When the Self Becomes Content, Therapy Has to Catch Up

CLINICAL PERSPECTIVES|DIGITAL AGE IDENTITY

When the Self Becomes Content, Therapy Has to Catch Up

By Lindsey Dwyer-Tong, LCSW

Founder, LT Clinical Consulting & Concierge Services|Beverly Hills, CA

In a recent interview with People Magazine, social media influencer Summer McKeen captured something clinicians are hearing with increasing frequency: traditional therapy does not address the psychological impact of living publicly. Her experience is not an outlier. It signals a broader shift. Mental health care has not fully caught up.

As therapists, we are no longer just treating anxiety, depression, or trauma in private life. Now, we treat distress shaped and intensified through the public eye. Social media has changed how we construct, evaluate, and maintain identity. The self is not just internal. It is also performed, curated, and measured in real time.

This distinction matters. Traditional therapy models were built on the premise that identity develops privately. They assume relationships are contained within clear boundaries. They also assume self-worth is not continuously quantified. Those assumptions no longer hold for a growing segment of the population. This is especially true for those who are highly visible, rely on digital platforms professionally, or organize their psychology around external validation.

The research reflects this shift. Studies have shown that social media use is not always harmful. But specific engagement patterns are linked to more anxiety, depression, and identity distress. Clinicians should pay close attention when clients describe frequent upward comparisons, constant online feedback-seeking, or a focus mainly on appearance. These patterns show that social media use may be adding psychological strain. Recognizing these signs can guide assessment and enable more focused intervention.

When identity faces constant feedback, psychological stakes rise. Criticism is not a single event; it is ongoing. Approval is not rare; it is unpredictable. This cycle drives compulsive checking, mood swings, and more sensitivity to input.

The most affected are high-functioning and outwardly successful. They may have strong careers, large followings, or considerable social capital. Yet internally, they report anxiety, fragmentation, and a fading sense of self when not observed.

In treatment, many clients share a concern: therapy feels misaligned. The issue is not depth or quality. It is that therapy relies on an identity concept that does not align with how these clients live and function. We should take this seriously.

This is not an argument against therapy. It is an argument for its evolution.

Adapting the Clinical Framework

Therapy must explicitly address public identity, not just private symptoms. Clinicians should analyze the feedback loops of digital environments and their role in patient distress. Beyond asking, “How often are you on social media?” clinicians should also ask: How do you use it? What is its function in your self-concept? What are the psychological effects when you engage, and when you abstain?

The answers to those questions are where the work begins.

Effective treatment should focus on two clear goals. First, help clients develop an identity that can withstand external feedback, and encourage reducing compulsive engagement with digital feedback systems. Second, work collaboratively with clients to create practical boundaries between their internal and performed selves. For those reliant on visibility for work, provide concrete strategies to balance public and private identity.

Clinicians should prioritize two key areas: symptom reduction and active support for clients to stabilize identity amid public scrutiny. Integrate this into treatment plans and sessions, ensuring strategies are targeted and actionable.

A Contextual Reality, Not a Personal Failing

This also requires acknowledging something uncomfortable. We ask individuals to maintain psychological coherence in environments designed to fragment attention, amplify comparison, and reward performance over authenticity.

That is not a personal failing. It is a contextual reality. The mental health field has adapted before. It changed practices for trauma, family, and new neurobiology. It can change again. But adaptation must be precise. We must recognize that distress has changed, and our frameworks need to change with it.

The question is no longer whether social media affects mental health. It is whether we are prepared to act—by adapting our therapeutic models, updating our practices, and equipping clinicians to meet the realities of digital-age identity. Now is the time for the field to lead this evolution.

About the Author

Lindsey Dwyer-Tong, LCSW, is the founder of LT Clinical Consulting & Concierge Services. She is a licensed clinical therapist and forensic consultant. She specializes in trauma, identity development, and the psychological effects of high-performance and high-visibility environments. She works with executives, attorneys, physicians, and public-facing professionals.

tongconcierge.com|(424) 404-TONG|Beverly Hills, CA

Sources

Summer McKeen interview on mental health and social media pressures. People Magazine. https://people.com/summer-mckeen-says-her-mental-health-spiraled-at-height-of-social-media-fame-exclusive-11946881

U.S. Department of Health and Human Services. (2023). Social Media and Youth Mental Health: The U.S. Surgeon General's Advisory. https://www.hhs.gov/surgeongeneral/reports-and-publications/youth-mental-health/social-media/index.html

Burnell, K., George, M. J., et al. (2024). Experimental Evidence on the Effects of Social Media Use on Mental Health. University of North Carolina. https://cdr.lib.unc.edu/concern/articles/d217r402s

Hjetland, G. J., et al. (2024). Social Media Use and Adolescent Mental Health: The Role of Self-Presentation and Social Comparison. BMC Public Health. https://link.springer.com/article/10.1186/s12889-024-20052-4

Yang, C.-C., et al. (2018). Social Comparison on Social Media and Adolescent Identity Distress. Journal of Adolescence.

Wang, et al. (2024). Short-Video App Use and Self-Concept Clarity in Adolescents.

Luo, M., et al. (2024). Authentic Self-Presentation and Mental Health in Emerging Adults. PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC12084248

Bray, A., et al. (2024). Mental Health of Social Media Influencers: A Systematic Review. Journal of Occupational Health. https://academic.oup.com/joh/article/66/1/uiae045/7733692

Harvard T.H. Chan School of Public Health. (2025). Content Creators and Mental Health Study Findings. https://hsph.harvard.edu/news/content-creators-are-struggling-with-mental-health-study-finds

American Psychological Association. (2023). Social Media and Body Image Concerns. https://www.apa.org/news/press/releases/2023/02/social-media-body-image

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