Tag Archives: social media

Addressing the loneliness epidemic

By Samantha Cooper October 12, 2023

An adult sitting in a swing looking back at a sunset over the ocean

Antonio Guillem/Shutterstock.com

Rates of loneliness have been increasing over the past two decades, and the COVID-19 pandemic only seemed to exacerbate the issue. In May, the U.S. Surgeon General released an advisory declaring loneliness a public health epidemic and noted that approximately half of U.S. adults are experiencing levels of loneliness.

Counselors are noticing the effect this public health crisis is having on their clients. Amy Lasseter, a licensed professional counselor (LPC) in Georgia, estimates about 80% of her clients are currently suffering from loneliness in some capacity, and she believes the number has increased over the past few years.

This increase in isolation and loneliness affects both physical and mental health. In terms of mental health, loneliness is associated with depression, anxiety, cognitive decline, a poor immune system and early morbidity, according to the article “The lonely brain: Unraveling the neuroscience and psychology of isolation,” published by Neuroscience News in July.

In the past few years, kids have missed out on essential social interaction experiences because of the need to use virtual learning during the pandemic, and inflation has also played a role and often caused adults to choose to stay home rather than go out with friends just to avoid high costs, says Paul Krauss, an LPC and the clinical director for Health for Life Counseling in Michigan.

Despite living in an age of social media and constant connection, more people are feeling isolated. And that is because loneliness is complicated and multifaceted. One person can be physically alone without feeling lonely. Another person may be physically around people but feel lonely, Krauss explains.

He says there are two main ideas involved in loneliness: the physical act of being alone and one’s perception of being alone. Krauss finds that a person’s perception of loneliness is often the most important factor because if a person doesn’t feel deeply connected to others in a meaningful way, they’re likely going to experience loneliness no matter what.

“As counselors, we need to do our best to connect with the client to understand their unique story and experience of loneliness before we can help them make any changes,” he says. “That means counselors need to deeply understand why a client feels alone, whether they are in proximity to people or not.”

Rethinking connection after the COVID-19 pandemic

The COVID-19 pandemic has irrevocably changed the way we communicate with each other and how we interact with the world.

“There was an incredible amount of grief and loss experienced during the pandemic,” Lasseter says. “If you were struggling with addiction, people couldn’t meet with their groups. … Buses stopped running, which impacted … clients as it was their only form of transportation. And that doesn’t cover people who lost someone to COVID and couldn’t be at their bedside during that time.” She says these factors only increased the loneliness her clients felt.

“The loss of stability and the predictability a person once had in their life was unexpectedly stripped away without much warning or indication of when it would return. It was overwhelming for many people, and the experience of this is another layer, or trauma, for the person or client to carry,” she adds.

Students were also heavily affected by loneliness during the pandemic, and this social isolation has affected their experience in the workplace. After spending a significant portion of their college years in virtual classrooms, many recent graduates are now working remotely, so they haven’t been to a physical office or met their co-workers in person.

Although remote work has many benefits, it can cause new employees to miss out on an important part of socializing professionally. Each developmental stage in a person’s life is a transitional time — one that comes with losses and new beginnings. When a young person leaves high school, they leave some friends behind, but then in college or at work, they make a new set of friends, says Gerald (Jerry) Opthof, an LPC in New Jersey who specializes in relationship and family issues. Because of the pandemic and remote work, “people have lost that steppingstone to build up more relationships and connections with others,” he notes.

Having more time alone during the pandemic may have also shone a light on issues many people were facing regarding loneliness and given people the chance to sit down and explore their feelings. “I think what the pandemic did is allowed some space and some reflection for people … to start feeling their emotions where maybe they were numbed out before. And so, I think that the pandemic showed people what was already there,” Lasseter says.

The effect of social media

Lasseter believes that a lot of people turn to social media because they feel it’s a safe place to interact with others, but some people have spent so much time interacting with others online that it is starting to hurt their in-person social skills, she adds.

“I think people are struggling more with loneliness because in some ways we’re more disconnected,” Opthof says. Although social media allows people to connect with others, it can also be harmful because people are only presenting curated bits of their lives, which can cause people to feel as though they’re missing out on the experiences they see. And sometimes it can make people feel lonely if they see their friends’ and families’ online posts about events and activities that they weren’t invited to.

“[We’re] only seeing the fantasy — the image people are putting out there,” Opthof explains. “It can make us lonely because everyone else seems to be happier and doing more than we’re doing.”

Our addiction to social media also prevents us from going out and making connections with others in person. Social media “is addictive; it’s pervasive,” says Krauss, who hosts the podcast The Intentional Clinician. “We can get hooked to the dopamine rush of using social media apps to entertain us for hours on end, distract us or [help us] zone out.” In other words, social media may not necessarily help people build stronger relationships with new people, he adds.

But social media isn’t all bad. It also allows people to stay in contact with others or find community events. Social networks and applications such as Bumble BFF and Meetup can help connect clients with people who share similar interests so they can meet in real life, Opthof notes. These apps also allow people to have control over their social interactions, which can help them become more confident before meeting others in person, he says.

Learning to reconnect

With the right mental health techniques and approaches, counselors can help clients start to overcome their loneliness. Lasseter works with her clients to help them reconnect with themselves and figure out what activities they enjoy doing. This allows them to connect with others through those activities and build a stronger sense of self.

She also encourages her clients to set goals for themselves. For example, Lasseter may ask a client to select a task or activity that will help them connect with others, such as starting weekly dinners with family or going on regular walks with a friend. And she has them set a reasonable time frame to accomplish this goal.

She and Opthof both use cognitive behavior therapy to help clients who are struggling with loneliness work on cognitive dissonance and black-and-white thinking. This approach helps clients understand the underlying thought process related to their unhealthy behaviors. By working together, the counselor can help the client “step out of the unhealthy behaviors, thus reducing the feeling of loneliness,” Lasseter notes.

For example, some of Opthof’s clients have told him they feel left out if they see social media posts of “all their friends and family” on vacation when they aren’t. When this happens, he challenges this unhealthy thinking by asking the client to think of people they know who aren’t on vacation. This helps recalibrate their thinking, he explains, because they realize they are not the only people who are not doing the activity.

Krauss is a fan of role-playing with his clients to prepare them for scenarios they may face during offline socialization. For example, if one of his clients wants to make more friends, then he may ask them to pretend they are at a bar or social gathering and try to befriend him. Throughout the exercise, Krauss will help the client learn to read social cues, engage in conversations, ask questions and get others to talk so they can create connections with others more easily when it comes time to go out in real life.

“Role-playing is important,” he says. “By practicing in the office, it may help decrease their anticipatory anxiety of actual social situations. By practicing conversations and even discussing strategies, a person may experience less fear of the unknown while increasing their ability to be authentically themselves in a situation with another person or a group.”

The counselors interviewed for this article agree that it’s the quality and strength of friendships that matter, not the quantity. Even developing just one or two friendships can help alleviate loneliness, Lasseter says. And being willing to try new things, such as hobby groups, can help people start to develop meaningful relationships with others.

Opthof cautions his clients to avoid the temptation to be on their phones when they are with others because if they are glued to their phones, they will probably still feel lonely and disconnected. “We need that connection,” he says. “We need to unplug [and] enjoy the time we have with people.”

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Loneliness — By the Numbers

According to the 2023 U.S. Surgeon General report Our epidemic of loneliness:

  • Approximately half of U.S. adults report experiencing loneliness, with some of the highest rates among young adults.
  • Rates of social isolation are highest among older adults, but young adults are almost twice as likely as those over 65 to report feeling lonely.
  • The amount of time the average American has spent alone has increased from 142.5 hours a month in 2003 to 166.5 hours a month in 2020 — the equivalent of a whole day.
  • The lack of social connection can increase the risk of premature death as much as smoking up to 15 cigarettes a day.
  • People in the U.S. who reported using social media for more than two hours a day had about double the odds of reporting increased perceptions of social isolation than those who used social media for less than 30 minutes per day.

According to a Gallup survey conducted in February:

  • Loneliness has been in a steady decline since early 2021. This year, 17% of U.S. adults reported feeling lonely “a lot of the day yesterday,” compared with 25% of people who reported those feelings in March 2021.
  • Young adults under the age of 30 (24%) and people in lower-income households (27%) experience higher levels of daily loneliness.
  • Of those who reported being lonely, 33% had or were being treated for depression, nearly triple the level found among nonlonely respondents.

 


Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@counseling.org.


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.

Voice of Experience: Social media and mental health

By Gregory K. Moffatt February 21, 2023

person sitting in front of a laptop with negative social media icons coming out of the screen indicating cyberbullying

Image by Htc Erl from Pixabay

Earlier this month, viewers across the country were stunned by a video showing the assault of 14-year-old Adriana Kuch in the hallway of her New Jersey high school and to learn that she took her own life the next evening. The cruel attack on the young woman by her high school peers was broadly shared on social media. Adriana’s father said the pain his daughter felt in being attacked paled in comparison to the humiliation she experienced online.

Bullying has always been a problem. I was bullied off and on through many of my years as a student. It was frightening and temporarily humiliating. But bullying has evolved with the advent of social media. Three major changes have escalated the impact of bullying.

The first major change involves increased exposure to embarrassment and humiliation. In 1968, the first year a bully picked on me at school, most of what he did to me was either just between us or witnessed only by a handful of people. Once it was over, it was over. I don’t remember ever carrying my humiliation into the next day, and each incident was known only by those who had witnessed it or those who heard about it during its short-lived “news” cycle.

Today, seemingly everyone has a device to document events, to share events and to view/experience these events as often as desired. That allows not only the “news” cycle to remain alive but for the entire world to witness one’s abasement. I can’t imagine the weight of that kind of ongoing embarrassment.

Recently, an Arizona man ran naked across the green at a Phoenix golf tournament. In one video, I saw hundreds of golf fans in the stands on their feet, nearly all of them with their phones in the air, capturing the event. This is our world.

Second, cyberbullying can take place no matter where the child is. When I was bullied, it was almost exclusively at school. Otherwise, bullies had no access to me or I had options for avoiding them. Today, a child can effectively be bullied while alone in the middle of a desert.

Finally, online bullying doesn’t require the bully to face the consequence of the mean thing said. I wrote a newspaper column for 30 years. Comments about my column were often kind and thoughtful, but people — many hiding behind the anonymity of screen names — said some of the meanest things on occasion. I couldn’t imagine anyone saying in person some of what they said online. In person, the speaker would have to defend themself and see the effects of their hurtful words firsthand.

Social media has allowed thoughtless people to quickly find one another. One mean comment or post can seemingly serve as a ready-made invitation for other equally thoughtless people to add mean posts of their own.

Online, a thoughtless or cruel post requires absolutely no thought and no exposure to the pain being caused. I would like to think that the bullies in the Adriana Kuch case felt remorse for their behavior following her suicide, but if she had not done that, they would never have known the tears she shed and the pain she bore in the privacy of her personal life.

A 2021 study by the Centers for Disease Control and Prevention (CDC) discovered that 30% of the teenage girls surveyed had considered suicide — a rate twice as high as among boys. That number was 50% for girls in the LGBTQ+ population. The study proposed that these rates were rising prior to the COVID-19 pandemic but that the isolation of the pandemic accentuated them.

Even before the pandemic, teens spent much of their time staring at their phones. For some teens during the pandemic, their devices were the only link they had to their social worlds. Like it or not, young people live much of their lives in a digital world. Bullying through text, video, Snapchat, Instagram or any of the other social media options is easy and quick — and the one doing the posting doesn’t have to face the hurt they are causing. What’s more, those hurtful words or images can be viewed over and over, not only by the rest of the world, but by the victim, leaving teens such Adriana feeling isolated, humiliated and hopeless.

These issues are not exclusive to teens, but the CDC study should ensure that those of us in the mental health community are alert to these frightening statistics for the teen female and LGBTQ+ populations in particular.

I encourage my clinicians and supervisees who work with these populations to include suicidal ideation as well as an overview of a client’s social media footprint in the intake process — something that was not even an issue 40 years ago when I started my practice.

 


Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu. 


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.

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.” 

ImYanis/Shutterstock.com

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.