What’s Killing the Psychotherapy Profession, and Why You Should Be Worried

image therapy Linda Esposito, LCSW TalkTherapyBizThe truth is I didn’t want to write this. I intended to post a more upbeat, universally relevant topic like “The Beginner’s Guide to Overcoming Anxiety + 5 Tips to Get Calm…but I’m angry.

Not the fired up, balls-to-the-wall type that gets you going after someone’s wronged you. You know — when they tell you you can’t, and you set out to prove them wrong?

Not that one.

And not the “I’m so pissed I could drive down the street, windows open, Imagine Dragons blaring, and scream ‘Arrrghhhh!’  to random people.”

Oh, you’ve never done that?

Well, if you did –negative on that ballast, too.

This anger stems from what could be. When you look at someone going down the wrong path and shake your head because you know there’s an easier way. The problem is this person refuses to listen.

Or these people.

Namely, the majority of individuals in your professional network.

Which brings me to the point of this article–therapists who don’t do social media, and how this negatively impacts psychotherapy clients and society.


Facebook and The Therapy Room:


I found out he was seeing someone else from a status update one of our mutual friend’s shared. I felt sick to my stomach that he’s moved on. And it’s so…public. ~Client composite

Facebook has made its way into the therapy room. And if you’re unfamiliar with the platform, you’re missing the biggest, boldest social network impacting our culture since television. About the only demographic not using Facebook is children 9 and under. To call Facebook huge is an understatement.

According to Gary Vaynerchuk, author of Jab, Jab, Jab, Right Hook:

~Facebook had 1 billion+ monthly users as of December 2012
~ One out of every five internet page views in the U.S. is on Facebook

Cyber culture is here to stay. Maybe you’ve had a client discuss a break-up similar to the one above. You’re dealing with two issues: The pain of the breakup in real life, as well as her rejection being aired publicly.

“Facebook Depression” was cited by Pediatrics as a very real threat to the emotional well-being of many youth who spend time on Facebook and other social media platforms.

Sure you can read about social media, but you’ll have a richer frame of reference if you experience it organically.

Facebook and Business

So I was about to go to the meeting when I saw what my buddy posted on Instagram…I was furious! Oh, wait–you probably don’t know about Instagram, huh? ~Client composite

Perhaps a client has referenced a social media platform you’re unfamiliar with?

I know. It’s hard to keep up.

And though you may not see the immediate benefits of joining social networks, the exposure to relevant, up-to-date knowledge about psychology and mental health could help move your clients off the couch quicker.

I often share therapy exercises, downloadable stress management posters, and free relaxation Mp3 files on my Facebook business page. More than a few clinicians have messaged me to say thank you. And it feels great to pay it forward. Imagine if we all shared our best therapeutic go-tos…

Besides a free platform to market your services, it’s a great tool to pass along solid information about your niche. And if clients can’t find YOU and your uniqueness, they will go elsewhere and maybe not get the best intervention.

Caveat: Facebook recently made drastic changes to its algorithms and it’s difficult to get traffic to your page without paying for ads. But it’s still a helpful tool to check out newsworthy sites such as CNN, HuffPost, and NPR.

Case in point: A Cyberbully expert and fellow @HuffPost Contributor recently shared that teens receive an average of 30 texts per day from their ex. Whoa. So if I’m counseling a teen or young adult client and the subject of ex’s comes up, you bet I’m going to inquire about post break-up communication and texting. And if I’m working with a family, this statistic will be shared and discussed.

I believe we have an ethical imperative to keep abreast of the latest trends in cyber culture.

Another case in point: I recently attended a community forum about adolescent brain development. While the mental health presenters shared solid information, they fell short when the Q & A inevitably lead to teens and social media. Since it wasn’t my gig, I only briefly mentioned the concept of “edited reality.” Many questions went unanswered as the meeting adjourned. So I did what any self-respecting, social media-savvy therapist and family advocate would do, and I took it to @HuffPost and wrote 7 Practical Tips for Parenting Digital Natives.

And just last night I participated in a tweet chat #InnoPsy (Innovative Psychology) with other therapists. When the topic of social media came up, @TherapyOnline, @Susan Giurleo and @DrBeckerShutte tweeted about the lack of mental health professionals online.

Where’s Your Mobile Device?

You could make a valid argument against the necessity of being on social media in order to do good therapy. I’ll give you that. Our profession is made up of different credentials, training, and expertise, and there’s myriad client issues which aren’t centered around the use of technology and social media.

But this is not your mama’s therapy room…

Which leads me to why I’m really angry…

I learned about the daunting statistic of 46+ million adults in the U.S. prescribed Xanax yearly while…wait for it — scanning my iPhone in the grocery checkout.

This cultural trend bothers me more than you know. Mostly because anxious adults raise anxious children. I’ll save that rant for another post, however.

Regarding Xanax Nation — about the only reason I can come up with as to why the masses would rather pop a pill than make lifestyle and other changes is that people are too often psychologically lazy and don’t like to think.

Change takes time and grunt work.

And maybe therein lies the issue around the reluctance of mental health professionals to get with the social media program.

But since when did not thinking about a problem and not doing something positive ever get us on the other side of anxiety?

When did it ever teach us that to connect with humans –  whether on the couch, on Twitter, or in real life — that we don’t have to inhabit their world?

Our clients live online. Maybe you do, too. Chances are if you’re not reading this on your mobile, it’s within arms reach, am I right? There’s nearly 325 million mobile subscriptions in the U.S. alone. It’s probable that almost half of us network on social media. We shop, check out consumer reviews, and make dinner reservations.

And search for therapists to help with relationship issues, school problems, and sleep deprivation.

In summary, the therapy profession must find a way to navigate the digital divide. We need to understand how and why to use social media to better connect with our clients’ issues and the unique boundary challenges that social media presents. And we should all have a vested interest in the bigger mental health picture.

But in order to de-stigmatize mental illness we must become more brand and tech-savvy.

The scale and reach of social media is staggering. And the possibilities to effect change on local, national, and global levels are endless. So if you’re a therapist and you’re not on social media, you’re like yesterday’s news: Boring, outdated, and only slightly relevant.


What about you?

Should therapists be on social media?

Leave your brilliance in the comment box below.

And please share this post on social media to help therapists get out of the dark ages!

Yours in mental wellness,



About Linda Esposito

Hi there! I'm an Anxiety Saboteur and the creator of the soon-to-be retired TalkTherapyBiz.com. If you want to join me on Wired for Happy click this link to subscribe for details.

20 Responses to "What’s Killing the Psychotherapy Profession, and Why You Should Be Worried"

  1. JennifERNo Gravatar says:

    I’ve never really thought about the importance of understanding the unique boundaries of social media for therapists, interesting angle! To me, it’s more a matter of keeping up-to-date with (mass) cultural phenomenons and the latest psychological research than of personally knowing the ins and outs of every social media network, but I can definitely see your point.

    • Linda EspositoNo Gravatar says:

      Thanks Jennifer! It can definitely be overwhelming, but I focus on relevant psychology news + mental health updates to stay on track.

  2. BirthTouch.com (@KathyAMorelli)No Gravatar says:

    Yes absolutely! I love socme altho I get a mild form of Facebook depression sometimes and need to get off of it! Love you, Kathy

    • Linda EspositoNo Gravatar says:

      Love you Kathy! I know we’ve spoken about your FB depression — I think we’ve all been there. Honestly, the “edited reality” and the pull of comparing our lives to others is hard to resist. At least we have a frame of reference when our clients bring this up in session.

  3. Susan giurleoNo Gravatar says:

    Linda, great piece and thanks for mentioning #InnoPsy chat.
    You know I’m a big proponent of therapists understanding social media.
    In 2014, I believe that we should be assessing all clients social media use as part of intake.
    More research needs to be done on the pros and cons of social media and social tech use.
    I agree that therapists will be rendered irrelevant and of no use to clients struggling with MH issues if they cannot and will not address social media. How can a client trust someone who doesn’t have a basic understanding of how she socializes most of every day?
    When I speak these opinions to colleagues I often get withering looks and dismissive comments.
    Yet, they will ask me how to get new clients and why clients don;t stick around after a few sessions. The profession needs to come to terms with our relevancy to the public at large.
    Our hope with #InnoPsy is to give the public a place online to learn about psychology and mental health in an accessible way. Hopefully colleagues will join in and learn about one way to use social media effectively and ethically in the process.
    Thanks for continuing the conversation on your blog. We need to advocate for the public who needs us to be present in their communities online as well as in the community.

  4. Linda EspositoNo Gravatar says:

    Wow Susan– what you said.

    Your message about the connection b/w therapists and social media is much more sold than mine.

    So glad I’ve always followed you. You’re such a pioneer!

  5. Dr. Jessica MichaelsonNo Gravatar says:

    Hallelujah! I think it’s part of being ‘culturally competent’ to meet the client where s/he is. We troll social media looking for someone to ‘like’ us, ie, looking to feel better. It’s nice if a therapist shows up in our feed and gives us some authentic help for our pain. Thanks Linda for a great post!

  6. Linda EspositoNo Gravatar says:

    Ooh, I like that “cultural competence” reference. So true. And I personally have been the recipient of a pick-me-up message, tip, video, or image when feeling down. Sometimes that bit of inspiration can make all the difference in your day.

    Thanks Dr.J!

  7. Elizabeth D. Thomas, MS, LAMFT (@MarriageKids)No Gravatar says:

    One confusing point for therapists (I’m presupposing) is the very big differences between:

    a) Getting an account for personal use to be “culturally competent” as a secret therapist not public one

    b) Getting an account AS a real therapist but not engaging clients on social media (for myriad reasons) but rather focusing on our field, finding our colleagues (I have I think 800+ listed on my Twitter lists so there are many of us) and reaching out to allies in our niche areas. Or, be a cool kid like me and Tweet the founder/creator of Minecraft and *GET A PERSONAL REPLY*

    Simply having an account and one way tweeting (which seems to be the problem for 80% or more of therapists) is hardly being culturally relevant or using Twitter in a productive way. Same with Facebook pages that mostly go uninteracted, often have stigma words in them that prevent clients from wanting to publicly announce they may be seeing that person for therapy and following them.

    All of this is to say the way, I believe, therapists should be on social media either not purposefully engaging the public directly per se, but, for example, finding key allies and that takes you to thousands of real people when they run large websites, radio stations, etc, or by having a psychoed client face of zippy, well marketed self-help options with the “yes, I’m also a therapist” voice. The “serious” therapy stuff isn’t really going to cut it in social media *IF*, in my opinion, there is not a lot of fun, engaging material around the occasional, say, super depression fact about suicide, or bullying, or whatnot.

    Social media is about *social* and fun, and learning. Therapists seem to get on their high horse, get too serious, too preachy, and forget that we can’t lift this field into the bold new world we’re in if we only talk to our officemates.

    I personally believe a lot of therapists are open to the challenge. They just need a lot of baby steps, warm, loving care, and the ability to ask questions, express concerns and dip their toe in slowly. They also need a *LOT* of real life stories of therapists who are doing well, loving it, getting clients, etc. I don’t believe anyone has accumulated those stories so for now, I don’t blame people for believing it’s a confusing, time sucking waste of energy over, say, networking with super local referring professionals who can consistently send you ideal clients.

    Those are my 18 cents worth of thoughts ;-)

    Your fan,

  8. Linda EspositoNo Gravatar says:

    Are you and Susan related, Elizabeth? Love your insightful comments. And I didn’t mention the lack of updated profiles on Twitter and FB, as I didn’t want the article to be too long. But yeah–too much one-way communication and an overall lack of engagement.

    Therapists on their high-horses — such an unsavory phenomenon. And we do need to tell more stories and show our human side.

    Re: last paragraph. I see the dilemma re: lack of ROI when you could be marketing locally and generating income. So I guess it comes down to the scale of your reach. Personally I love local and global, but some may not feel comfortable with that reach. Still think it’s a shame that so many are not using social to benefit the greater good.

    And thank you for your appreciated wisdom–always a pleasure!

  9. Ann Becker-Schutte (@DrBeckerSchutte)No Gravatar says:


    If everyone who participates in the #InnoPsy chat leaves to write articles like this one, I’ll be so thrilled! Actually, I’ll be thrilled if the chat allows engaged, competent, passionate professionals like the folks responding to this post to share the best possible mental health information with the general public.

    While I was originally a reluctant participant in social media, I have long since converted. One reason was the need to be culturally competent that several other responders noted–that was what pushed me in. I’ve stayed active and engaged because I found great communities of colleagues and clients/patients (I work in health, so the term ePatient is an important identity label) that teach me new things every day.

    As for the ROI issue–here’s my two cents. One of our ethical guidelines is an expectation of beneficence–to contribute to the greater good. I can only have so many session hours done pro bono and pay my bills (or save for college funds). But, I can write a blog post that might benefit many people for years to come. It’s free to them, and a small investment of my time. I can share a post by a colleague or patient advocate that inspires or teaches someone else. I can participate in health-focused tweetchats and provide education and support to an entire community–or make sure that issues such as survivor’s guilt, fatigue, relationship challenge, and anger are addressed with a competent professional on the response team. None of that pays a bill for me. *All* of it allows me to feel as though I am being an ethical, engaged member of the profession and the larger community. That’s my ROI.

    I’d love to see all the folks responding to the article drop by an #InnoPsy chat. Clearly, these are some of the voices we need. :)

    Thanks for a thought-provoking read.


    • Linda EspositoNo Gravatar says:

      I really appreciate your definition of ROI, Ann. And though we all have different obligations and financial responsibilities, I think the meaning of our work should be factored in to the equation.

      I never thought about the timelessness of blog posts before. Hopefully we’ll look back in the not-so-distant future and realize this topic is no longer relevant….

      Thank you for sharing your wisdom. Here’s to #InnoPsy on Twitter :)

  10. Uriah guilfordNo Gravatar says:

    I feel like it is a big part of my job description as a teen therapist to stay fluent and up to date with all things related to youth culture. Fortunately, I also enjoy these things. I read Ender’s Game, played Minecraft & Call of Duty, listened to Black Veil Brides and participate in all sorts of social media in order to be a better therapist. The resistance of therapists to engage with technology and culture will only limit their impact and ability to attune with their clients, while making it more challenging for clients to feel fully understood.

    Thank you Linda for highlighting this important issue.

  11. Linda EspositoNo Gravatar says:

    You’re such a cool guy Uriah! I remember we chatted about your use of tech in the therapy room. Such an innovative tool to attune and connect w clients.

    Btw– one of my lovely FB page readers shared this youth who struggled with depression and substance use. Showing this on my iPhone or iPad is a much more judicious use of 5-minutes than if I speak on it. Teens connect with other teens and we need to inhabit their culture (and I’m sure it was really hard to motivate yourself to be a kid again while playing Minecraft :) )


  12. jo CaseyNo Gravatar says:

    This is such a rich and smart discussion! Social media is a massive part of life and the way that people communicate. I had a coaching client earlier this week experiencing trust issues because her new partner wouldn’t be her ‘friend’ on Facebook. It was obviously a big deal for her – but if I as her coach didn’t understand facebook and the the amount of social interaction, friendships, community, affairs, etc. that go on via that medium it would have been hard for me to understand why she was having this issue and therefore even harder for me to help her to work through it.
    Ditto with teens – it’s a massive part of their culture and to dismiss it as ‘not real’ or ‘escapist’ is to patronize and belittle something that’s very important to them – and thus risk widening the generational communication divide.
    I like Jessica’s point that it’s about being culturally competent and enables deeper empathy because we also need to be inhabiting and understanding the world of our clients, partners, friends, kids and peers.

    • Linda EspositoNo Gravatar says:

      And thank you for adding to the richness of the social media discussion, Jo. Always a pleasure to have a non-therapist’s POV :)

  13. Kelly HigdonNo Gravatar says:

    Well, you probably already know what I am going to say but… I AGREE!!! Social media is about relationships and it is a part of our lives and our clients lives. Stick your head and the sand and you will not be able to connect or understand your clients. How many times has a client mentioned that they were “talking” to someone and I clarified if it was texting, snap chat, messaging on facebook, and so on. This stuff matters.
    And from the business aspect of things, it is a major player in my success. I have no shame about that. I maintain my integrity and ethics, but I don’t hide in my office hoping someone will find me. I give people opportunities to get help from me.

    • Linda EspositoNo Gravatar says:

      Such an important distinction to clarify, Kelly. Does “talking” mean face-to-face, or via digital device? Hadn’t thought of that…

      Congrats on your success, and you shouldn’t have any shame in your social media + marketing + branding game! And yes–we can’t expect clients are going to find us if we’re not findable.

      Thank you for sharing your insights.

  14. Keith DorschtNo Gravatar says:

    Thanks for the great article! Great way to leverage your ‘anger’! I am utilizing Facebook and Google+ Hangouts on air to host live Q & A sessions. A great way to reach an unlimited number of people. I will be inviting other experts into the hangouts to share their expertise and resources. I can offer it for free because Google takes care of everything. It is very exciting to ‘get in’ on this movement of offering online help through social media.
    It allows me to help more people in one hour than could ever be helped in my office one on one. I can build my list (which is everything as far as marketing is concerned) and engage with people who have already shown interest in my brand, services and resources.
    http://www.TheCommunicationCure.com (FREE samples with sign-up

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