When TikTok Therapy Is More Lucrative Than Seeing Patients

Dr. Julie Smith is sitting behind a rainbow of five Post-it notes, each meant to represent one of the “Top Five Signs of High-Functioning Depression.” Said signs will be familiar to anyone who has spent time scrolling through the part of social media devoted to improving one’s mental health: “You do everything the world asks of you, so no one would ever know you feel empty inside,” you don’t find pleasure in the same things anymore, social events are tiring. Perhaps you relate to No. 3: “You find yourself scrolling on social, watching hours of TV, and eating junk food to numb those feelings.”

The British psychologist and author is an inescapable presence on TherapyTok, where psychologists, psychiatrists, and licensed therapists — along with a swarm of “coaches” with varying levels of credibility — make short, digestible videos educating the public about how to decode their own brains. She’s amassed a following of 4.7 million not just by distilling mental health into 60-second spoken-word listicles but by using intensely colorful gimmicks to draw in viewers who might otherwise think they’re about to watch an object being crushed in a satisfying way. Before explaining “3 Ways Past Trauma Can Show Up in Your Present” or “5 Signs of a Highly Sensitive Person,” Dr. Julie will use a visual hook — she’ll pour out a bucket of candy, flip over a giant hourglass, or pose next to a tantalizingly tall stack of dominos (like any skilled content creator, she knows not to give us the final knockdown until at least halfway through) to keep you watching. Does it matter that “high-functioning depression” and “highly sensitive person” aren’t actual diagnoses? Maybe. Or maybe not.

That’s because these clips have less in common with actual mental-health treatment than they do with your average “get ready with me” video. At a time when people may be getting fatigued with therapy, it seems like some therapists don’t want to do it anymore, either. Hence the sheer number of them who are spending less time seeing clients and more time producing content in the hopes that millions of people will see it. While most full-time therapists whose rates are set by insurance companies max out at around $100,000 per year, therapists who are full- or part-time content creators can make much, much more. @TherapyJeff, real name Jeff Guenther, an individual and couples therapist in Portland, Oregon, says he can make eight or nine times that amount on social media in the form of brand deals, merch, and direct subscriptions. When I clarify whether he’s making nearly a million dollars, he says, “It’s been an especially good year.”

Though he still sees about eight to ten clients on Mondays and Tuesdays (a full-time therapist would see about 20 to 25 clients a week, he says), Guenther is best known for his straight-talking TikToks about dating and relationships where he’ll refer to his audience as “anxiously attached babes” or “relationship girlies” who are “still in their healing phase but horny AF.” With 2.8 million followers and a dating-advice book coming out this summer, he is perhaps the best example of how to become a therapist influencer by making people feel as though he’s on their side.

While most therapists whose rates are set by insurance companies max out at around $100,000 per year, therapists who are content creators can make much, much more.

Therapists have always been influencers, in a way — they may write books, do speaking gigs, or promote products — but in order to get famous on TikTok, they must play by its rules. What works on the app is simple, visually arresting videos that make you feel like they landed in your lap with a kind of cosmic destiny (the comments on these videos often repeat some version of “my For You page really said ‘FOR YOU.’”) Therapists do cute little dances next to cute little graphics about what it’s like to have both ADHD and PMDD; they’ll lip sync to trending songs in videos about how to spot a depressed client who might have made a suicide plan; they’ll hop onto memes as a way to criticize parents who haven’t gone to therapy.

The most successful TikTok counselors don’t typically advertise their one-on-one therapy services; instead, they’ll sell products that establish themselves as mental-health experts but have the potential to net influencer-size salaries. Many offer digital courses similar to those of other educational influencers; they’ll promote their books, merchandise, or in the case of Dr. Kojo Sarfo, his comedy tour, where he sometimes asks the audience about their mental health diagnoses. Tracy The Truth Doctor also offers special mental-health coaching to fellow influencers.

And then there’s the validating relationship they cultivate with viewers: Guenther has referred to people who call others “too sensitive” as “emotionless turds” and says he wishes he could write “psychologically lethal” texts on behalf of his clients (while acknowledging that this would be considered unprofessional). “I have been accused of being a toxic validator,” he admits. “Like, imagine that your ex-boyfriend is watching my content. Somebody might be coming across, like, a piece of my content that they can use in order to feel better about themselves, even when they should probably actually be doing some work and taking accountability.” But ultimately, who TikTok shows his videos to isn’t in his control.

Like many therapists on TikTok, Guenther is also extremely forthcoming about his own personal struggles in a way that previous generations of therapists might look down upon. He speaks about going no-contact with his mother, also a therapist, and his experience as the “scapegoat of the family.” (His tips for fellow scapegoats: Wear a T-shirt with the words “Official Family Scapegoat” on it; tell your mother she’s “constantly hijacked by shame” before asking her to pass the potatoes.) Elsewhere, the counselor KC Davis of “Struggle Care” recently confessed to a bout of hyperfixation with romantasy novels so intense it led her to forgo showering and basic care tasks; Therapy Jessa has filmed herself crying, while Courtney Tracy, better known as Courtney the Truth Doctor, makes intimate “get ready with me” videos and speaks about what it’s like to have borderline-personality disorder and autism as a therapist.

Despite his gangbusters year as a content creator, Guenther says his career as it stands now isn’t sustainable. Spending so much time on TikTok, he tells me, has affected his own mental health. “It’s exhausting. There’s burnout. It’s a gross place to be,” he says, pointing to the endless demands of the algorithm, hate comments, and the bizarre parasocial relationships that form among audiences who feel that because they watch his content they have direct access to him. “I want to get out of here because Daddy Algorithm is my boss and I get a performance review every single day based on an algorithm that’s mysterious and doesn’t make any sense.”

If the content is a little trite, and the therapists don’t enjoy making it, what good is any of it doing? You can make the case that by turning mental health into TikTok engagement bait, influencer-therapists are lowering the stigma of mental illness and encouraging people to seek treatment, or at least to provide a stopgap for those who can’t access direct care. But what it also seems to be is a stopgap for therapists who are burned out by the daily grind of seeing clients one-on-one with little opportunity for career growth, whose salaries are mostly outside their own control. And who can blame them? Even if viewers know watching therapy content isn’t the same thing as actually going to therapy, when a professional therapist comes up on your feed to tell you exactly what you most want to hear at a time when you’re most in need of hearing it — that you are good, that you will be okay, and also here’s a cute little visual hook — you’ll keep watching.