A funny thing happened to me lately. I got to over 10k followers on Instagram. I have always had a policy not to check the number of followers (although of course I don’t always keep this policy) because this keeps social media a healthy place for me, and stops me from making comparisons (which inevitably lead to an unhealthy place).
I was pretty excited to get the ‘swipe up’ option on Stories, so I can now easily share articles and events with people. But the other thing that happened was I started to get messages from people proposing to help me grow my following, inviting me to events, asking me to comment on news articles and offering me free stuff. All of a sudden, I find myself an ‘expert’.
Becoming an expert – ethical dilemmas on social media
In fact, it is very much part of my practice not to take on an expert position, but rather to collaborate with my clients to reach a common goal (set by them). When I started blogging and using social media, it was to raise awareness of the common mental health difficulties that arise during the perinatal period. I hear the same concerns time and time again - said by people who feel alone in these thoughts - and wanted to normalise them.
I never really thought about how it would feel to be speaking to over 10k people and the position this would place me in. It sometimes leads me to question whether, as psychologists, we should be on social media at all. But this is countered by my belief that, also as psychologists, it is part of our role to share evidence-based information to as wide an audience as we can. Increasingly, this is to counter the masses of information out there (presented as information, often opinion). As a therapist, I’ve had to think about what this means to me, and how I ensure I maintain an ethical approach.
This has meant sharing little personal information and letting people know I’m not able to answer clinical questions without speaking to them first – although I am always happy to help people think about how to access help (services can be hard to navigate). For me, maintaining my professional integrity has meant I have taken on a policy of not doing any adverts, and only attending events which are related to mental health. However, of course this will be different for different therapists who may take a different approach. What has been most beneficial is finding other therapists, particularly Emma @thepsychologymum, to navigate some of these issues with.
I have recently had clients contact me via social media, and have had to think about what that would mean for our therapeutic relationship. Usually as a therapist people come to see me without any pre-conceived ideas. This has always been part of my way of working - allowing myself to be a ‘sounding board’. To me, this is an important part of therapy. This is the one relationship in which you, as a client, don’t need to think about what the other person might be thinking, what is going on in their life, whether they are ok. Instead, you can be there just to listen, think things through and contain any emotions that need to be explored. It’s the one time you can fully expect someone to be there just for you.
Making myself more accessible raises the possibility that people might have expectations of me before we meet. One client told me recently that, having got to know me already on social media, they felt some pressure to be liked by me. This is something that can often come up in therapy, particularly with women, the pressure to be a ‘good patient’ (just as we feel pressure to be ‘nice girls’, this doesn’t go away in the therapy room). My clients also know what is going on in the rest of my working life, which could lead to them feeling that my attention is divided. And, just like everyone else on social media, as such a limited part of my life is up for display, there is lots of room for conjecture.
The Client-Therapist Relationship
Particularly for those who come from psychoanalytic traditions, the therapeutic process between therapist and client is a really key part of therapy. The relationship itself becomes part of the work, and the relationship is used to inform the therapy and bring about change. This can only be achieved if the therapist is seen as a blank slate on which the client can project their own expectations and patterns of relating. In other models, the therapist might bring more of themselves and their experiences to the relationship. In recent years, mental health communities and services have challenged the ‘expert’ position even more with a heightened value of hearing from those with lived experience - experts by experience. More and more therapists have spoken out about their own lived experience of mental health difficulties and use this to inform their work.
There is a fine line between sharing our experiences as therapists and disclosing information that could burden our clients. As I said above, as therapists our role is to hold on to others’ distress, not share our own. Of course it can be helpful to share experiences when this can offer hope – and sometimes these are the most powerful interventions that clients speak about. Even small pieces of information could make a big difference to clients. Most of my clients are aware that I have my own children, and I talk sometimes about techniques that I have found helpful with my own kids – which I try and ground in an evidence base rather than my own anecdotal experience. But I’m aware that many fantasies could exist around my own parenting, and the more of an ‘expert’ I appear, the stronger these fantasies could be. Ideas about whether I lose my temper with my own children, whether I’m always patient, what patterns from my own past might influence my decisions as a parent (and therapist!) Even in a small way, I’m aware that these small snippets can set up ideas that change a very fine balance at a time when people are feeling particularly vulnerable to judgment or criticism.
There’s no easy way of resolving these dilemmas, other than speaking about them as they arise either online or in person. My hope is that, having ‘met’ me via Instagram, potential clients might feel that they know me a little already and perhaps make it easier to meet in person. And that others might find it easier to reach out to a therapist knowing a bit about what goes on behind the scenes. And that others still might find something useful in helping them with their own experience.
Ethical Guidelines for Therapists on Social Media
It’s a bit of a brave new world for us as therapists, navigating this new online society for the first time. My professional body, the British Psychological Society, has published a rather slim guidance document about using social media, which mainly focuses on being aware of the potential for professional misconduct. Certainly, individually I’ve noticed the need to navigate new boundaries on social media. This might include not offering clinical advice, but also not having personal relationships with clients via social media, not sharing information about clients, maintaining professional relationships with colleague and, that good old favourite, not bringing the profession into disrepute. But there are many other issues that arise when you take psychology into the sphere of social media, concerning both clients and therapists.
We also need to think closely about self-care. Social media makes us accessible 24/7 and, being in the profession we are, we tend to want to help people. It is really hard to leave a message unanswered. But it’s helpful to think about what expectations you want to set up long term. Are you only going to use social media during office hours, or perhaps only answer DMs during office hours? Or limit checking social media to certain times of the day? Being constantly available can only lead to burn out, and also sets up an expectation that we may not be able to sustain.
These boundaries, just as in our clinical work, have to be constantly negotiated and shifted. The openness with which we can access other people’s lives via social media also changes our expectations about therapists too. Generally, while perhaps in the past we did want a therapist to be a blank slate, now in our age of ‘authenticity’ maybe we need to know they are human.
Social Media as Community
One area which fits well with social media is community psychology – an approach which moves out of a focus on individuals or families and towards a wider focus on the systems in which they belong. Community psychology often aims to promote ‘wellness’, prevention and early intervention in problems, and collaboration with an overall goal of creating change.
In my field, perinatal psychology, theories of community psychology fit perfectly. With its emphasis on social change and questioning the context in which people are in, it encourages us to question whether it is parents who develop mental health problems or a society that is so unfriendly both to families and to women which causes such difficulty for parents. By changing the environment in which people become parents, we might hypothesize that we would see a dramatic reduction in perinatal mental health problems.
And this is where social media can be so powerful. It’s an easy way of bringing people together, as parents when we can feel particularly isolated, but wider communities too - as I try to do with my Village campaign. People can connect into groups and there is evidence that social media can sometimes feel like a newer form of peer support. Particularly in the mental health field, sharing experiences or even just reading others’ can reduce stigma, inform people about what is available to them and offer support which might not otherwise be available.
There is of course a downside, one which is not yet as well regulated as it perhaps should be. There are groups which normalize harmful strategies such as self-harm or eating disordered behaviour. Of course most accounts are not moderated and some have suggested that only milder mental health difficulties are openly discussed – which could actually increase stigma for those who feel their difficulties are not represented. And social media itself, as I’ve talked about before, is not always a healthy place to be.
Too Many Experts?
Social media in its very nature creates ‘experts’. Even the very structure of profile pages means that we are presented a certain way. Your page, whether you have 10 followers or 1,000,000, sets you up as your own personal brand. Something funny happens when we start to use social media too, which you might notice in the kind of language that is used there. Social media makes us lose our tentativeness, and often we might take on a particular persona. On Stories we become a newsreader, or a roving reporter. In posts, we generalise our personal experience to connect with others. Even in using the term ‘followers’, that suggests we become leaders. What does this set up for us?
The Death of Privacy
As soon as someone begins to get a ‘profile’, and be seen as an expert (whether that is in psychology, parenting, interiors, fashion), there is a change in the dynamic between them and their followers. All of a sudden, as a ‘followed’, we begin to think that people want to know about us. This has been great for small businesses, who can build a brand and reach people they couldn’t before. It’s also enabled us to build communities at times when we might be feeling isolated, such as when dealing with new parenthood, older age or lack of mobility. But there also creates a relationship of voyeur and viewed. Take a step back and consider how intrigued we are by watching other people put on their make up. Why do we want to do that? And why do we want to be watched?
Over the past twenty years, let’s say beginning with Big Brother (or maybe it goes further back to the MTV Show, ‘Real World’) we began to hold an expectation that normal life was entertainment. This creates such a vicious cycle – we start to look into other people’s homes, so we make our homes worthy of being viewed. We buy something we saw on someone’s InstaStories – and then feel we must reveal them on our own, creating a particular cycle of voyeuristic consumerism. Because we speak to our phones as if we are reaching an audience, do we act as if we have an audience? And what does it do to our mood, and our sense of self, in those times when we don’t have an audience. Did it really happen if we didn’t Snapchat it?
At the same time as we have accepted our audience, companies have also started to invade our privacy. You might remember the uproar that occurred when CCTV came into use in the UK back in the 1980’s, and some controversy around new laws concerning retention of personal data by companies (the unfortunately named Drip bill…as a fitting aside, when I searched for that link Wikipedia asked to know my location which just demonstrates how often we are asked to give away our privacy). But yet, for the sake of convenience, most of us don’t mind selling our data. It helps us do the grocery shop faster if the Tesco app has stored all our previous purchases, or to know when to leave the house if our phone has synced our GPS with our calendar. No matter that this affects our mood, and could even make us easy to manipulate (see here for how easily Facebook can manipulate our emotions and here for the suggestion that it also manipulates our political stance). Gradually we have become used to being public property.
Why is it that we accept our audience in this way? The expectation not only that we are watched but that we are worthy of being watched reminds me of David Elkind’s theories on adolescence. Elkind suggested that, during our teenage years when we are developing the ability to fully understand the thoughts and ideas of other people, we cannot yet separate out what they might be thinking from what we are concerned with. Coupled with the essential egocentricism of adolescents, we can come to imagine that those around us share the same concerns as we do while at the same time feeling that our experiences are unique to us. This can lead to a sense of an ‘imaginary audience’ – the idea that others are as preoccupied with us as we are! Linked to this is the theory of a ‘personal fable’. If we believe others are preoccupied with us, we can start to feel special and deserving of that audience. You can see how that can lead to feelings of invulnerability (and some of the risk-taking behaviours that are common in adolescence). But you can also how self-conscious that can make us. Elkind’s theory was that we grow out of this stage when we can differentiate between the preoccupations of ourselves and others, and come to the end of the identity exploration and separation from family which tends to occur during this phase. But if social media feeds into the idea that we have not just an imaginary audience but a real one…can we ever get past this developmental stage? Or do we get stuck at adolescence, waiting for our imaginary audience to really notice us.
Influenced or Idealised?
The counter to this is, of course, is when we ourselves are the audience, and how we respond to those who become our ‘followed’. Because the flip side of the coin is the idea of the influencer and, by the same token, our willingness to be influenced. Which brings me back to where we began – because at 10k followers you become a ‘micro influencer’. Although I’d suggest that, as soon as one person starts to pay attention to you, you have some influence.
What’s interesting is our need to put others into this position, to watch them put on their make up and buy the same products as them, to find ourselves styling our home differently having watched their renovation – or to even begin to alter our beliefs and values based on what we may be saying. I’ve written before about the social referencing that happens on social media, with the creation of in groups and out groups (and how often we can feel that we are in the out group…) But – when we all feel we are in the out group looking in – what do we do to those we are gazing upon?
This reminds me of another psychological theory - based on psychoanalytic ideas of defense mechanisms. Defenses are what we create to protect ourselves from feelings we don’t want to face. One of these mechanisms is splitting, judging things as either all good or all bad, because this feels more bearable than the reality that life can be pretty messy and uncertain. We do this with people too. When we fill them with entirely good qualities, we idealise them. They become someone to look up to, to admire, to emulate. This, in many ways, feels easier than looking at those parts of us that we might feel are less than admirable. However, the other side of idealisation is devaluation – the inevitable fall from the pedestal which occurs when our idealised fails to meet our high expectations.
(Pertinent too is the defence mechanism of narcissism, in which we highlight only the idealised aspects of ourselves and deny the more negative aspects of self. Something which social media allows us to do rather beautifully.)
This idealisation and the influence we then allow to the idealised helps us all to see the world as an inherently simpler place. Maybe, in such an uncertain time, we need to oversimplify more than ever. Maybe it feels easier to admire others when our own lives feel messy and insecure.
So, if you’ve managed to stick with me to this point…what’s the point? Well, it’s to point out that even the most expert of experts may still feel inexpert, and to question why we need to place people in the position of ‘expert’ at all. Whether on social media or wider society, perhaps we’ve moved towards a more black and white view of reality. But this promotes the idea that life can be perfect – instead of the realisation that life, in all it’s messy and uncertain guises, cannot always be controlled.
What can we do to counteract this?....
As a Reader:
Consider the ‘expertise’ you are placing on someone. Are they qualified to receive your trust?
Keep a critical eye. Even the strongest evidence has a challenge to it. Use your own judgement to consider what is right for you
Think about what you are sharing, and hold in mind the privacy that you might be letting go. Why are you doing this? Do you need to rethink the boundaries between your private and public life?
Differentiate between the information you are being presented with. Is it expert advice, opinion or anecdotal evidence?
As a Therapist:
Stay tentative. Remember that golden rule of CBT – ‘thoughts are not facts’. Be cautious of presenting your opinions as facts
Whether you have 100,000,000 followers or 10, you are still an influencer because you do have influence. Think about how you choose to use it
Consider your boundaries, and constantly review these
Monitor your burnout. It may be easy to become accessible 24/7, but it may not be wise