By Jay Lankau
Healthy breakfast recipes, falling off milk crates, beauty hacks, and 10 ways to know if your husband is cheating on you: TikTok has it all.
There are millions of videos on TikTok, and hundreds of thousands using the hashtag #mentalhealth. Some videos have more than 9 million views. And some are from licensed therapists advertising their services or trying to promote therapy for those who might have reservations about it.
But a lot of videos that explain diagnoses or mental health issues are from “content creators” who don’t have any licensing or professional experience. That’s what makes this part of TikTok controversial – especially since, according to 2022 Influencer Marketing Hub statistics, 32.5% of the app’s users are between the ages of 10 and 19. Of course, there’s no rule that only people with degrees can give mental health advice, and a great thought can come from anywhere. But with no system of review or verification, the app is a bit like the Wild West.
For Faith Arkel, the app is a bit of a mystery. She is a licensed professional counselor (LPC) and national certified counselor (NCC), as well as a master addiction counselor (MAC) and certified professional counselor supervisor (CPCS). With a master’s degree in community counseling from Georgia State University, Arkel has been in the field for over 30 years, supervising therapists working to get their state licenses and putting her expertise into practice both in the Cherokee County, GA, mental health system and her private practice. In short, she’s been trained to know what she’s talking about.
Arkel jokingly refers to herself as a bit of a “dinosaur” – she has a love-hate relationship with Facebook but doesn’t use any other social media. So, while she had heard of TikTok, she didn’t know much about it – until we presented her with five videos from the #mentalhealth side of the social network. Some posters were therapists, and some were not. Arkel had insights (and some choice words) on the matter.
Things Narcissists Say
This video comes from TikTok user @therapythoughtswithjb, one of many therapists using the platform to bring attention to mental health and trauma. In her video, JB goes through examples of what a relationship with a narcissist or someone with narcissistic traits might look like and what things they might say. She also briefly discusses the stages of that relationship, which she calls the “idealization stage,” the “devaluation stage,” and then the “discard stage.”
This video gets a good grade from Arkel. “I think she made some very good points and things to think about when people are in relationships with people who are narcissistic.” Unlike some videos, which were reductive, too dense, or outright wrong, this one had good information, specific examples, and a creator that sounds a bit more down-to-earth, rather than one who rapid-fires information.
Of course, it’s not an in-depth treatise, but on TikTok, that’s par for the course. “I think she was being broad-brushed, as certain people are when they want to label narcissists,” Arkel says. “Now, everybody who’s selfish, people want to label them a narcissist.”
Trauma Dump Therapist
This TikTok was deleted, but the user made a video with text in it that reads: “When a client wants to trauma dump first session.” The caption reads: “Not happening on my watch ever again.”
“Trauma dumping,” as explained by Psychology Today, refers to the act of intense oversharing, specifically of traumatic thoughts or events. People who are being “dumped” on are not a neutral, consenting party to this type of emotional oversharing, so it can make them uncomfortable.
Arkel was unimpressed. “If a therapist is reluctant to receive [traumatic information] and feels that it’s not OK to do that, then what are the signals that the therapist is giving around safety to this client who is needing someone to catch her or him?” she says. “We need to let them know we can handle this. ‘You’re not going to overwhelm me.’”
“Trauma dumping” usually applies to oversharing trauma with someone who is unaware or did not consent to hearing traumatic information and is rarely applied to situations in which someone asked for the information, or is getting paid to hear it as part of their job (as a therapist is).
When asked about how a therapist should approach a situation like this, Arkel says that if a client opens with a description of intensely traumatic events, that can be a helpful window into their style of interaction. “To lead with trauma tells me a lot about this person,” she says. “They have no sense of boundaries.”
Arkel explains that if someone goes into a first session – an anxiety-causing interaction at the best of times – and discusses trauma, normally something that is very difficult to talk about, then they might be testing the therapist to see how well the therapist handles it. The therapist should be handling this person delicately and compassionately, not shutting them down.
Why You Have an Anxious Attachment Style
In this TikTok, which has over 8,000 likes, user @therapyjeff discusses the reasons why someone might have an anxious attachment style. Overall, Arkel says this video is on the right track, but it’s tough to tackle a nuanced issue like this on TikTok, given that videos can only be up to 3 minutes long.
Arkel concedes that the advice in this video isn’t bad, but it may be answering the wrong question. It’s too focused, she says, on uncovering the mysterious reason behind a psychological problem instead of solving it. “This may be an accurate story, but there’s so much more complexity involved in working that through,” she says of therapyjeff’s video. “It feels like his focus is on uncovering the ‘why’ of the problem. It’s one of my pet peeves in terms of things therapists think they’re supposed to do. I call them archaeological digs.”
Many clients come to Arkel wanting to understand why something bad happened to them, or thinking that having a diagnosis might explain why they do the things they do. But that’s not always useful information to have. Say you have attachment issues. Would knowing why you have them really help you change your thought patterns? “Where I take that is, what is underneath that ‘why’?” Arkel says. “If we were to spend the time to figure it out, what would be different when we have that answer?”
Clients hope that they’ll be able to “move on” once they have that information, or that if they understand why they behave in undesirable ways, they won’t behave in those ways anymore. This isn’t what happens, Arkel says, as much as people might hope. Instead of trying to find the reason for every belief, it’s better to ask how valid those beliefs are.
Signs You Have Been Mentally Abused
A video’s success on TikTok depends on how long a person watches it and whether or not they interact with it, so attention and engagement at any cost is highly valued. In Arkel’s view, that’s only too obvious in this video, which explains the “signs you have been mentally abused.”
Arkel had an extremely dim view of this video. She felt that it could “set people down the wrong path.”
Being uncomfortable is not the same as being abused, and the person who causes us discomfort isn’t necessarily abusing us, but you wouldn’t know that from this video. One video with pessimistic messaging like this may not be a big deal, but if someone’s entire feed is made up of videos like this, their mood and self-image might be at risk, especially for the young people that make up much of TikTok’s user base.
“It is too easy to over-identify with being abused, now,” Arkel says. “We think that every uncomfortable or painful thing we experience means that we were traumatized. That’s not true.”
Humans are resilient when faced with suffering and struggle, Arkel explains. Over-identifying with being abused can trap someone into the idea that they are a victim and won’t be able to have a fulfilling life. TikToks like these certainly don’t help.
ADHD and Object Permanence
This TikTok comes from user @peterhyphen, who makes no claim to being an expert – just an advocate. He discusses a part of having attention deficit hyperactivity disorder (ADHD) that he says he wishes he had known about sooner: If something isn’t in his field of vision, he might forget it’s there. He explains that he copes with it by putting things in plain view. He says people with ADHD struggle with object permanence and his brain will forget that things and people exist.
TikTok has plenty of videos explaining the signs or symptoms of a disorder, usually from users that have that disorder. Sometimes these include relatable issues that even neurotypical people can see in themselves. But this user’s experience isn’t the most common one Arkel has seen in her practice.
“I don’t think forgetting is the big problem with ADHD. It’s attention,” she says. ADHD is often a problem with attention and attending to things, not whether or not a person can remember things. Arkel gives an analogy: People without ADHD who can attend to things may see that there’s a bird flying outside, but they know they’re taking notes or reading a book, so they don’t attend to the bird. For a person with ADHD or ADD who cannot prioritize the attention, the bird outside has as much priority as the book they’re supposed to be reading.
Arkel says: “ADHD is more about what’s happening in the brain and the process around not being able to filter out stimuli or prioritize stimuli as they’re being experienced.” In many cases, that leads to problems with attention, rather than problems with memory. So this user’s experience may be relatively rare.
Of course, the disagreement here may just be a matter of using different words to mean essentially the same thing. There might not be a vast difference between having your whole attention drawn to a bird outside the window and forgetting that there’s still a book on the table in front of you. And, of course, no two people’s experiences will be the same, even when they have the same disorder.
Identifying Mental Illness on TikTok
The controversy with TikTok’s algorithm still stands: The more someone watches a particular kind of video, the more the algorithm will recommend similar videos. If you watch a lot of cute cat videos, of course it’ll show you more of that, but it works in less kind ways as well. Should you linger on a video about unfaithful partners too long, you may start to see more videos like that, and before you know it, your feed is full of videos titled “15 Signs That Your Partner is Cheating on You.”
The algorithm can be damaging to people with anxieties who may find their fears worsened by the videos on their feeds. Similarly, TikTok content seems hung up on diagnoses and symptoms. It’s easy to see videos talking about relatable symptoms and thinking, “Hey, that’s me.”
“People come in, and the first thing they tell me is, ‘Oh, I’m bipolar,’” Arkel says. “I work on correcting it right away and try to work on separating them from over-identifying with what becomes limitations or excuses or their own self-inflicted victimization of it. We can become very over-identified, so I really resist diagnostic-speak.”
For therapists who wonder where their clients are getting their information about diagnoses and symptoms, TikTok may be something to ask about.