One good TikTok therapist
Creator and psychotherapist Meg Josephson shares how to responsibly talk about mental health online.
Embedded is your essential guide to what’s good on the internet, written by Kate Lindsay and edited by Nick Catucci.
Who else began their mental health journey in 2012 thanks to Zoella? Just me? — Kate
As someone who learned all their mental health vocabulary from Tumblr as a teen, I take a “I can’t interfere, it’s a canon event” attitude towards the same thing now happening on TikTok. On Tumblr, I was learning about anxiety from 16-year-old British goths. At least today’s teens have a chance of bumping into an actual therapist on TikTok, even if their ethics may be dicey.
In 2021, one therapist went viral with a video she made lamenting when patients “trauma dump” on their first session, begging two questions: If you can’t trauma dump in therapy, where can you? And do I now have to worry about my therapist making fun of me online?
Of course, this isn’t representative of all therapists on social media. But there are bound to be some misfires as the two spheres collide. Therapists normally interact confidentially and one-on-one with patients, so how can that work be thoughtfully translated to an audience of people they do not know, and who come to TikTok with their own backgrounds and issues?
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The best example I’ve seen is
. The San Francisco-based psychotherapist has only been practicing for a year and a half, but having worked in social media prior to graduating from grad school, has been able to bring her work to Instagram and TikTok in a way that feels miles ahead of her peers. She doesn’t sensationalize to grab people’s attention, nor does she attempt to diagnose viewers, but she still earns sometimes millions of views for hitting on truths that resonate, and hopefully encourage viewers to reflect with their own mental health professional.“There’s a lot of responsibility with being a therapist on these platforms,” Josephson says when we connect over Zoom. “So that means a lot that that intention is being seen.”
Josephson also has a Substack where she goes more in-depth on the topics she shares on Instagram and TikTok and provides journaling prompts and a monthly guided meditation. In this interview, we talk about social media as a mental health tool, how therapists can ethically use social media, and why it’s important for them to even be online at all.
Has social media always been something that you integrated with your therapy work? Tell me a little bit about how you decided to approach that.
Social media was something that I was already involved in, in a different capacity. Prior to deciding to go to grad school, I was doing freelance marketing and managing people's social medias while I was figuring out and saving money for grad school, knowing that I was going to go down this path. I just needed a year to get things together. So I had already kind of been in that world in a different way and had always known I'd wanted to use social media to reach people with information and knowledge. I didn't have a plan going into it. I was like, “I guess I'll just start really with the intention of sharing general themes, things that are coming up within the therapeutic setting that I just think more people deserve to know and think about.” And, more than anything, sharing things that I think about a lot and seeing if it resonates with other people as well.
How do you see that relationship between your private practice and social media? Do you see it as a tool to get more clients, or is it an extension of your practice, or both?
Pretty much all of my clients have found me through social media, which is really cool. It's kind of like its own form of marketing, which I think it's really exciting for clinicians, that you can kind of, in the same way if you had a Psychology Today profile, you give a view of yourself, you say, “This is what I'm about, this is how I approach therapy.” Social media and Instagram, it's like, that's your profile and your tools for how you market yourself. And I've just been blessed to have clients that—we align with each other. My priority will always be my clients, and that's where I spend most of my time. But I think they inform each other where what I gain in the therapeutic container, I translate into social media in an appropriate way, and vice versa. So they're kind of joined in that way.
What you said about the Psychology Today profile replacement is so interesting, 'cause I would say that is the hardest part, just finding a therapist. You get these often faceless profiles and I remember when I was looking for my therapist, I really needed to make sure I found a therapist who understands social media because so much of my anxiety is derived from it. I also just wanted to see the vibe of the person. Like, how did they talk? And if a therapist has a social media profile, that's a big need met.
It is like dating, where not every therapist is gonna be for you and vice versa. And it's not personal and it's just about finding the right fit for you. Someone who does understand the impacts of social media on our mental health would maybe occupy those spaces and so it's self-selecting in that way.
Mental health professionals showing up online has become pretty ubiquitous. Everyone talks about therapy speak, or there was an infamous TikTok a while ago of a therapist talking about their client “trauma dumping” on them. Those are clearly the negative effects of mixing social media with therapy. What are your thoughts on that, and how does a mental professional ensure they're being responsible with their platform online?
Totally. It's a big question. I guess all I can speak to is my own approach. There's a lot of information out there and we don't know who's consuming it. And so I think that has to be the utmost consideration—thinking about the different types of people and if they don't have any background on mental health, could this cause harm to that person? And on the flip side, the responsibility of the consumer is to know that there's so much information, not everything is going to be for you or about you. Not every single video has to apply to your relationship or your mental health, and that's the responsibility of the consumer because there's just so much information. But in terms of the responsibility of the clinician, I try really hard not to lean into the sensationalism that can exist in this space. You won't find me using diagnostic language. You just shouldn't find a diagnosis on social media. You need to consult a professional with that. But what I try to think about is like, if this applies to the person, will it be more helpful than harmful? I focus more on general wisdom that can be used for reflective purposes as opposed to solving something for someone and giving someone the answer because I don't have the answer for that person. They have the answer. And I think that the danger of social media is that we often look for personal answers in general content, and it's just not gonna be there. It can help guide us to that, but it's not going to solve it for us.
I go both ways. It's easy to point to all the negatives. But as a teen, social media—Tumblr, specifically—was how I figured out that what I was feeling was anxiety. And then I was able to address things that way. But then even more recently, it was stuff online, people were talking about OCD and I was like, “Wait, some of these things you're describing, I do.” And I'm in therapy. So I was able to bring it to my therapist and be like, “I actually think this sounds right.” And then we were able to tailor my therapy to looking at things from an obsessive mindset. And that has been instrumental in changing things for me. And so it's like, maybe we would've gotten there in therapy, but I almost feel like I wasn't even representing my problems in the most effective way. And then I found the words for it because of conversations on social media.
And that's exactly how I feel as well. I think it's such an amazing tool to give people the vocabulary and the awareness surrounding topics that maybe they didn't have before and then can use it. And that's exactly what I mean by using that information to guide you in a greater conversation with your therapist or with a friend or a loved one. And so using it as a reflective tool is incredible. And I just think that there's so much more awareness around these issues and how to talk about it. And again, it's not like it solves it all for us, but it sets us up to be able to start thinking about it, which I think is cool, you know?
One thing I'm interested in hearing about is—so obviously audience members have become clients, but I imagine you also have an audience that's just an online audience. Do you have to set boundaries with them? 'Cause I imagine you get people in the comments being like, “I'm going through this, can you help?”
Totally. For the most part, I don't reply to comments. I'll say “thank you” if someone says something sweet. But the most common comment is like, “So how do I fix it?” As if I could solve their childhood trauma in a 140 character Instagram comment. So I'm very careful. I'm licensed in California so I can only see people in California. I don't really check my DMs. Also just mentally that's what works for me. I think just keeping things separate I think is what's best. And what I try to do is connect with my audience in a meaningful way, while also maintaining the ethical boundaries that are necessary.
You mentioned that both inform the other, and I imagine that sometimes ideas for videos come from seeing a theme in issues that clients are struggling with. What topics or issues seem to be front of mind for a lot of people right now?
One that—and again, I'm still so early in my therapeutic career, so I think this speaks to how prevalent it is because I see it so much and I'm so young—what I so often see is fear of getting in trouble. Fear of being bad. Fear of just overthinking social interactions. Just this general feeling of being in trouble is so, so prevalent. Unsurprisingly, especially with women. But all this is to say, these are often past protective patterns seeping into our present day in seemingly more self-sabotaging ways. But so often what is self-sabotage now was one self-protection in that way. So that's usually the lens that we go about it.
Do you think people are feeling that level of vulnerability because we're living lives very publicly? Or is it just a myriad of reasons?
I'd say probably both. So often that feeling of getting in trouble is rooted in early attachment trauma and how conflict was dealt with in your home. And at the same time, it's probably reinforced because we are so accessible. Like you're saying, there's so much room for overthinking. And so I think that old pattern and wound becomes reinforced and brought up again and again.
Do you have any goals for social media? Are you looking to grow it and become a public figure, or is private practice your main focus?
It's an interesting question. I feel there are conditions to it. I'd rather have a smaller community that is the right fit than be super known and it kind of be scattered all over the place. That doesn't feel like what my purpose of this work is. Of course, the more people it reaches, I think the better, but my goal isn't to be famous from it. I don't really know if I have a goal with it, because it's also always changing. Three years ago, who would've thought that it would be all video now?
And there doesn't always need to be growth, like actually you can just enjoy exactly where you're at.
But I think maybe growth in terms of it changing, that feels like growth to me too. Not even about numbers, but just it evolving in some way. Like, that to me does feel like growth. It can be tiring to post the same types of videos, same format. There's always an invitation for some evolvement at some point. So when I think about growth, yes. Excited for that. And who knows where that leads, you know? I love the creativity of it and so when I think about goals and growth, I'm like, “I just wanna lean more into creativity.” Who knows what that will look like? And I guess that's the point. I can't predict it, but I just try to follow my intuition with it and so far so good.