While an influx of followers can be confusing for therapists just looking to blow off a little steam online, some see this as an opportunity to expand their client base. Marquis Norton, a licensed professional advisor based in Hampton Roads, Virginia, posts under the TikTok account @drnortontherapy. (His bio reads, “CEO of Therapy.”) He opened his account in February after a friend who’s a psychiatric nurse also started posting on TikTok. By the summer, Norton had 100,000 followers. “That’s when I said, I’m a content creator now,” he said. “I’m an influencer.” He has since hired a team of two interns to manage his social media accounts, which he sees as marketing for his private practice. As with other therapists interviewed for this piece, the demand for his services has increased since he went viral. He has just started taking in new patients again after working with fellow counselors to discuss his full outpatient practice and long waiting list.

The line between content creator and licensed professional fuzziness often occurs in TikTok’s frenetic ecosystem. Especially for therapists, who are often referred to as stoic intellectuals with notepads, it can feel like rebellion to reveal social aspects of their personality. Therapists are trained “primarily as a blank board,” said Dr. Tracy. “We shouldn’t talk about ourselves, pretend we don’t have a past.” This distinction could be an obstacle to healing. Dr. Tracy is open about her experiences with mental illness and trauma. She said she heard from more than 150 teenagers with symptoms like hers that they didn’t think they could become therapists themselves until they saw their videos.

It can be difficult to distinguish between educating young people about mental health and providing therapeutic advice. A group of around 40 TikTok therapists joined a Facebook group to discuss the challenges and advise one another in safe rooms. They exchange tons of text messages and hold monthly Zoom meetings where they discuss the ethical dilemmas associated with content creation – how to talk about suicide or how to respond to public comments – and trends they face in their own practices have seen.

“I think it’s all oversimplification for everyone,” said Lisa Henderson, a licensed professional counselor and former Southern Region Chair with the American Counseling Association. She fears that on TikTok, where videos are necessarily short, mental health treatments may be presented as quick and easy solutions rather than “long, hard work”. “It can be misleading,” she said, “more than deliberately harmful.”

Therapists need to be careful about pushing patients not to self-diagnose, said Dr. Tracy. The tips she offers online are educational and non-diagnostic. “We want them to take in the information and then decide whether to speak to a professional instead of believing that this is actual therapeutic advice,” she said.