Tag Archives: social media

Self-diagnosis in a digital world

By Lindsey Phillips March 28, 2022

For better or worse, social media posts about mental health, paired with the ease of Googling one’s own symptoms, are enticing many people to self-diagnose. In fact, a 2021 Vox article, “How mental health became a social media minefield,” asserted that social media is becoming known as the “WebMD for mental health.” 

Some clinicians appreciate the self-awareness that can result from social media postings and online searches about mental health, whereas others focus more on the potential harm that self-diagnosis can cause. Counselors need to be aware of the hazards of self-diagnosis, but many in the profession believe they can also use it to gain insights into the inner world of their clients. 

Micheline Maalouf, a licensed mental health counselor and owner of Serein Counseling in Orlando, Florida, chooses to focus on what she can learn from a client’s self-diagnosis. In her practice, she has noticed more clients asking if they have a particular mental health disorder because of social media content. Recently, a client told her they thought they might have obsessive-compulsive disorder (OCD). When Maalouf asked why, the client explained, “I saw this TikTok video about signs that you may have OCD. I resonated with some of the symptoms but not all, so I’m not sure if I have it. My situation wasn’t exactly like the person’s in the video, but it got me thinking.” 

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Maalouf asked more questions about the symptoms from the video that had resonated with the client, and she also educated the client on the process of determining a diagnosis, emphasizing that it is not as simple as matching symptoms from a checklist. Disorders manifest differently for everyone, she told the client, and depend on many factors, including life experiences, gender, race and more. But Maalouf also reassured the client that their awareness about OCD symptoms was “important information … because it could be the first step in figuring out if something is actually going on.”

Maalouf, an American Counseling Association member who specializes in treating anxiety, depression and complex trauma, says she is thankful for conversations such as these for two reasons. First, it means the client has some self-awareness, which is a good thing, she says. And second, it provides her with more insight into her client and the potential issues they need to work on in session — regardless of whether the issues match the client’s self-diagnosis.

Searching for answers 

People are hungry for mental health answers, observes Lindsay Fleming, a licensed professional counselor (LPC) with a private practice, Main Street Counseling Solutions, in Park Ridge, Illinois. They want to learn how a potential diagnosis or certain symptoms are affecting their lives and ways to better manage them. What’s hard, she says, is “when someone is doing that by themselves and doesn’t have a professional guiding them” and helping them understand it.

“A lot of people like to have that diagnosis because it explains [what’s happening],” says Tristan Collazo, a licensed resident in counseling at Wholehearted Counseling in Virginia Beach and Carrollton, Virginia. “Some people think it’s stigmatizing, but a lot of people find hope in it because it finally — for once in their life — explains what’s going on.”

Kaileen McMickle, an LPC and founder of Inner Ascent Counseling in Rice Lake, Wisconsin, often works with clients who are struggling with anxiety disorders. She finds the more anxiety a person has, the more likely they are to seek information about what they are experiencing. “It can be hard to feel so isolated and not know what’s going on,” she notes. “People just want certainty. And with Google and social media, it’s so easy to go [online] and try to make sense of what they are experiencing.”

McMickle specializes in treating anxiety, trauma and OCD, and she frequently sees self-diagnosis with clients who have OCD. They often wonder if what they are experiencing is “normal.” 

“We all have intrusive thoughts. We all engage in safety behaviors in some way,” McMickle explains, “but OCD can feel a lot different … [and outside] the ‘normal’ range of behaviors,” such as feeling compelled to tap one’s car 10 times before going into a grocery store or spending two hours trying to find “just the right” products. “People want to know what’s happening to them; they want to know what they’re experiencing,” she says.

Collazo says that a couple of his clients initially self-diagnosed because they identified with a particular trait of a disorder. Someone may see a video about how controlling behavior and manipulation are traits of narcissistic personality disorder, for example, and fear that they have the disorder because they engaged in this type of behavior once in a past relationship. They might have been upset and accused their partner of not loving them, for instance. Making such a statement can be a form of manipulation used by someone with narcissistic personality disorder, Collazo notes, but he points out that it is also something many people who don’t have the disorder might blurt out in the heat of the moment. 

It is human nature to sometimes relate to a disorder or disease after learning a little bit about it, Collazo says. “We probably all have traits from different personality disorders,” he observes, “but it takes certain criteria to have an official diagnosis, which people don’t often understand. They may have a trait or symptom [from a personality disorder] … but that does not mean they have that disorder.” In his social media posts, Collazo tries to debunk the tendency to self-diagnose based solely on resonating with a particular trait. 

That is why it is so important to help clients distinguish between symptoms or traits and an official diagnosis, says Shani Tran, a licensed professional clinical counselor. If a person sees a post about how an inability to sleep, a lack of energy and feelings of sadness are symptoms of depression, they may assume they are depressed because they are struggling with one or more of those symptoms. But having trouble sleeping could be the result of an array of issues, Tran notes, and not necessarily evidence of a mood disorder. 

Tran, owner and founder of The Shani Project, a group counseling practice in Minneapolis, attempts to personify anxiety, depression and trauma on her TikTok account as a means of educating others about mental health issues. She has noticed people resonating with some of her mental health “characters” by commenting, “Oh, that’s so me.” 

In her online posts, Tran makes a point of saying, “these may be the signs of” rather than “these are the signs of” to underscore that just because someone resonates with a particular trait in one of her videos doesn’t mean that they necessarily have a diagnosable disorder. 

For example, someone can experience a trauma and not have posttraumatic stress disorder (PTSD). It often depends on functionality. “Whenever a diagnosis is being made, there has to be an area of the person’s life” — social life, personal life, work or school — “that they aren’t functioning in for it to be a diagnosis,” Tran notes. Even if someone with a mental health issue is high functioning (meaning they function at a higher level than others with the same condition), thereby making it more challenging to determine a diagnosis, there is often a change in the severity or duration of symptoms from how they were functioning before to how they are handling things now, she adds.

Tran hopes her social media content will invite conversations about mental health and get people who relate to some of the symptoms she highlights to consider talking to a mental health professional. Her book Dope Therapy: A Radical Guide to Owning Your Therapy Journey, which she wrote to help people navigate therapy from start to finish, will be published this summer.

McMickle observes that “when people self-diagnose, they are looking for information about themselves, and that can be a really helpful, positive thing. That might mean they’re experiencing some discomfort or emotional dysregulation and they want to change that.” But given the potential for misinformation online, she also cautions counselors to ask clients where they are getting their knowledge of symptoms and disorders and to be careful about any resources — especially social media accounts — that they provide to clients. 

Potential dangers 

As counselors know, accurately diagnosing mental health conditions is complex, requiring years of education and training to truly understand the nuances. Social media, however, tends to simplify this process and often reduces psychological theories or disorders into brief snippets or common stereotypes. For example, a social media post might boil diagnosis down to “Signs you are with a narcissist” or “Things you didn’t realize were ADHD.” Or a meme may depict someone with “avoidant attachment” agonizing over their choice of either cutting someone out of their life or clinging to the person so the person won’t abandon them. 

These types of posts don’t address the complexity of mental health issues or any new research on the topic, such as how attachment is a pattern and not a fixed state, says Ilyse Kennedy, an LPC and licensed marriage and family therapist. “So, people may think certain things about themselves or may resonate with something without having all the nuisance behind it of what that actually means,” she says. Kennedy notes that it has taken her years of studying attachment disorder and reading several books before understanding her own attachment style.

Some clients who self-diagnose come to counseling wanting to receive that same diagnosis from a professional, but people don’t necessarily think about how certain diagnoses could affect them long term, Tran says. For example, some diagnoses could alter the type of life insurance policy someone can get or hinder their ability to obtain security clearances for their job, she points out. Understanding the potential long-term implications makes her careful and cautious when diagnosing clients, she says.

Tran reframes clients’ attempts at self-diagnosis to emphasize their symptoms. If someone asserts that they have depression, for instance, because they are having trouble sleeping and don’t have much energy, she focuses on those symptoms, which could be because of depression or because of anxiety, PTSD or just daily stressors. “People come to therapy looking for answers, but [therapy] is actually very informational,” Tran says. She spends substantial time asking questions and gathering more information about clients: “Tell me more about this low energy. Is it when you wake up? Does it happen at social functions or when you are doing schoolwork?”

Another problem is that anyone, regardless of their qualifications (or lack thereof), can post what might be interpreted as “expert advice” on mental health issues online, which can lead to widespread misinformation. Even people who are well-intentioned can misread or misunderstand mental health information and portray it inaccurately online, causing others who are simply looking for answers to be misled, says Fleming, an ACA member who specializes in attention-deficit/hyperactivity disorder (ADHD). 

Social media algorithms, which filter content based on people’s interactions, can also play a role in leading someone toward an incorrect self-diagnosis. The first thing people see when they open up TikTok is the platform’s feed of recommended videos, called the For You page. If someone resonates with a TikTok video about ADHD, for example, and they “like” it, then their For You page begins to show them more ADHD videos. This creates a type of self-fulfilling prophecy, Fleming says, because the person begins to feel that they are “meant” to see the videos.

According to Collazo, this misinformation has the potential to create a nocebo effect — someone develops certain negative or harmful side effects or symptoms because they believe or expect that they will occur. In other words, a social media post saying that people with these particular symptoms have a particular disorder could cause someone to feel that they do, in fact, have the disorder or cause them to engage in behaviors that confirm it.

Given the potential for error when it comes to self-diagnosis, McMickle explores what that particular self-diagnosis means to the client and how it affects the way they view themselves or approach certain situations. Learning about a diagnosis online has the potential to reduce the stigma around it and instill hope in the person that they too can get help, McMickle notes. But if they are self-diagnosing without also seeking professional assistance, or if they are misdiagnosing themselves, then they are potentially stuck in a difficult place and not getting the help they need, she says. 

Potential benefits 

On a positive front, social media can foster a sense of community and belonging for those who are looking for mental health answers. Discovering online videos and communities of other people who share similar symptoms and struggles, especially for stigmatizing diagnoses such as bipolar disorder, can be rewarding and encouraging, says Kennedy, founder of the group practice Moving Parts Psychotherapy in Austin, Texas. 

People typically have a general idea about anxiety and depression, but Kennedy says social media has opened the door for more discussions about trauma and neurodivergence, including diagnoses such as autism and OCD that have often been highly stigmatized. 

Kennedy, who specializes in trauma work and individuals with trauma related to dissociative disorders, recalls that when she was first making her professional website eight years ago, colleagues advised her against mentioning trauma because it was a “complex term” and people wouldn’t understand it. Fast-forward to today, and that advice seems ludicrous because there is so much more awareness around trauma. 

One of the biggest benefits to the rise in self-diagnosis, at least when prospective clients follow up and seek professional help, is that it provides counselors with insight into the client’s inner world and how they perceive their experiences, Kennedy says. She notes that she has experienced more female clients resonating with social media content on ADHD lately in part because people are just beginning to highlight how the diagnosis can look different in women than in men. When clients tell Kennedy they think they have ADHD, she can use their self-diagnosis to help them reframe how they view their experiences. These clients can then consider their difficulty starting tasks through the lens of neurodivergence rather than as an inherent flaw within themselves. 

“Self-diagnosing [online and through social media] can help people identify how they feel and what they’re struggling with,” Fleming says. “It can also be the only place people have access to mental health information.” 

From her perspective, client self-diagnosis can provide more context, and the more information she has about the client, the more likely she will be able to help them. A self-diagnosis of ADHD, for instance, gives her the opportunity to ask about when and why the client feels distracted. Are they bored and having trouble focusing, or are they anxious about all they have to do later that day?

McMickle finds that with OCD, the more insight clients have, the better the outcomes. If they realize on their own that they might be experiencing compulsions, obsessions or intrusive thoughts that are interfering with their quality of life, then they may come to counseling more prepared to make changes to improve their situation, she says.

Online mental health searches can be a slippery slope, however, McMickle warns. People can find useful information about what they are experiencing, she says, but they can also “go down a giant rabbit hole with any disorder or any medical problem” and get lost in the possibilities of what is happening to them. There is a difference between being genuinely curious and wondering “Do I have this disorder?” and ruminating about all the ways that a diagnosis is affecting your life, she stresses. That’s why it is important for counselors to do a thorough assessment and figure out where clients are getting their information and how it affects the way they view themselves and their world, she says. 

The need for validation 

Counselors must be tactful when reacting to a client’s self-diagnosis, always keeping in mind how much courage it takes to seek help, even if the self-diagnosis proves to be off base. Counselors who don’t handle this situation well risk making clients feel invalidated and turn away from getting the help they need.

Validation with self-diagnosis is crucial, Collazo stresses, because it’s likely that other people in the client’s life have told them that their symptoms or potential diagnosis is “just in their head” or that they “just need to put a smile on it.” Therapy is the one place where they can finally hear someone reaffirm that they are not “sad for no reason” and they are
not “broken.”

Collazo first listens and validates clients’ thoughts and feelings about a potential self-diagnosis. Then he explains about diagnostic criteria and, depending on the client’s needs, offers to do a formal assessment. “If their self-diagnosis was right, then great,” says Collazo, “but if not, then counselors [can] offer hope; they can still help the client” get better. 

McMickle also errs on the side of validating clients who come in with a self-diagnosis, even while exploring their symptoms further. If a client states that they have had a panic attack, for example, then McMickle would acknowledge that they’ve experienced some type of pain or discomfort (regardless of whether the occurrence was an actual panic attack). She would also ask about the context surrounding the assumed panic attack, any other symptoms the client is experiencing and what the client knows about panic attacks from online or social media. 

Learning how to navigate a client’s self-diagnosis without invalidating the client is a crucial skill, McMickle says, because the therapeutic relationship is the cornerstone of effective counseling. “No matter what clients come in with — right or wrong, accurate or not — they’re coming in [to] a really vulnerable space,” she says. “It’s so important that we are really understanding and sitting with them and holding space for them so they can continue talking about things that are upsetting to them and come back for better assessments.” 

Collazo acknowledges that it can be difficult to balance validating with assessing the accuracy of someone’s self-diagnosis. He finds that asking questions and remaining curious are good approaches to learning more about what the client is experiencing while maintaining a healthy therapeutic relationship. 

Kennedy also relies on questions to discover more about the self-diagnosis. She may ask a client, “What does it means for you to have that diagnosis? Why does it feel important to have it? Does it help you better understand yourself or better learn coping tools? Does it give validation to your pain?”

Even if clinicians disagree with a client’s self-diagnosis, they can still validate the client’s feelings, Tran asserts. If a client says, “I’m feeling sad, and I think I have depression,” she rephrases the statement by saying, “So, what I’m hearing is you are feeling sad. Can you tell me more about that?” This language allows her to clarify what the client is experiencing and provides her with more insight. 

The need for a safe space 

Recently, after TikTok videos about Tourette syndrome went viral, doctors started noticing an increase in teenage girls who were suddenly experiencing verbal and motor tics. Tourette syndrome tics are unique to each person, so when doctors from different geographical regions observed similarities in the girls’ tics, they started to suspect that social media was playing a role. However, the evidence was anecdotal and overlooked other contributing factors (such as anxiety and stress). Others fear that blaming social media could further stigmatize Tourette syndrome, especially for young women, making it harder for people to disclose symptoms
to professionals. 

Likewise, counselors sometimes forget how difficult it is for people to ask for help, Fleming says. By the time someone calls or is sitting in the counselor’s office, they have typically invested a lot of thought and energy in making that decision. 

Fleming cautions counselors to avoid hinting at any negative reaction they might have to a client’s self-diagnosis. They should refrain, for example, from saying, “Oh, everyone has that diagnosis on TikTok.” Reacting in disbelief or dismissal could be harmful to the client.

To make it easier for clients to disclose potential diagnoses or symptoms that resonate with them, Fleming invites clients to text her anything they might be hesitant to mention in session, such as their eating habits or a potential self-diagnosis of an eating disorder. She doesn’t respond to the text, but at some point during the next session, she says, “You texted me that you wanted me to check in about your eating habits. How’s that been going for you this week?” If the client still doesn’t want to talk about it, Fleming doesn’t push it any further in the moment but makes a note to try again in a future session. The important thing is for counselors to give clients a safe space to bring things up so they can address it when they’re ready, she says. 

Counselors also must be aware of their own preconceptions and stereotypes about certain disorders. Kennedy has noticed that some clinicians may be quick to dismiss a self-diagnosis of bipolar disorder, for instance, because the client exhibits healthy boundaries. Because of stereotypes, even some counselors may incorrectly assume that this isn’t possible for someone with bipolar disorder. Or, if the counselor is fond of the client, they may be hesitant to give the person such a stigmatizing diagnosis.

It is particularly important for clinicians to create a safe, welcoming space for younger clients and avoid dismissing their thoughts and feelings around self-diagnosis. “Adolescents are still trying to figure out who they are, and they sometimes latch on to things that aren’t them” in the process of discovering more about themselves, McMickle says. For example, adolescents often pull away from people, especially their parents, as they form their own identities, but this behavior is similar to traits associated with borderline personality disorder, she notes. So, if they see a video about that disorder, they may worry that they have it and interact with the world as if they do have it.

Kennedy has noticed that with some younger clients, self-diagnosing may be more about needing someone to see their pain or seeking validation from their parents than about being accurate. But it is still important to validate and explore this diagnosis, she emphasizes, even if it doesn’t align with what the counselor is noticing in session. 

From self-diagnosis to self-awareness 

“Self-diagnosing is giving people more [of an] ability to advocate for themselves and say, ‘No, I think I have this, and this is why,’” Fleming says. “It’s giving people a voice within the professional world.” 

It’s also helping to normalize mental health. A few years ago, Fleming often had to reassure clients that it was OK to have anxiety or ADHD. Now she’s having fewer of those discussions because with the increase in self-diagnosis, the stigma around mental health is also lessening. 

In addition, social media is helping people develop a sense of self-awareness related to mental health. “People feel less isolated and have a deeper understanding of themselves,” Maalouf says. Many of her TikTok followers leave comments on her mental health videos such as “This explains so much,” “I thought I was the only one” and “This is helpful because now I understand what’s happening with me.” She’s also noticed (based on comments and messages) that this awareness sometimes results in people seeking out counseling to find ways to manage or cope with these issues. 

Tran has noted an increase in self-awareness among clients and prospective clients as well. In fact, she considers self-diagnosis to actually be “self-awareness around symptoms.” Before the COVID-19 pandemic and the rise of mental health on TikTok, Tran would get emails from potential clients saying they were looking for a therapist and she sounded like a good fit. Now, she’s noticed the emails are more detailed: “I’ve been struggling with sleep, and I want to have a better relationship with my brother. I’m looking for a therapist with these particular values. Are you able to help me?” 

When someone has a general idea of what they are experiencing, they tend to seek out a clinician who specializes in the mental health issue with which they are struggling, McMickle says. This also helps her when she needs to refer someone because it gives her an idea of what type of therapist the person is searching for.

Counselors can make self-diagnosis more of a collaborative process in session rather than viewing it as “dangerous” or “misguided.” If a client comes to Kennedy thinking that they have a certain diagnosis, she goes through the criteria with them and asks what resonates with them. When clients seem to want or need a particular diagnosis assigned to them, she asks about the reasoning behind that. Is it to get accommodations at work or school? Is it to get medication? Is it to have peace of mind and a better understanding of themselves? If clients do need accommodations or medication, Kennedy will recommend a more formal assessment, but if they just want to understand what they are experiencing and find ways to manage it, then she uses their self-diagnosis as a framework to learn more about the client and help them find a treatment plan that works for them. 

“When a client comes in with a self-diagnosis, it’s a very brave act,” Kennedy says. “It’s very brave and vulnerable for them to be testing this theory out with you. It’s brave and vulnerable that they’re letting you into their inner world in that way. It can be such a powerful space in the therapeutic relationship to welcome it [the self-diagnosis], even if you don’t quite see it or even if it doesn’t feel ‘right’ for the client. It still allows us to learn so much more about them and to have a moment where we really welcome their vulnerability and create more safety in the therapy room.”

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Read more in an online companion piece to this article, “The rise of counselors on social media.”

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The rise of counselors on social media

By Lindsey Phillips March 25, 2022

Micheline Maalouf, a licensed mental health counselor and owner of Serein Counseling in Orlando, Florida, started making YouTube videos with inspirational and educational messages in 2018, but they weren’t reaching many followers, and making them often consumed a lot of her time. In 2020, her friend suggested she use TikTok, a video-sharing app well-known for its dance challenges, to educate people about mental health. These videos are short, ranging from a few seconds to three minutes, and she worried she wouldn’t be able to provide helpful information in this bite-sized form. But she decided to try it.

Florian Schmetz/Unsplash.com

At first, she created a few fun videos, including one that featured her dancing around her office by herself celebrating a client’s breakthrough. Then she decided to make a short video that introduced herself as a counselor and listed her specialties. That video gained her 120,000 followers overnight.

“From that video, I started getting a lot of questions” about mental health, such as how to manage anxiety or what to do if you have a panic attack, Maalouf recalls. “So, I started generating content based on the questions I was being asked.” That’s when she realized the potential this social media platform offered.

Navigating the unknown

Tristan Collazo, a licensed resident in counseling at Wholehearted Counseling in Virginia Beach and Carrollton, Virginia, was taught in school not to add clients on social media, but newer platforms such as TikTok are changing the rules because counselors don’t have any control over who “follows” them.

To further complicate the matter, some counselors are now getting clients based on their social media posts. Collazo says social media has functioned as a referral source for him because a few of his clients found him through his Instagram or TikTok posts.

This is unfamiliar territory, Collazo notes. Counseling programs “taught us all about boundaries,” he says, “but this is so new that it wasn’t even brought up.”

He constantly talks with his supervisor about how to set boundaries around social media, especially for clients who follow him. From these discussions, he has established some guidelines: He makes social media posts, but that’s where his engagement with his followers (and any possible clients) ends. He doesn’t respond to direct messages. He also includes social media in his disclosure statements and discusses it verbally with clients.

Shani Tran, a licensed professional clinical counselor, suggests counselors add disclaimer statements on the social media content they create. She became overwhelmed with the high volume of comments and questions on her TikTok videos, so she joined a group for therapists on TikTok. Together this group decided to create disclaimers stating their online content is educational and not a replacement for therapy.

Lindsay Fleming, a licensed professional counselor (LPC) with a private practice, Main Street Counseling Solutions, in Park Ridge, Illinois, also creates a clear boundary between her social media presence and her therapeutic one. She gives her clients the option to block her on social media, and she tells them that she will not respond if they do comment on her content and that she will not follow them.

She encourages counselors to make social media a part of the conversation in session. She often asks if clients have seen any of her posts online. If they have, she asks how they feel about the videos they have seen and if any made them feel uncomfortable. This gives them the space to talk and process if needed.

Tran receives daily follower requests based on her social media posts, but many are unaware that they must find a counselor licensed in their state. It’s hard, she says, because she doesn’t like having to turn down someone who needs help. For that reason, she added a link under her profile name that provides her followers with more mental health resources, including ways to find a mental health provider.

She also cautions clinicians against responding to comments or direct messages from people asking for clinical advice about their situation or potential mental health diagnosis. If counselors answer them, they could technically be entering into a therapeutic contract without paperwork, she warns, which is unethical.

Self-disclosing

Social media allows people “to see therapists before they are in the room with them,” says Tran, owner and founder of The Shani Project, a group counseling practice in Minneapolis. “They get to see what content therapists put out, what their voice sounds like when they talk, [and] how they talk about the different specialties. … They get an inside look into the therapists’ own personal lives.”

Allowing others to see the human behind the professional has benefits and potential challenges, so Ilyse Kennedy, an LPC and licensed marriage and family therapist, recommends counselors still maintain healthy boundaries when self-disclosing. But what these boundaries look like can vary from clinician to clinician.

Kennedy, founder of the group practice Moving Parts Psychotherapy in Austin, Texas, shares her own healing journey to normalize therapy, but she’s careful not to overshare to the point clients may worry she’s unable to do her job. For her, posting about having a glass of wine to calm down after a stressful day would cross a professional boundary because it is an unhealthy coping behavior for some. There’s nothing wrong with counselors drinking a glass of wine, she says, but she feels more comfortable sharing other coping strategies such as watching reality television.

Maalouf also discusses her mental health on social media to remind others that “mental health doesn’t discriminate” and to start a conversation on various resources and support systems that can help. Some of her clients have told her that it’s validating to see she’s also working on her own mental health concerns like they are.

But counselors have to be careful with the information they share and how they discuss this with clients, says Maalouf. A client who once saw a video she posted about struggling with depression asked her at the start of the session whether she was OK and able to see her in session that day. Maalouf reassured the client that she is fully present when she comes into work and that she takes mental health days if needed.

Is social media right for me?

Social media allows counselors to humanize the profession, educate others about mental health and even connect people with the resources and services they need. With all these benefits, counselors may find themselves contemplating if they too should create social media accounts.

“Social media is not for everyone,” Maalouf cautions. “There are people that would love it because they enjoy educating and helping people, but then when they get on it, their levels of anxiety go up because they don’t feel safe enough doing it [or] don’t know how to do it appropriately.” She recommends counselors carefully consider the reason and purpose behind why they are joining social media.

“If the purpose is because you love making this type of content or love educating on a large scale, then go for it,” Maalouf says, “and remind yourself why you’re doing it.”

Here are a few tips for counselors who decide they do want to use social media for marketing their business or as a tool to promote or advocate for mental health:

  • Grab people’s attention. If your content doesn’t capture the audience’s attention quickly, you could lose them, Collazo says. He often uses slogans such as “You are not alone” or “Bet you’ve never heard about this before” within the first few seconds of his videos to engage his followers.
  • Don’t compare yourself to others. Avoid modeling yourself and your content after others, Maalouf says, and don’t focus on how many followers you have. Instead, focus on your purpose and the goals you want to achieve. She says she’s seen therapists who begin to doubt their own clinical skills because their videos aren’t getting as much attention or doing as well as another clinician’s. “A lot of social media has to do with timing and has nothing to do if you are better than another person,” she notes.
  • Develop a thick skin. Prepare for negative, hateful comments, Maalouf advises, because you will get them. “You cannot read into those comments and take them personally,” she says. “Remember you’re not going to please everybody.”
  • Find support. Fleming and Maalouf both recommend counselors find support systems. Maalouf has a group chat with other therapists who are on TikTok and Instagram, and they check in with each other regularly. Fleming consults with other mental health professionals on potential social media content she’s creating to make sure she’s getting her message across in a healthy, educational way. These colleagues can also serve as a source of support if counselors receive hurtful comments or their posts are taken out of context. Fleming once had a video she made about suicide awareness altered by another person so that the audio said, “Go kill yourself.” This was a triggering moment for Fleming, but her online counseling friends reached out and offered support.
  • Remember, it’s hard work. Creating content and gaining a large following isn’t easy, Trans says. It’s a job that comes with its own stress.

Expanding the reach

Social media, of course, is no replacement for therapy, but more people, especially youth, are turning to these platforms for mental health advice and to share their own mental health struggles. As of March 2022, TikTok videos with the hashtag #mentalhealth had been viewed more than 29 billion times, which shows the popularity of this content.

Many worry this app could be making mental health concerns worse, not better. Recently, several states have begun investigating the potential effect TikTok may be having on young people’s mental and physical health.

Counselors, however, have an opportunity to use these platforms to offset misinformation and educate others on mental health. “Every therapist has their specialties, they have a unique personality, [and] they have something they can offer,” Collazo says. They “can add value to TikTok among all the misinformation.”

Social media can also normalize the process of going to counseling. Collazo’s first TikTok video explained why counselors don’t hug you or hand you tissues in session, and it got more than 200,000 views. That motivated him to keep going. If this information was new to people, he wondered what else could be interesting and educational for them. So, he made videos explaining why counselors have a clock in the room and why the chairs are a certain distance apart.

Many people have an inaccurate understanding of what happens in session, Fleming says. They sometimes assume that they have to talk about anxiety or their feelings the entire time. She’s created TikTok videos that demystify what therapy looks like.

TikTok videos on mental health are “having a big impact on people,” Fleming says, “and helping people recognize it’s OK if they don’t want to feel like this and [that] they can feel better.”

Social media has the added benefit of potentially decreasing the stigma around certain mental health issues. Kennedy has noticed an increase in posts about trauma, neurodivergence and mental health concerns that often have been highly stigmatized, such as autism and obsessive-compulsive disorder. “There wasn’t a lot of information about how it really feels to experience them [these stigmatized diagnoses],” she notes. “And now that we have social media where people are sharing their … experiences of living with these diagnoses, people are resonating with that and noticing the stereotypes of it versus how it actually feels to live with it.”

Social media can also allow more access to mental health care for people who might not be able to go to counseling because of the expense or time constraints, Kennedy says. “Not everybody has insurance that covers it or … can afford sliding-scale therapy,” she notes. The social media content, however, “can allow some access to the beginnings of self-healing work, which is really important.” Counselors can also use social media to connect people with resources and find low-cost counseling services, she adds.

“I do not think the rise of therapists on social media is keeping people from therapy. I think it’s actually helping more people seek out therapy,” Kennedy says. Going to counseling can be scary for many, especially those who have experienced trauma, she continues, “so feeling like you already have a sense of a therapist because of social media can make you feel a lot more comfortable to take the first step in reaching out.”

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Related reading:

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

@Tech Counselor: Fighting the fake news and misinformation onslaught

By Adria S. Dunbar and Meghan Manfra November 6, 2020

Unplugging is hard. So much of our lives are tied to technology. We use it to manage our schedules, to keep up with our social acquaintances, to research our questions. The important, the urgent, and the things that can wait all reach us in a similar way, making it difficult to differentiate between the three.

Unplugging means disconnecting from our people. At a time when there is already so much social distance in the world, the idea of unplugging can feel overwhelming or impossible. For most of us, the positive aspects of social media certainly outweigh the negative ones, so it is more important than ever that we consider our own media literacy to differentiate facts from fake news and misinformation.

Our online identities are an extension of ourselves, so it is not surprising that the way we interact online, and our exposure to online content, impacts our sense of self in real life. As a country, we are experiencing a vulnerable time in which people are unsure who or what to trust, particularly online. Anxiety, depression and substance use are all rising during this global pandemic, and online misinformation campaigns have the potential to exacerbate symptoms for some clients. Counselors might find themselves in situations where they need to address clients’ mental health concerns without straying too far into politics.

Here are some recommendations and resources that might help counselors in this work, particularly over the next few weeks or months, as the results of one of the most contentious elections in American history draws to a close. Regardless of our political leanings, our ethical responsibility to empower our clients toward wellness creates a need for new media literacy tools in our toolboxes.

 

Recommendations

Read laterally: Use fact-checking sites like snopes.com to research news items and social media posts. They can usually tell you if the item is misinformation, malinformation (i.e. propaganda) or an outright hoax. For example, search Snopes for “shark on highway after Hurricane Harvey in Texas.”

Conduct a reverse image search: Hover your mouse over the image, right click on the image and select “search Google for image.” You will see other places the image has been used. Again, you will find out pretty quickly if the image is credible.

Determine the perspective of the source: Look for the “about us” page. Keep an eye out for “paid content.” And, when visiting news sources, look for their editorial ethics page.

 

The following resources can help you strengthen your social media skills:

  • Pew Research Center —- A nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world
  • The Sift —- A free weekly newsletter published by The News Literacy Project, a nonpartisan national education nonprofit, that explores timely examples of misinformation, addresses media and press freedom topics and discusses social media trends and issues
  • Spot the Troll — An interactive game that allows players to read a brief selection of posts from a single social media account or “profile” and then decide if each is an authentic account or a professional troll. After each profile, you’ll review the signs that can help you determine if it’s a troll or not.
  • Lamboozled: The Media Literacy Card Game — A card game designed to help youth develop media literacy skills.

Image from the United Nations COVID-19 response page at unsplash.com

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@TechCounselor’s Instagram is @techcounselor.

Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

Meghan Manfra is an associate professor in the Department of Teacher Education and Learning Sciences at North Carolina State University. She lives in Raleigh with her husband and two daughters. Contact her at mmmanfra@ncsu.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Social media and active listening skills don’t seem to mix

By Grace Hipona October 13, 2020

Since the onset of COVID-19, I have observed through my work with clients via telehealth that people’s reliance on social media as a vehicle for connecting with others has intensified. While this engagement may be beneficial and necessary during the pandemic, it does not afford us the opportunity to connect on a more meaningful level. Even more concerning is how this contributes to individuals not directly learning active listening skills.

Simply put, COVID-19 and our over-reliance on social media as a means to connect has impacted the process of ACTIVE communication. Think about a typical post, whether it consists of a picture, a funny quote or the sharing of a political news article. The main benefit of social media is to put information out into the universe as a means of sharing with others. However, this process is usually one-sided and does not typically result in active conversation. Individuals may use social media to stay “up to date” with others, but this might involve simply scrolling through posts without providing any comment or engaging in any conversation.

Think about the typical responses to a post. Individuals can choose to “like” a post, comment or scroll on. These responses lack much opportunity for active exchange. I emphasize “active” because even with a high-engagement social media post in which there is an exchange of comments, there is a passive reactiveness that ensues. Sometimes, the thread may become lengthy and escalate, leading to some inflammatory or not-so productive statements. Regardless, the active listening process is not present.

When we are talking with others in person, common courtesy is to ask, “How are you?” or “How are you doing?” The other individual responds with a reflexive, “Good” or “Fine,” and then also asks, “How are you?” But on social media, this quick and simple process is completely bypassed. Typically, there is no exchange of questions. There is a responsiveness, but people are responding to statements, NOT questions.

For example, I recently posted a picture of a family outing. One of my friends wrote, “Beautiful,” and several others “liked” my picture. But people did not typically ask, “How was it?” or “How did it go?” Nor did I expect them to. There is not “room” for an active exchange. I am unidirectionally telling you about my life, not asking you to engage with me. Social media is no substitute for an actual conversation because there is no depth.

What happened to asking questions?

More and more, my clients verbalize challenges related to developing meaningful relationships. In many cases, I believe their reliance on social media in place of more interactive engagement is a primary reason for that.

Some people are not being taught how to have a simple conversation — not just an exchange of ideas but questions that can enrich a conversation. The clients I work with who fall into this category, many of whom are younger, are developing without an understanding of the importance of asking questions.

We ask questions to demonstrate that we care about the other person. We also ask questions to obtain more information, more details. We ask each other questions so that we can have a conversation. We ask open-ended and follow-up questions to learn the depths of a person.

Asking questions allows us a window into someone’s inner world, and this glimpse is key in building relationships. Without creating this opportunity, our connection with someone will remain surface level and superficial. I can recall interactions with people in which I shared about myself, but the listener didn’t ask any follow-up questions.

Those experiences feel odd and confusing. It can even come across that the other person is self-involved or selfish. Having such an experience can be deflating and potentially cause a barrier to further interactions.

Unfortunately, when people use social media as a substitute for connection, these feelings of isolation can be exacerbated, with users not always consciously realizing that they are missing critical aspects of engaging.

Actions to take

As counselors, we are constantly searching for opportunities to help others. So, what can we do in this instance?

1) Educate: One of the many hats counselors can wear is that of the educator. We can talk about the process of active engagement and share strategies to maintain active engagement even during these challenging times. We can directly teach our clients, students and supervisees about the significance of active listening. We can point out why social media does not easily allow for this. Because the process of active listening is typically a strength of counselors and because we are trained in it, we may sometimes forget that it is a developed skill and that it takes education and practice.

2) Role model: We can role model in our everyday lives by taking the time to ask others, “How are you feeling?” Typically, we might ask, “How are you doing?” However, if we want to demonstrate how to have a more meaningful exchange, asking how a person feels gets below the surface and provides an opportunity to show that we care and want to have a more significant interaction. We can also ask, “How can I better help support you?”

In other words, the active engagement process begins by asking a simple question. But once that has been mastered, we can more thoughtfully ask specific questions. In our sessions with clients, we can help them practice this art of asking questions, and they can experience the benefits.

3) Advocate: Students need to be taught these skills directly. Sometimes we assume that people will learn active listening skills somewhere along their journey in life. However, the only way to really know whether someone has learned a concept is to teach them that concept.

To piggyback on my first point, we need to advocate in our communities and education systems for classes, groups or other learning formats that can be geared toward active listening and interpersonal skills. This is especially important for a younger generation that is much more reliant on social media for communicating. From my perspective, it seems that students are given the opportunity to directly learn these subjects only if they have a formal diagnosis and undergo the process of obtaining an individualized education program.

4) Research: My insights into the impact of social media and technology in general on active listening are not heavily researched. I have found some anecdotal information on blogs and in newsletters, but there do not appear to be many evidenced-based articles available. Given that reality, another important opportunity we have as counselors is to collect data, both formally and informally. We can then share our findings to help inform others.

It is challenging just to survive in these times, let alone do any one of the things I describe above. But when I feel overwhelmed by our collective experience, I focus on what I can control. I can purposefully choose and feel empowered by these choices. I can choose to directly communicate with people rather than relying on social media.

Sometimes when I think about macro-level change, I feel like I am not doing enough. I do believe that our individual efforts have an impact on the larger community, however. Therefore, I remind myself that even the simplest of exchanges can be significant. It starts with asking a question.

 

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Related reading: See Counseling Today‘s October cover story, “Helping clients develop a healthy relationship with social media

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Grace Hipona is a licensed professional counselor for NeuroPsych Wellness Center P.C. and holds a doctorate in counselor education and supervision. Her dissertation focus was on disaster mental health (specifically sheltering in place). She is also a certified substance abuse counselor and approved clinical supervisor. Her experiences over the past 15 years includes working in private practice, managing behavioral health programs, teaching graduate students, and providing supervision for master’s-level counseling students and counselors-in-residence. Contact her at ghipona@hotmail.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Helping clients develop a healthy relationship with social media

By Bethany Bray September 24, 2020

When a user opens Facebook, Twitter or many other social media platforms, there is a slight delay before an icon illuminates to indicate that the person has a notification, signaling that someone has liked or interacted with one of the user’s posts.

That moment of delay is purposely designed into social media apps to create an alluring cycle of anticipation and reward, according to Amanda L. Giordano, a licensed professional counselor (LPC) whose main area of research is behavioral addictions, including addictions to technology and social media. “Social media is made to be irresistible. It taps into the pleasure centers of the brain. It’s designed to keep you on it as long as it can,” says Giordano, an associate professor at the University of Georgia. “They operate from the variable ratio reinforcement scenario. That’s the most powerful reinforcement schedule there is. [Social media’s draw] is like gambling, knowing that there could be a big payout at any time, so you keep playing. Users know that they’re going to get some kind of reward, but they don’t know when it’s coming. There is a strong dopamine response [to that].”

That drive to seek the rewards that are triggered by social media can lead to compulsive and problematic use. But by providing psychoeducation about the ways that social media platforms are designed to affect neural pathways, counselors can help clients achieve a healthy balance with their social media use, says Giordano, a member of the American Counseling Association. This is especially true with child and adolescent clients, who are digital natives who have been exposed to technology all of their lives but may not yet possess the maturity to recognize the control that social media can exert over them, she adds.

Providing psychoeducation is just one of many ways that counselors can assist clients in flipping their perspectives and using social media to get what they want out of the experience rather than vice versa. Taking simple actions such as changing a smartphone’s color scheme to gray scale can render Facebook’s notification icon — a red bell — less powerful, Giordano notes.

“By becoming aware of all of that, and understanding how social media is tapping into some of these more primitive brain responses, clients can be empowered by the knowledge and take more control over their use,” she says.

Part of life

According to the Pew Research Center, 72% of American adults use at least one social media site “to connect with one another, engage with news content, share information and entertain themselves.” Pew found that those ages 18-29 had the highest usage at 90%, followed by 30- to 49-year-olds at 82%, 50- to 64-year-olds at 69%, and those 65 and older at 40%.

Pew’s data collection in early 2019 found that more than half of adults who used Instagram, YouTube or Snapchat visited those sites at least once per day. Facebook was pinpointed as the most popular social media site, with 69% of adults using the social networking platform. In addition, 74% of Facebook users visited the site daily.

These statistics point to a hard-to-ignore conclusion: Social media is a very real part of the fabric of people’s lives today. Regardless of counselors’ personal feelings about social media — whether they view its impact and influence as a net positive or a net negative — they must do their best to understand it and the role it plays in their clients’ lives.

Don’t discount the positives

Social media use can factor into any number of presenting issues and challenges that clients bring to counseling, from relationship friction discussed in couples counseling to self-esteem or body image issues in clients who struggle with perfectionism, eating disorders, social anxiety or other conditions. The COVID-19 pandemic has added another layer to this issue, as many people are quarantined or otherwise spending more time at home, feeling isolated and turning to social media to find connection or quell boredom.

As it relates to their clients’ lives, professional counselors may first think of the potential negative implications of social media use. However, the counselors interviewed for this article emphasize that there are both good and bad aspects of social media use. And for many people, the pluses can far outweigh the minuses.

“It’s an area that many counselors shy away from. … A lot of times, it feels like folks demonize social media. There are a lot of ways to keep from using it in an unhealthy way and to use it to your benefit,” says Kertesha B. Riley, a career coach at the University of Tennessee’s Center for Career Development and Academic Exploration, where she is working on a doctorate in counselor education. “There are hundreds and thousands of examples where social media is not a good thing at all, but I don’t let that outweigh the good that can come from it.”

Riley is active on Twitter, using the platform to stay up to date professionally, follow leaders in the field and forge connections. In the realm of career counseling, social media sites such as LinkedIn can play an integral role in clients’ job searches, Riley says, adding that she often talks with her clients about leveraging social media to enhance their career development. Creating posts with hashtags such as #jobs and #hireme can catch the attention of potential employers, while clients can follow hashtags within their own industries to stay abreast of trends or connect with colleagues.

“It can help [clients] to stay in the know and connect with people, but also further their career goals in a way that propels them a lot quicker than without [using social media],” says Riley, a member of ACA. “For networking, follow leaders and movers and shakers in your industry, and see who they follow. See what gets you noticed on this platform, and in your field.”

Social media can also serve as a tool to find and connect with professionals with whom clients relate, Riley notes. “Especially for those who are having feelings of doubt or mention that they’re not seeing people who look like them in the field, they can follow people they admire and identify with.”

As a Black doctoral student, this is the case for Riley. Although she doesn’t have many Black colleagues at her university, she follows and interacts with many Black doctoral students and professors via social media.

ACA member Jordan Elliott saw how social media could play a beneficial role in her work as a residential counselor at a treatment facility for women with substance use disorders. Many of the women at the facility had extensive trauma histories. Elliott, an LPC intern and licensed chemical dependency counselor in San Antonio, often worked with clients to create social media plans for after they were discharged. In many cases, this included joining social media groups and following pages with others in recovery.

These connections helped the women support each other and keep moving forward in their recovery after discharge, Elliott says. If a friend began to relapse, they would often recognize the signs in the person’s social media posts — or lack of posts — and reach out to check on one another.

“They often found intense connections with each other once in treatment. They were already drawn to connect with each other, and they wanted to continue that after they were discharged,” recalls Elliott, a doctoral student in counselor education at the University of Texas at San Antonio (UTSA). “This was huge for them, to stay in contact with one another through social media. … Social media has such a healing capability because it helps people connect and stay connected with each other.”

“When working with clients who have experienced extreme disconnection, via addiction, loss and grief, trauma or other ways, think of the power [social media] can have to bring people together and find connection,” Elliott continues. “In counseling, the relationship is key — we are relational creatures and drawn to connect. Think of how social media can be a connective intervention for clients.”

Getting up to speed

Counselors who aren’t familiar or comfortable with social media should think of it as “just one more way to connect with clients,” Elliott says.

“It’s our responsibility to keep up with it and how it is changing. It can be difficult to keep up with everything, but take that initiative to educate yourself on these platforms as much as you can,” Elliott urges. “For counselors who don’t feel as comfortable with technology, think of it as a creative intervention [to reach clients], and it might not be as intimidating.”

Giordano agrees, noting that counselors have a duty to bring themselves up to speed on social media to better help their clients. Having even a basic knowledge of the different platforms and their varying attributes will help practitioners ask the right questions to connect with clients,
she says.

“The best way is to ask clients, ‘What does it [a particular social media platform] do for you? Escape boredom? Find identity? Connect with peers?’ It’s really important to have a nonjudgmental view of it because, in large part, people have a good experience and find benefits,” Giordano says.

Counselors who want to learn more about social media can begin by doing an internet search on the different platforms and the terms they hear clients using in session. In some cases, counselors might want to consider creating a profile themselves so that they can log in and explore a platform further. Erin Mason, an LPC and assistant professor at Georgia State University, notes that some of the school counselors she knows have created TikTok accounts to better understand the video-sharing platform that is particularly popular among teens and young adults.

Mason, an ACA member, has maintained an active presence on Twitter, professionally, for nine years. She says it helps her stay up to date on trends and developments in the field of school counseling.

Riley recommends that counselors “stay open-minded and talk with someone in your personal or professional life who does use social media. Talk with your clients. Ask what draws them to it and what are some challenges that they’ve encountered. Hearing some firsthand perspective can help pull the wall down against social media,” she says. “[Social media] is a living, breathing, evolving entity, and because of that, there’s a place for everyone if you choose to look for it.

“If a client really loves TikTok, have them walk you through it: What do they like about it? What makes a good video [post]? What do they engage with the most? This helps open them up and tells you a lot about why and how they engage. … It gives you a better idea about their motivation, their mindset and their personality based on the type of platform and how they engage [with it].”

When it becomes a problem

There are no uniform diagnostic criteria for social media addiction, either in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or through the World Health Organization or other agencies, Giordano notes. However, she says, it is estimated that between 5% and 10% of adults have a “problematic relationship” with social media — a prevalence that is comparable with most other behavioral addictions.

“What we know is that it’s prevalent among adolescents, adults and young adults across the globe,” Giordano says. “In the United States, researchers have found that almost 10% of undergrads have social media dependence.”

With that in mind, Giordano urges counselor clinicians to complete thorough assessments of clients’ relationships with social media. The frequency and amount of time they spend on the platforms are good places to start, but there are many more nuanced indicators to consider. Giordano recommends that practitioners check in with all adolescent and adult clients about their motives for engaging with social media, their compulsivity levels, how social media use affects their moods and the emotions that they associate with it. For example, does it disrupt their sleep cycles? Do they experience envy, a lack of belonging or self-loathing?

“When the client is not on social media, do they have an urge to check it? Are they craving it? Do they have FOMO [fear of missing out]? Is it creating anxiety when they’re not on it?” asks Giordano, co-author of an upcoming article on cyberbullying and adolescent social media use that will appear in the Journal of Child and Adolescent Counseling.

Practitioners should note that using social media while driving is a red flag that can indicate social media addiction, Giordano adds. There is also a documented link between social media use and nonsuicidal self-injury — so much so that many of the major platforms have created guidelines for banning photos and posts that glorify self-injury, she says.

Overall, people with poor regulation skills are at higher risk for social media addiction, Giordano says, whereas those who have healthy regulation skills are better able to self-regulate their emotions rather than relying on social media to manage their moods. Counselors should listen for the hallmarks of addiction in the ways that clients describe their social media use, she says. Among the possible warning signs are:

  • When clients’ social media use becomes compulsive and they find themselves checking it when they didn’t plan to
  • When clients have a loss of control, staying on social media longer than they intended
  • When clients continue to engage in the behavior even after experiencing negative consequences such as cyberbullying, family or relational conflict over their social media use, or disruptive sleep patterns

Practitioners can use several assessment tools and questionnaires to screen clients for social media addiction, Giordano notes. More information on these tools can be found in “Investigating psychometric properties of social media addiction measures among adolescents,” an article that Giordano co-wrote with Joshua C. Watson and Elizabeth A. Prosek for the October issue of the Journal of Counseling & Development.

Elliott emphasizes the importance of assessing each client individually because what a healthy relationship with social media looks like will differ for each person. “One client could say that they only use social media six hours per day — but they used to use it for 12. Shift your perspective to meet them where they’re at with their social media use, and don’t pathologize it. … Don’t have a set idea of what it would or should look like, thinking you know what’s best for them. Let them be the judge of how they interact with these platforms instead of us placing our perceptions on them,” says Elliott, who co-presented a session with Stacy Speedlin titled “Healing the Brave New World: Resolving Trauma Issues for Millennials Using Social Media” (available at https://imis.counseling.org/store/detail.aspx?id=PEES19010) at the ACA 2019 Conference & Expo in New Orleans.

For Riley, a general indicator that a client has an unhealthy relationship with social media is when its use begins to interfere with the person’s daily life and functioning. If clients talk about choosing activities because they might result in posts or photos that will garner likes or attention on social media, that should prompt further questioning from the counselor, she says.

“It’s not as simple as the amount of time you spend on [social media]. That can be an indicator, but not necessarily. … Right now, with everyone at home [because of COVID-19], use will be higher,” Riley says. “If it’s impacting the time you [the client] are spending on self-care, or time with loved ones, being in nature or in your community, and you’re finding it’s taking time away from the things you want to do, then it might be approaching an unhealthy relationship. … Asking [clients] about their time spent on social media is a way to start the conversation. But from there, flesh out what is behind that. What is compelling them to spend so much time on social media?”

Cold turkey isn’t the answer

A recommendation that clients delete their social media accounts or discontinue their use altogether may be appropriate for the small percentage of individuals who truly struggle with social media addiction, Giordano says, but it might not be helpful — or even possible — for many other clients.

“There are a lot of benefits to social media, from building relationships and social connectivity to advocacy,” Giordano says. “The answer is not to stop using social media. The answer is for clients to take more control of their social media use so they’re not just going along with whatever impulses they have but [instead] being intentional.”

Counselor clinicians should also keep in mind that social media may be part of a client’s livelihood, adds Mason, so it would not be feasible for the person to quit the platforms entirely.

The same holds true in the realm of addictions recovery, notes Elliott, who counsels mostly adult clients at UTSA’s Sarabia Family Counseling Center, which offers free community services. Deleting one’s accounts would mean severing contact with those who support them during recovery. Social media “is often their lifeline to each other,” she says. “Say they relapse. It’s so important to have that network that they can plug back into. If they’ve deleted all their accounts, how are they going to do that?”

“I think the best way to help someone learn to have a healthy relationship with social media is [for them] to use it,” agrees Riley. “There can be instances where it can be helpful for clients to step back for a time, but for me it’s important to help them engage with it in a healthy way, and that’s not as easy if you go cold turkey.”

“I have a love-hate relationship with this idea, but social media is ingrained in our society,” Riley continues. “Not using it is lessening your engagement with the world, especially for those in rural or isolated areas. It’s a way to see the world without leaving your ZIP code and engage and learn from those who aren’t around you.”

Getting to the why

Researchers from Harvard University, in a November 2019 study published in Health Education & Behavior, found that routine use of social media could have positive health outcomes on social well-being, mental health and self-rated health. At the same time, researchers found that having an emotional connection to social media use could generate negative health outcomes, such as increased anxiety, depression, loneliness and FOMO.

Having a healthy relationship with social media involves understanding why one uses the platforms, and counselors can play a key role in helping clients explore that perspective. It’s most important for clients to decide on and create their own goals rather than counselors making suggestions, Giordano stresses.

“They probably already have people in their life telling them that they spend too much time on social media, so that’s not helpful to say. Instead, help them find their own motives for making change. From there, come from a nonjudgmental stance [and] use the client’s own motivation for making change rather than just imposing rules,” she says.

Giordano finds motivational interviewing and cognitive behavioral techniques helpful when engaging in this work with clients, but she says that counselors can adapt whatever framework they prefer to address this issue.

Practitioners can start by helping clients “give voice” to the pros and cons of their social media use. Giordano suggests asking clients in session why they use it, what they like about it and what they wish they could get out of it.

Giordano notes that research studies on the function of social media in people’s lives have pinpointed that people turn to it to meet three main needs:

  • The need to belong
  • The need for self-presentation
  • The need for emotion regulation or mood modification

She suggests that practitioners ask clients about their thoughts and beliefs prior to using social media, during social media use and after social media use. Then, listen for language that could indicate deeper issues or maladaptive core beliefs that might be motivating clients’ behavior. For example, a client who struggles with self-esteem may mention feeling inadequate or self-critical if they don’t post a witty response to a friend’s post.

Elliott emphasizes that the client should be the driver in this process. “I’m a huge advocate for meeting clients where they’re at. If they’re presenting with negative side effects of social media or an unhealthy relationship with it, ask them about their relationship, what is its role in their life and how is it affecting them. Enhance that conversation instead of challenging it head-on. [If you say], ‘It sounds like you’re addicted to social media,’ that’s not going to help. Fall back on motivational interviewing techniques to have them evaluate what it is giving to them versus taking from them.

“Social media is good because you get to choose who you’re connected to. There’s so much freedom. A counselor can help with flipping that perspective: [Clients] have control of who they’re friends with and what they might see in their feed.”

Perspective shift

Counselors can help clients move toward intentionality and control over their social media use. A good way to start this process is to prompt clients to talk about what social media gives them and what it takes from them — and how or whether they’d like to change those benchmarks, Elliott says.

Elliott recalls one client with whom she worked at the residential treatment center in San Antonio. Social media was a prevalent part of the woman’s life, and she had more than 1,000 “friends” on Facebook.

Clients were not allowed to have cellphones while they were in recovery treatment. As this particular client neared discharge, Elliott allowed her to turn on her phone — for the first time in two months — as part of creating a social media plan in a session.

Elliott sat with the client as she went through her social media contact lists, blocking, unfollowing and severing ties with people who had previously been part of her life of substance abuse. Many of them had sent her messages, knowing full well she was in a recovery program, to ask her to contact them once she was out.

“If she had looked at those messages at the beginning of her treatment, she might not have stayed. There were a lot of unhealthy people in her life,” Elliott says. “It was a really important exercise to do. In hindsight, I can’t imagine what would have happened if we didn’t address this together. Would she have left treatment, turned on her phone and been bombarded with all these messages?”

Instead, in session, Elliott and the client talked about setting boundaries with social media and processed each friend decision together. They talked about why she wanted to block some people and unfollow yet remain connected with others — those to whom she could be a help, Elliott recalls.

The client also was able to add women from the treatment program to her social media accounts. This greatly broadened her pool of friends, adding people of different ages and backgrounds. The process represented “a complete reframe” for the woman as she exerted control over her social media and decided what role she wanted it to play in her life and her healing moving forward, Elliott says.

This process was often part of creating social media plans with clients at the facility, Elliott says. She served as a support as clients deleted or began to follow accounts, set boundaries and rethought their social media use.

For example, if a client followed a page that glorified drug use, such as the account of an artist or musician, Elliott and the client would process that choice together. “I would talk it through with them: ‘How will it affect you to see that? If so, what are you going to do about it?’ We would evaluate which of these things [the people and pages the client followed] are worth it to them and which things aren’t, as well as knowing their triggers and making a plan for if they were triggered by social media. For example, ‘What if you go on to social media and find that someone has passed away [from an overdose]?’ I would talk all of that through with clients.”

Setting boundaries

Exerting control over one’s relationship with social media often involves setting boundaries and limits. Counselor clinicians can support clients in this process by helping them create a social media plan in counseling sessions. Giordano says this can be particularly helpful for adolescent clients, who may benefit from writing down parameters to which they can refer back outside of sessions.

Social media plans should delineate specific times that clients do not want to use social media, such as during mealtimes, while driving, right after waking up in the mornings or within two hours of going to bed at night, says Giordano, who is writing a book on behavioral addictions that is slated to be published next year. Part of a client’s social media plan might include deciding not to engage in phubbing, a term for when people are glued to their smartphones while gathered together with others — in essence, snubbing people in favor of their phone.

Offering psychoeducation about the triggering aspects of social media can also be helpful during this process, Giordano says. For example, discussing the brain’s dopamine response to a phone’s notification alerts might lead clients to deactivate the notifications for their social media apps. Similarly, explaining how the blue light emitted from digital screens can disrupt sleep cycles might prompt some clients to set a goal of putting their phones in another room when they sleep, thus removing the temptation to check it while in bed.

There are also numerous apps and programs available that limit the amount of time a user can spend on a particular website, including social media. Giordano recommends an app called Offtime, whereas Mason uses Freedom, which is available both as an app and a Chrome plugin. In both cases, the user selects the amount of time they’d like to allow themselves to use certain sites each day, or they have the option to block sites entirely.

“One of the things that makes social media so different from reading a book or watching a movie is that a book and a movie have a set end. With social media, you can scroll without end, so you have to be intentional,” Giordano says. “Clients and counselors can decide [as part of making a social media plan] to only use social media when the results are positive and to do emotional check-ins on how using social media is making them feel.”

 

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Social media and youth: Taking a proactive role as a counselor

For counselors who work with young clients or in school settings, part of staying up to date with social media includes becoming knowledgeable about cyberbullying, says Erin Mason, an assistant professor at Georgia State University.

Cyberbullying, or harassment via digital means, including through social media, is a complex topic. It can take place both during and outside of the school day and both on and outside of school property. In school settings, the responsibilities of counselors and administrators regarding cyberbullying can vary significantly from school to school, as can the consequences imposed on students, notes Mason, who was previously a school counselor.

Mason recommends that counselors visit Common Sense Media (commonsensemedia.org) to stay updated on the latest trends in social media and its use among children and adolescents. The site’s many resources include detailed descriptions and ratings of TV shows, movies, apps, video games and other media for parents and educators.

Mason emphasizes that counselors need to take a proactive role — rather than a punitive one — when it comes to cyberbullying. Efforts should go toward fostering a healthy school culture that includes a focus on positive social-emotional behavior, she says.

“Counselors need to be really vigilant about what’s trending at their schools. Sometimes the trends start in schools and then filter out and become problems in lots of places [in the community],” Mason says. “This is where partnerships are really important — partnering with other school staff, local police and families, and making sure everyone’s on the same page with what’s happening.”

In a trend that was brought to Mason’s attention by one of her graduate students, a problem arose at a school where students were exchanging and sharing messages via Google Docs. The students would type a message and change the font color to white so that any parent or school staff person who intercepted the document would just see a blank page. This method was a way to conceal cyberbullying among students, Mason says.

“Kids figure out the workarounds, ways to trick the system or at least trick the adults,” Mason says. “It’s a lot for educators to stay on top of, and it’s a lot for families to stay on top of.”

On the flip side of the coin, Mason says she has seen social media used as a positive tool in schools. One of her colleagues was running a small group for female students in high school that was focused on empowerment, confidence and positive body image. She created a Pinterest board, and the teens were able to “pin” inspiring quotes and positive messages to share with one another. This activity bolstered the group’s cohesion, Mason says. The young women would add to the board outside of sessions, and the group would discuss the posts when they met in person.

“Some of this comes down to generational differences, and I wonder if over time we will see more of a shift in understanding how social media and these kinds of tools can be helpful, because they are so integrated in people’s lives,” Mason says. “Over time, the negatives won’t diminish, but the advantages will begin to outweigh the negatives, and counselors have a role to play in that — with families and in school settings. We need to be thinking about how social media can contribute positively to school environments.”

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

ACA Code of Ethics (counseling.org/resources/aca-code-of-ethics)

  • Section H: Distance Counseling, Technology and Social Media

Continuing education

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.