Lisa A. Olivera's Instagram account is a reservoir of recommendations. But she is no influencer, at least not the kind who peddles products. She is a licensed marriage and family therapist with a practice in Berkeley, Calif., and one of dozens of such counselors using social media to reach people who may not be able to afford mental health services.
Despite appeals from the so-called therapy generation, a lot of mental health care remains prohibitively expensive and moderately stigmatized in the United States. Of the nearly one in five adults in this country who experience mental illness, just over 42% received mental health services in 2017.
Mental health professionals are seeking to address this issue, in part by doling out advice online.
Instagram therapists are the new Instagram poets, in a way — only instead of posting free verse in typewriter font, they deal in pithy pronouncements about embracing imperfection, self-care, "growth mind-set," mothering oneself, impostor syndrome and trauma. The digital words of accounts such as @thefatsextherapist, @nedratawwab and @the.holistic.psychologist are meant to encapsulate the "aha" moment of a therapy session.
The best part for a lot of people? There's no bill afterward.
Olivera started her account, @lisaoliveratherapy, in November 2017 while transitioning to private-practice work from community mental health. She thought Instagram could be a good way for new clients to find her. In the past two years, she has gained 161,000 followers.
"I started it on a whim, not sure what it would look like or where it would go," she said. "There weren't many therapists on Instagram at that time. It was inspiring to see how many people were wanting to learn more about emotional health and look internally and do the work inside themselves, even if they weren't able to access therapy."
Allyson Dinneen is a marriage and family therapist in Great Barrington, Mass. Online, she is @notesfromyourtherapist, posting advice for 130,000 followers. Like Olivera, Dinneen opened her account in late 2017. She wanted a way to have an effect on more than one person at a time.
"The internet is filled with directives: 'Do this, do that, stop doing this, do that.' That's hard for people to take in," she said. "I'm coming from my own experience, and people feel more open to taking in what they need."
Both therapists said that these accounts should not be used in place of therapy but that they can help people heal themselves.
"While Instagram isn't therapy, much of the work we talk about and teach in therapy has to happen outside of the session to be meaningful," Olivera said. "One therapy session per week is a very small portion of our overall time — the rest of the time is up to us."
David Marques, a web and design consultant, saw a therapist every other week for a year, then began booking appointments on an as-needed basis. He said Olivera's Instagram posts helped him through moments that were tough, but not tough enough to merit a face-to-face consultation.
"Things Lisa Olivera would post about are things I know my therapist would be recommending to me," he said. "If I find myself stressed, take time to breathe. If I find myself getting overwhelmed with kids and family, create some boundaries."
Both therapists spend about 10 to 15 hours per week creating content, responding to comments and reading messages on their accounts. Both say it's important for them to "hold boundaries" around the amount of time they spend on Instagram.
Lynn Bufka, associate executive director for practice, research and policy at the American Psychological Association, is working on the organization's first formal social media guidelines. She said therapists in online spaces need to be particularly careful about soliciting patients and advertising products and make sure they're not treating someone outside the state where they're licensed.
"It's understood that somebody who is being treated for a mental health condition is feeling more mentally vulnerable," Bufka said. "You want to be particularly careful in the kinds of communication you have, so they're not inadvertently taking advantage of or misleading people."
Neither Olivera nor Dinneen gives followers individual advice because the platform is not confidential. If followers message them asking for specific advice, they reply with a resource such as a book or website dedicated to that particular issue.
"It's really important work, even though it's Instagram," Marques said. "It's reaching people where they're at: on social media."