Social trends and technological developments have made little impact on the fundamental theories and practice of psychotherapy and counselling since they emerged at the turn of the 19th century. Concerned as they are with universal human nature and experience, and using non-medical and non-technical tools and relational skills, why would they change? But the arrival of digital technology and social media has, arguably, cracked open the black box of the therapeutic relationship. Our increasingly psychologised world is becoming more emotionally literate; TV and video channels are proving a very effective public health medium, and reality shows attract seemingly insatiable audiences with their exposés of the most and least attractive aspects of human nature and how we conduct our relationships.
And social media has given individual practitioners a global platform to promote and explain themselves and what they offer. Many have seized these opportunities with enthusiasm; younger generations of therapists don’t think twice about having a visible and vocal presence on Twitter, Facebook and Instagram. But is this for better or for worse? What are the benefits of opening the black box of the therapeutic relationship for therapy, for therapists, for their clients, and for human relationships in general? Do clients gain from their therapist having a public persona?
Captured on screen
Relationship psychotherapist and broadcaster Anjula Mutanda was one of the pioneers in popularising psychology on our television screens. A psychological on-screen expert to the Big Brother series when it first broadcast in 2000, she has a string of shows and series about human relationships on her CV, including the recent Sex Tape, on Channel 4, where she works on-screen with couples experiencing difficulties in their sexual relationships. Alongside, she has built a successful practice as a psychotherapist (she is a senior accredited member of BACP and Fellow of the NCS), and was recently appointed President of Relate.
Mutanda sees the two roles, public and private therapist, as complementing each other. The TV work is an opportunity to bring therapy to a much wider audience: ‘It is education first, delivered in a relatable, informative and hopefully engaging way,’ she says. She reckons Freud would have seized the opportunities that the broadcast and digital media offer: ‘He was a bit of a rock star and pioneer in his own time, and I think he wanted his work to be known about.’ Her TV work is an effective way to deliver public mental health: ‘Not everyone can afford therapy or access it, and TV and social media can be great spaces for explaining what we do, and maybe even helping some people to go on to get appropriate help for themselves.’
Of course, her media presence does impact on her work with clients, she says. Sometimes a client will come having watched her apparently achieve miracles with someone in one single episode of Sex Tape: ‘The intention of television relationship shows is to be transformative and show a person’s journey to achieve their personal goals. This can also sometimes come across as a bit like magic. You have an hour’s show in which there appears to be an instant transformation. You see a couple at the beginning struggling with their relationship and, by the end, they are in a better place. So sometimes potential clients might think that you can achieve such outcomes quickly and that you can deliver this for them. So, I am very transparent about this aspect, and start by saying TV is a very different medium, it’s more of an action-based, coaching relationship, and a therapeutic relationship is a very different journey. On the other hand, a client in pain might have initially contacted me because they’ve seen my work on TV, and they just want me to roll my sleeves up and get on with my job.’
Anjula Mutanda, TV therapist and President of Relate
Philippa Perry, Therapist, author, broadcaster and agony aunt
Psychotherapist, writer and broadcaster Philippa Perry gave up her private therapy practice when her writing and television career took off, after the publication of her first book, Couch Fiction. ‘I took a year’s sabbatical to promote the book, and I was so enjoying talking to rooms full of people who weren’t colleagues, talking to the general public about therapy and how it can help, that I felt I was doing more good that way,’ she says.
‘These days, I see myself more as a therapy outreach worker. I write about therapy, and I hope that, by so doing, I can pass on some of the great things about it that people can use to help themselves.’
Nothing to hide
For the traditional psychoanalytic or psychodynamic practitioner, to have any kind of identity that might contaminate the transference is theoretical anathema. Freud deliberately sat at the head of the couch so his patients could not see him (although, it is also said that he didn’t like his patients looking at him). Brett Kahr, psychoanalyst and author of numerous books, including Coffee with Freud, is regularly invited to give a professional opinion on broadcast media. He is an unashamed advocate for the therapist as a ‘blank screen’, he says – but less because he worries about the transference and more because he believes his total focus in the therapy room needs to be on his client.
‘I do strongly adhere to the notion that the psychological practitioner must ensure at all times that the patient or client receives 100%, if not 1,000%, of our attention, and I think to turn the narrative in any way towards oneself as practitioner has the potential to threaten that extraordinary, unusual focus,’ he believes.
Freud, of course, was the first person to foreground the patient’s narrative, rather than that of the practitioner, he points out: ‘Doctors were the ones who got to say what was wrong with you. I don’t think it is appreciated enough that Freud was the first to reverse those roles when he said, “I don’t know what is wrong with you, why don’t you tell me and I will listen.” Not only that, but he put his chair behind the patient so the patient could really be the star of the show, the centre of attention.
‘The American relational school has championed the potential benefits of self-disclosure, and that may be the case. It depends on the nature of the disclosure. If you disclose something about yourself, you always run the risk of overtaking the narrative, or provoking envy or competition or making the patient feel displaced.
‘For me the essential elements of therapy are showing up reliably, keeping everything about the patient’s life in the archive of your memory so they know you are really listening, and helping them unravel the complexity of the secrets of their unconscious. By focusing on all those, one does not need to self-disclose.’
Psychotherapist, writer and CEO of the international psychology hub Stillpoint Spaces in central London, Aaron Balick was one of the first in the profession to explore the impact of social media, in his book The Psychodynamics of Social Networking, published in 2013. He has no truck with the notion of the ‘blank screen’ therapist, as he explains in a recent blog.1 ‘The therapist’s values assert themselves, whether they are explicit or implicit,’ he argues. ‘Neutrality is never really neutral: it is rather a reproduction of normative cultural constructs prevalent at any given time…’ He points out that the idea of neutrality was created in the early 20th century, when psychotherapy was largely delivered by white middle-class analysts to patients not so dissimilar from themselves. Practice according to those rules in today’s multicultural society is simply no longer fit for purpose: ‘For anyone who experiences themselves as different from conventional norms (and the vast majority of us do), being in a neutral therapeutic space is more likely to feel like oppression than care,’ he writes.
It is, he argues, even more of a fallacy to attempt to maintain the fiction of the blank screen and therapist neutrality in today’s world, and potentially unhelpful to the client: ‘Every relationship is messing with the transference because every relationship is now contaminated by what people find out about each other on social media or by googling. So, to pretend you can have a protected space that is separate from the relational spaces we are all occupying doesn’t make sense,’ he says. ‘By assuming that the therapeutic relationship can be somehow pure from the contamination of people being or even looking online, are you preparing your clients for the actual world we live in? Shouldn’t we accept that is reality and work with that reality?’
But that doesn’t necessarily mean the therapist should disregard the potential impact of their social media presence and personal disclosures on their clients and potential clients, he says. Balick uses social media but ‘it is my professional persona that is deployed across them, and I am always aware that any client, past, present or future, can see anything I post’.
In the early days, use of social media was widely frowned upon within the psychological therapy professions – and still is to an extent among the older generations. ‘I didn’t come into this profession to be a monk. I think therapists should allow themselves to participate or not participate as they see fit, and accept the realistic consequences,’ says Balick. ‘For younger people who see no evidence of their therapist online, there will equally be an effect and a consequence – the client may be curious about that, or the therapist might not even get the business. People want to know about who they are consulting these days before they engage with a therapist. That doesn’t mean the therapist has to have a social media presence or should not; it just means they have to ask themselves some questions about the consequences of either, and come up with some answers, and be prepared for the consequences of whatever choice they make.’
Balick highlights a crucial point for counsellors and therapists today: many clients, and especially younger ones, look for a therapist online – and not necessarily even on an online directory such as those provided by the professional associations. Coach and psychotherapist Charlotte Braithwaite, co-founder of the Network for Younger Counsellors and Psychotherapists (NYCP), calculates that some 40–50% of her clients find her, find out what they can about her and contact her entirely through Instagram. ‘They find me through hashtags like mental health, trauma and recovery. They say they really liked a post I did on trauma responses, or they went to their GP who offered them antidepressants and then they found me on Instagram, and what I said made them feel I would get them – the self-awareness resonates. They feel a level of being understood just through the content I share,’ she says.
Social media isn’t necessarily good or bad, it’s a tool, she believes. ‘It’s about how it’s used. Yet I do still have a residual sense that I am doing something wrong when I use it!’ She deliberately chooses to make use of herself on her website and through her social media posts, but she is also very selective and deliberate in considering the ethics of her choices about what she says. ‘For me, social media is a great storytelling platform. My clients who have found me through social media have resonated with the stories I tell. They are psychoeducational; they’re not stories about me, my life, who I am – they’re more stories about situations that clients or potential clients may relate to. I’ve done a few podcasts or interviews where I have talked about how I came to be a psychotherapist – about my own trauma experiences in childhood that came back at me in adolescence, and how my own experience of going to counselling inspired me to become a psychotherapist. But I am very mindful of what I choose to disclose, as I am with my individual clients, and that what I share publicly is of benefit to people who read it. I constantly ask myself, is it that I just want to be seen and heard? In which case, I should take it to my own therapy.’
But she, like Balick, thinks the notion of the blank screen is outdated, and even retraumatising for some clients. ‘I originally trained psychodynamically and I found it really limiting. Then I discovered psychosynthesis – to me it’s very relational, relatable. If you are moved by what the client is saying, you don’t need to be afraid to shed a tear. I find it is far more healing with clients to show humanness – if only to say, if I were in that position, I’d feel the same. There is a whole space between self-disclosure and blank screen – it isn’t saying “this happened to me too”; it’s being able to call on personal experience to humanise the therapy relationship. One client said to me, “I’d never trust a pilot who hadn’t been a passenger.” I thought that was a very creative metaphor for describing that we are human too; clients need to know where we are coming from.’
Brett Kahr, Psychotherapist, author and broadcaster
Aaron Balick, Psychotherapist and author
Philippa Perry puts it more bluntly: ‘Just sitting behind a client isn’t going to do it! We do good therapy by having a good working alliance, a connection. Moments of inclusion are what make good therapy, not being clever by recognising the transference a client makes. I can remember asking clients what helped them the most, and people would say, “It was that time you touched my arm just as I was leaving, I felt so much care.” Seven years of training and what made the difference was I touched their arm – and I shouldn’t have done it anyway! Nobody has ever said to me, “It was when you helped me realise I was seeing my mother in every female boss I had”.’
Charlotte Braithwaite challenges the suggestion that the stories on social media that resonate with and bring clients to her could influence and even obstruct exploration of the client’s own stories. ‘That can happen in any situation. For me, what matters is that something has resonated, something I have posted has helped them reach out, has made them believe I will get them. The presenting problem is rarely exactly the presenting problem in any client contact. I will use it as a starting point but it won’t direct where we go from there.’
For NYCP co-founder Ali Xavier, social media allows her to reach a particular type of client. She posts about her own life – her personal juggling to manage a life as a practising therapist and mother of young children – but does so carefully and selectively: ‘My main client base is mothers with young children. Last week, my daughter was ill and off nursery, and I had to spend some of the morning rescheduling my day. I shared a photo of me in my garden and posted a comment about how I had had to reframe my thinking to see this as an opportunity to spend time with my daughter when she was sick. I had some positive comments back about the helpfulness of reframing unexpected circumstances. Social media can be a helpful therapeutic tool and a gateway to reach clients who may relate to what I’m posting.
‘The challenge with that kind of post is if, say, a client came to a session and said she’d seen my daughter was unwell and how was she? My response would be to acknowledge her kindness, give her a contained response and gently move the focus back to her. I am conscious that I have to be prepared for a response to whatever I post, and I am aware of the need not to occupy that therapeutic space.
‘To me, my use of social media feels enough, and not too much. Most of my social media content is reflections about topical and relevant issues, but I supplement this occasionally with narratives that show me as a person too. But what I share is a small part of me, not the whole part. And I have noticed that the posts that feature me get far more attention and feedback – that is what people are more interested in, the person. I am a working woman, balancing motherhood with a job – that is where the synergy comes from and so I become a more relatable therapist.’
She is alert to the risk of shared assumptions: ‘Some clients do say, “As you’ll know, as a working mother…” but I tend not to pick that up with a response, so the dialogue stays focused on their experience. Equally, one client said of a post I shared about pandemic parenting: “You normalised struggle, and I didn’t want to see anyone who would judge me.” Sharing a small part of my story seemingly gave her permission to acknowledge her own struggles and engage with therapy. If there is a therapeutic intent or benefit to what I am sharing and it doesn’t compromise my wellbeing or that of others, then I am happy to share.’
Both Xavier and Braithwaite say that professional networking is also enhanced by social media, and particularly during the past two years of lockdown. ‘I have built some lovely connections with other therapists on social media,’ says Xavier. She’s also taken part in professional panel discussions and debates where she’s contributed on mental health and therapy. ‘For me professionally, social media provides an opportunity to build some good professional connections and provides another route in for clients. I wonder if in a few years website directories will still be the main route for clients to access therapy?’
Therapist as brand
Catherine Asta doesn’t use online directories at all to advertise her services – simply her own website and Instagram, and broadcast and published media opportunities. As her website states, her clients are mostly women. In her posts and published columns, and in the 12-minute weekly slot she had for three years on local radio, where she took calls from listeners and talked about mental health, she is ‘open when I feel I need to be – I weave in parts of my own story and the adversity I have faced in life. I’m an advocate of narrative psychology as a theoretical perspective. I believe our stories become the lights of hope on someone else’s dark runway.’
She has no qualms about describing herself as a ‘brand’ and uses social media as a platform to build a community around that brand. ‘I am a brand. This is me. I may not be everyone’s cup of tea, but people have a feel for who they are coming to see before they step through my virtual door. When I set up my therapy practice six years ago, I set out to do something different, to create a space where collectively I could start to normalise some of the stigma around talking about mental health. I deliberately aim to empower women to believe that, just because this is where they are now, it isn’t necessarily where they are going to end up – there’s some hope.’
It is, she argues, important to build a sense of relatability and common ground with those who might benefit from therapy with her. ‘I put myself in my clients’ position, and I’d want to work with someone who had a shared understanding of what was happening to me. So I attract women who have experience of some of the things that have happened to me. I have experienced a lot in my 42 years and it’s all part of how I work. I am working class, from a very dysfunctional family, I’ve been a young single parent and now have my own blended family, and I have faced my own mental health struggles. I am a wounded healer; I work from a very compassion-focused perspective. I take my own experience and bring that compassion into the therapy room. I am not immune to adversities in life, and I think it’s important to be able to say that – to say my life isn’t perfect, I am only human.
‘This morning I went into the local café for breakfast and a woman stopped me and said, “I follow you on Instagram and every single post is a post about my life. You make me feel like I have someone by my side.” It’s about feeling that you are not alone. I show up every day on social media, talking about things that matter in a collective sense. These are not individual stories; I post about things that many women are experiencing or have experienced and think they are the only person in the world with those problems, and I bring in my own experience, thoughts, values and feelings too. Instagram has progressed from somewhere to post pretty holiday pictures to a journal where women in the demographic I work with go every day to feel connected. I am not associated with any other bodies, other than my professional associations, and I don’t work with EAPs. The majority of people who come to me either come from word of mouth or say they’ve been following me on Instagram for many years and, at the point at which something went wrong and their life began to fall apart, I was the first person they thought of who they wanted to speak to.’
And sharing aspects of her own story online and on social media is very different from self-disclosure in the therapy room, she emphasises. ‘It’s less that the self-disclosure happens in the therapy room and more that it has already come before they even find me. In the therapy room, I might share things when I think it will help the client’s understanding to know that I know what it feels like, but I always caveat it as something that I think might be relevant and help, and follow up by stressing this is their unique experience.’
The concept of the ‘wounded healer’ is very strong within the counselling profession; many if not most counsellors and therapists came to the profession through their own experience of therapy and its potency to heal emotional trauma. But Anjula Mutanda sees dangers there. ‘My personal rule is I will talk publicly about what I have worked on and healed from. I give a lot of talks on multigenerational trauma, for instance. But I won’t talk about a crisis that might be happening now. I’ll talk about what happened to me in childhood in the context of how therapy helped me, and I’ll talk about it in terms of the work I’ve done on myself and what I’ve found helpful.
‘In the therapy room, self-disclosure in my opinion has to be appropriate and relevant to the client and used skilfully as a tool in the therapeutic process. It is something that I will also explore with my clinical supervisor if I am uncertain whether disclosure would be helpful or not. For me, talking about something that you are in the middle of means you are likely to get in the way of the client and their process. You are no longer in a therapist–client relationship; you have crossed the line and blurred the boundaries.’
And, she says, she works hard to maintain those clear boundaries between her public, professional and personal lives: ‘I don’t, for example, post anything that involves my daughter unless she agrees, and even then, it is only in relation to wider newsworthy issues and campaigns. I am always thinking about how my clients might feel and what they do and don’t need to know about me. When is it relevant? When does it matter? When do we step aside? These are things I am always thinking about as a professional.’
Says Philippa Perry: ‘The thing about putting yourself out there is that you will put off some people, and I think a lot of therapists are frightened of doing that. But if you don’t put yourself out there you won’t engage those people, and there’s always going to be some seed that falls on stony ground. I think it’s good if you put people off when you aren’t the therapist for them.
‘Social media is part of life now and if you aren’t on it, it is saying as much about you as if you are. Therapists should at least have a shop window online to show clients who they are, and I don’t mean pictures of some stones or a pretty sunset. That just says you’re a cliché. Clients need to be able to see who they are going to be in a therapy relationship with.’
Catherine Asta, Psychotherapist and media contributor
Karen Pollock, Therapist specialising in sexually minoritised groups
One area where self-disclosure can, arguably, be hugely beneficial is in making therapy more accessible to people from highly marginalised and minoritised groups who may assume (or fear) that it isn’t for them or that the therapist will be critical of or even hostile towards them or attempt to ‘cure’ a fundamental aspect of themselves that deviates from mainstream social norms. This is where Karen Pollock believes it is important for a counsellor or therapist to be upfront and open, and where having a social media presence that speaks to these beliefs and personal lifestyle can be very useful in engaging clients.
Pollock offers counselling to sexually minoritised groups such as sex workers, people from the LGBTQI communities and people with less usual sexual practices, such as kink. ‘I have thought about this a lot. I decided people need to know I am safe, that if they come to me I’m not going to judge them because they’re kinky or a sex worker, and the only way to do that is to talk openly about these things. Social media is wonderful for reaching hard-to-reach clients. People have been hurt by therapists who didn’t understand them or made assumptions about what they needed or what they were. So I do talk very openly about controversial things like trans rights or my views on conversion therapy. Clients who contact me can be confident that they won’t get a negative experience of therapy, because I am totally upfront about these matters. And I very much hope clients do see what I write and post about myself – we all have a personal brand, whether we like it or not. That is what social media has done. My personal brand is out there. The idea of neutrality is a myth. I probably go further into not being neutral than most others, and it’s OK if some people think I’m not the therapist for them – it’s just a shame when I think they might really benefit.’
Pollock also points out that every therapist comes to the work with a history. Pollock was publicly politically active as a queer person in their previous career; it isn’t hard for a potential client to find that out. ‘I couldn’t remove my identities and didn’t want to – the evidence base tells us it helps the client build a therapeutic relationship, and there were identities I couldn’t not disclose because of stuff about me that was already public knowledge,’ Pollock says.
But they are very careful to separate that public exposure from self-disclosure in the counselling room: ‘Research shows that the “we” self-disclosure is very important for minoritised people. To say “we” is a self-disclosure if the therapist says it in the counselling room, but it’s very broad, very gentle and doesn’t take up much space; it just helps the client feel more understood. The use of “I” takes up space. When you use “I”, you are turning the attention on yourself and you are revealing something about yourself; you are making yourself very vulnerable and you have to be sure the client can take whatever you give, and you are centring the therapy on them. It has to be done so cautiously – it’s their space.’
Another potential danger of self-disclosure of this kind with a client is that the counselling or therapy becomes a kind of echo chamber, Pollock says. ‘When I qualified, I enrolled on the Pink Therapy two-year diploma. If all you have is lived experience, you can do good sympathy and understanding, but that’s not therapy. Therapists have to be able to stand back and see the bigger picture, as well as focus in and talk about the minutiae of life. You really need to ensure that you aren’t just trauma-bonding. Most people need more structure to what they are doing. Supervision is vital for everyone, but if you are working at the edges where you are bringing more of your self, even if it’s only the gentle “we” disclosure, you have to have a supervisor who will challenge you on it – is that for you or in the interests of your client?
‘And you need a supervisor who understands the tension. I bear in mind what Dominic Davies at Pink Therapy says, that the huge risk for LGBT therapists working with LGBT clients is that the clients can become their community. That’s not OK. We can’t nourish ourselves with our clients as “our people” – you need to find another forum to do that in, outside your therapy work. It’s hard because we bring all of our self and heart to our work, but the client can’t be the way we express that.’
Aaron Balick has also explored the complexities around this issue. ‘If you come from any minoritised background, you may well be more comfortable having therapy with someone who shares that experience with you. I can understand why many clients make that choice. On the other hand, that doesn’t guarantee that the therapist is better able to understand you,’ he says. ‘In fact, a therapist can be so identified with their own experience that it can inhibit the clarity with which they can be fully present for the different experience of their client.’
A gay man, he chooses not to identify himself professionally as a ‘gay therapist’. ‘Gay is certainly a part of my personal identity, but only a part, and certainly not a foregrounded part of my professional identity. I think these days we are seeing a proliferation of identity categories, and the danger is that a single identity category can become the whole self-identification. When you think about the Jungian idea of individuation, the identification of a part of one’s self as the whole can be limiting. In recent decades there has been a broadening of how we understand the spectrum of experience – as there has been with diagnostic categories. While identity categories are important, most of them also have features of generalised human experience. The idea in critical psychiatry and post-modernism was not that we would have a thousand categories to identify wholly with, but that we would realise that we share various degrees of these categories with others.
‘For example, one may have an anxiety disorder but one doesn’t have to identify as one’s anxiety disorder – that can fix an identity in ways that make it difficult to move on, grow and change.’
Policing the profession
BACP has published several pieces of guidance on using social media, pointing members to the ethical principles that are relevant to social media presence and usage. Says Stephen Hitchcock, BACP Ethics Consultant: ‘The main areas of relevance in the Ethical Framework are primacy of the client, respect for colleagues, client confidentiality, therapist self-care and not bringing the profession into disrepute, and our guidelines on maintaining the boundary between personal and professional presence on social media. It’s about having an awareness of the consequences and being prepared for them. You need to have a plan to deal with your clients’ responses to your social media presence.’
BACP doesn’t currently collect data on professional conduct complaints relating to social media, although this may change following its current review of areas that are frequently reported and where more guidance may be needed. One area where respect for colleagues arguably gets thrown out of the window is in the sometimes very heated debates on social media about BACP’s policies and proposed initiatives, such as SCoPEd. Former Chair Andrew Reeves spoke powerfully and passionately at his final AGM about the personal abuse and attack he received from members on Twitter. For a case to be raised, someone has to make a formal complaint through BACP’s professional conduct process, and it may be that those who are subject to attack from their colleagues don’t want to go through that process. However, there could be an argument that it shows disrespect for colleagues and could bring the professional into disrepute if the critical comments are on a public forum, like Twitter.
Says Adam Pollard, BACP’s interim Chief Operations and Membership Officer: ‘We expect all our members to use their professional judgment and to apply the principles and values of the Ethical Framework when using social media. At the heart of this is a need to respect other people and their opinions. We’ve highlighted the importance of this to members through our social media guidance, community guidelines and Good Practice in Action resources. Our conduct process focuses on protecting the public and is centred around the therapist–client relationship. We assess complaints about members’ social media activities on this basis and, where appropriate, we’ll act to protect the public and the reputation of the profession.’
Balick sees these public displays of intra-professional disagreement and attack as typical of the polarity of opinion and intensity of expression that social media encourages. Social media is not an arena that encourages nuance, he says, and some of the professional disagreements are better worked through elsewhere. ‘I like the fact that therapists are out there, vocal and accessible as human beings, in the same way as others are. I also understand that social media offers a voice to those who might not otherwise have one. However, therapists occupy an important position with regard to how their profession is perceived by the public. They also have a duty of care to both their clients and the public at large. Ideally, I think it’s important that therapists model ways of relating that demonstrate mutual respect and avoid ad hominem attacks. Therapists should be cognisant of the fact that they occupy a public role that also represents the profession at large, and it’s important to be mindful of how we express ourselves publicly when doing so in a professional capacity.’
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