Anyone working as a psychological therapist over the past decade will be familiar with the steady stream of people citing trending concepts from social media. It's nothing new, and for the most part, it's positive they're recognising a problem in some form and reaching out for help.
Ten years ago, common worries were autism, bipolar, and borderline personality disorder. Sometimes, further assessment was warranted. In most cases, things could be easily unpicked with sensible information sharing and asking the person to describe things in real-life terms. But that's steadily changed over recent years.
Increasingly, I'm seeing people for assessments describing themselves as “traumatised narcissists”. Folk facing very normal emotional swells at the end of a relationship, now self-diagnosing themselves with “rejection-sensitive dysphoria”.
Again, it can usually be discussed sensibly. That is, unless it’s come from the counsellor they've previously been seeing. That adds weight to blurred knowledge and it's becoming increasingly tough to work with.
In the past twelve months alone, I've seen people assessed in primary care therapy services being told they have complex PTSD, based solely on the disclosure of childhood ACEs. Someone seeing a private therapist for repeated cycles of “ADHD burnout", later found to be bipolar following psychiatric admission. Little to no mental health assessment in diagnostic reports. The list goes on.
So what's changed?
Well it certainly isn’t DSM-5 or ICD-11; they remain intact, but the range of categories and criteria is being abandoned and skewed. Ultimately, it's the client who risks wading through sludge here.
And yes, I'm the first to admit the current diagnostic systems rarely map neatly onto human experience. But I do respect the fact they remain the most consistent guidelines we’ve got. They preserve some degree of shared understanding across clinical disciplines, however imperfect they may be.
But I'm increasingly worried about where things seem to be heading.
Just in the past couple of weeks, I've seen umpteen infographics telling me how to identify my own attachment style from outdated box categories. No mention of the complexity of an adult attachment interview for a trained clinician, let alone Joan, a bookkeeper from Bridlington.
But Joan will be fine. Now she’s realised she’s insecurely attached and clearly traumatised as a child, she can implement the validating affirmations cheatsheet and set about divorcing her emotionally unavailable husband. He’s a classic narcissist according to the LinkedIn carousel.
Apart from driving me up the wall and dragging the rest of us back to the 1980s, I'm left wondering if professional practice has finally well and truly tethered itself to the bolted horse that’s been doing circuits of the wild west.
Yet, we don’t train clinicians to use these types of concepts in this way. So, why do they end up in dodgy content marketing?
We've had a professional tendency in the past to lay the blame for conceptual stretch and misinformation firmly at the door of pseudo-therapists and the new wave of "coaches."
Take Dave, for example. Dave left his eighteen-year career in events management to start a "manifesting" podcast. He’s done well, now a certified manifesting coach, earning $19,000 a month from his bedroom. Granted, he's making unfounded claims about neuroscience, but his followers don't really care about that. It's easier to push common-sense aside when you have a chance to solve all your life problems by signing up for his $647 video-based course.
All you need to do is believe — isn't that right, Dave!
But we rarely stop to ask ourselves where the pseudo-therapists are actually getting their ideas from.
In fact, I'm not currently as worried about the Daves of the world as I am about bona fide therapists. As much as the influencer-types might speak with authority, they usually don't have the credentials to back it up.
As professionals, our qualifications give us credibility, not necessarily authority. But it can add weight to the twaddle if we're sharing it ourselves.
And I understand there can be pressure, especially if you work in private practice. Some therapists don't want to rely on insurance companies or accept session fee caps. They may need other ways to stand out and market themselves. There's nothing wrong with that, and many do it well.
Ultra-basic and robust can also work. I once saw a post gaining over 1,000 likes depicting the acronym SOAP for writing clinical notes. Who would have thought the dusty vaults of NHS e-learning could be so popular with the public?
But there's a lot of noise on social media, full of endlessly repetitive posts. It’s enough to send a glass eye to sleep. Makes sense that the attention-grabbing, influencer-style headlines gain much more traction. Naturally, there's then a temptation to jump on trending bandwagons, trading clarity for reach.
But at the rate we're going, we'll need diagnostic codes for compulsive infographic sharing, chronic carousel fatigue, and acute GPT-related burnout.
And in the unlikely event that DSM-6 decides to include those, I'll willingly eat my old SOAP notes.