force (SMTF) to create guidelines for psychology regulatory boards concerning therapists’ use of social media.

Released last October, the SMTF’s guidelines include recommendations on handling confidentiality, informed consent, risk management, and multiple relationships, to name a few. But they also include more ambiguous language. “Psychologists [should] strive,” reads one passage, “to the extent possible, to maintain their personal online presence distinct from their professional online presence.” Another advises psychologists to “maintain clear boundaries between their professional and personal social media accounts.”

But therein lies the problem, says Jennifer Sneeden, a former marriage and family therapist who’s spent the past 11 years coaching other therapists on how to build and grow their private practices. “Social media is where potential clients can get a real feel for a therapist,” she says, and getting a sense of who they are—professionally and personally—has become part of what she calls the client journey. “Before they ever set foot in your office, clients want to feel like they know and connect with you,” she explains. Seeing the therapist’s face, hearing their voice, or observing a few of their skills in action helps them do that—even if it’s in the form of a song or dance.

Clearly, this new approach defies the longstanding tradition of therapists hiding or subduing any semblance of their personal lives in the name of professionalism and objectivity. But what’s the harm? Sneeden asks. “You can challenge the norm and still do it in an ethical way. You can be a therapist and post a picture of you walking your dog. That’s what people really want to see.” Sneeden draws on her own experience. “When I post about my dog, Cocoa, those are always the most popular posts because people want the kind of connection that shows we’re relatable and human.”

Of course, Sneeden says, there are and should be boundaries. There is such a thing as disclosing too much, or posting information that could jeopardize the therapeutic relationship. But most judgment calls about disclosure boil down to using common sense, she says. For those grayer areas—say, whether and how to respond to a current or prospective client who’s left a comment on your TikTok video—the APA’s Ethics Code poses a valuable question that Sneeden agrees deserves consideration: How does the online relationship between the therapist and their audience fit within treatment?

Both/And

Shane Birkel wasn’t new to marketing his therapy practice when he signed up for TikTok last May. During his nearly 10 years as a marriage and family therapist, he’d taken several marketing courses, bought a few how-to handbooks, and created a podcast. All that helped grow his business, but TikTok was a game-changer.

After posting a few videos—including one about using the right words to communicate your feelings, another on the importance of expressing gratitude to your partner, and another on “The Five Losing Strategies for Your Relationship”—Birkel’s audience began to snowball. Within a month, his videos had accumulated thousands of followers. One year later, that number has ballooned to nearly 263,000.

“It’s insane how many people messaged me on TikTok,” he says. “People sent me emails and left voicemails trying to get therapy. Other people just had questions about their relationship.”

With people clamoring for more, Birkel, like Maalouf, experienced an identity crisis of sorts.

“I thought, Who am I to say what’s right or wrong for relationships, to be an authority in this space? It was an emotional process, really hard to get the confidence to keep moving forward. But once I started hearing how grateful people were, it helped me break through that fear.”

That gratitude speaks to the core of why Birkel does what he does on TikTok. It’s not a marketing tactic, he says—although there are certainly professional benefits—but a public service.

“I’d been looking for a way to get clinical information out there,” he says. “To provide valuable content to more people than I could ever work with in my practice.” Plus, he adds, “it really helps people who aren’t in therapy feel more comfortable about going. It helps them start to think that maybe a therapist is someone they could open up to.”

And Birkel is anything if not relatable. In a video posted last November, he strolls down a leaf-strewn path, bouncing to the beat of the Black Eyed Peas’ “Where Is the Love?” On my way to work as a couples therapist after I just tried to joke with my wife and made her upset, reads a line of text on the video. Relationships are hard. It has almost 128,000 views to date.

Birkel says he’s well aware of the negative attitudes about therapists using social media—including more than a few naysayers in the therapy community. He’s aware of concerns about confidentiality breaches and boundary violations. And he doesn’t blame psychotherapy’s higher-ups for being cautious. But, he clarifies, the payoff—for therapists, clients, and the general public—far outweighs the risk. And it’s risk he can mitigate.

“If a client comments on your video, that’s a valid concern,” he says. “But in that situation, I’d talk to them and make sure they know it’s a public forum and I’m not going to respond.”

But what about the dancing videos? Are they too much? “A good video will educate and entertain,” Birkel says. And even if a video entertains more than it educates, it’s common in the TikTok world to follow up that kind of video with one that has more substance.

It’s important that clients know they’re working with professionals, Birkel says. “But at the same time, there are a lot of old, crusty traditions that make people feel alienated by therapy, by this stereotype of the therapist with their nose up. I want to make therapy more fun for people, for them to feel like it’s something for everyone.”

Getting Started

The most popular therapists on social media have something in common, says Sneeden: they don’t use their platform primarily to get clients or sell products. They use it to provide value.

“Let’s say there’s a mom out there who’s stressed and pulling her hair out because she’s stuck inside all day homeschooling her three kids and they’re driving her crazy,” she says. “If you’re looking to build a social media following, you have to ask yourself, What can I offer her in this moment to help her cope, where she sees me as the person to help her? A funny little meme, an inspirational post, a few seconds that normalize what she’s going through—that’s what people are looking for. It connects with them in a lighthearted way. It gives them hope.”

In addition to being overly promotional, Sneeden says therapists trying to develop a social media following often fall into the trap of being too cerebral. “We therapists love clinical things,” she says, “whether it’s the latest research or a new, brain-based treatment for depression. We presume other people want to see that too. But there’s such a thing as content that’s too clinical, and that can be a turn-off for viewers.”

There’s another, more universal challenge Sneeden often sees with therapists looking to create a social media presence: stage fright. But overcoming the “terror barrier,” as she calls it, is part of the human growth process. “We want this thing that’s really exciting, but you have to do something that’s big and scary to get it. My best advice is to focus first on what you need to feel comfortable, because if you’re uncomfortable, you’re not going to come off as authentic. When you’re authentic, you’re effective.”

Maalouf agrees. “One of the most powerful things I’ve been able to do on social media is share my own struggles as a human and a therapist,” she says. “We need to let go of this false god of the therapist as a blank slate.” That authenticity has helped her reach not only potential clients, but also a few people on the fence about becoming therapists, hesitant because they’re struggling with anxiety, depression, or another mental health issue and believe it disqualifies them. “I tell them that’s not true at all,” Maalouf says. “I tell them they’re a human first. We need to be more reachable and more approachable. When we’re not these big, scary, inaccessible figures, people feel less alone and more willing to ask for help.”

What some people see as a disruptive force, Maalouf, Birkel, and Sneeden see as progressive, even transformative. “Obviously, the response shows there are people who need help,” Maalouf says. “So many people who watch my videos have told me they can’t afford therapy and use them to get by. Others who do see a therapist say they watch them in between sessions to stay on track. And kids whose parents won’t let them go to therapy tell me my videos make them feel like now they have some valuable tools.”

Still, maintaining a social media presence is hard work. Her viewers rely on her, Maalouf says, so she’s constantly fine-tuning her videos and relying on viewer comments to make her content more relevant and helpful. She doesn’t always get videos right on the first try, and when that happens, she hears about it. Sometimes, the skeptics seem louder than the supporters. Birkel recently joined a Facebook group for TikTok therapists, and says the moral support the group provides has been a balm against the criticism that therapists who use social media are somehow not taking their work seriously.

What keeps TikTok therapists like Maalouf and Birkel pushing forward isn’t fame, or monetary gain, or the prospect of a perpetually full caseload, but faith—the faith that even a seemingly insignificant song or dance might help someone in need, even if it’s just providing a momentary distraction from their pain. The faith that it might move the needle, however slightly, in making therapy seem more palatable and therapists more approachable. It’s the faith that the work you’re doing matters. The faith that someone, somewhere, sees you.

Let us know what you think at letters@psychnetworker.org.

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