Current ethical guidelines for therapists who make use of social media are very limited. As a consequence, they leave much open to interpretation by professionals, an openness that may place the public and professionals at risk. This is particularly of note as therapists are increasingly making use of social media and many professionals are taking on roles as mental health influencers, both purposefully and without realising. Such developments raise many important ethical issues including considerations around influencer competency, integrity, the maintenance of confidentiality and risk management. These issues are briefly discussed in this paper alongside related current research focusing upon them. It is concluded that, despite the existence of ethical guidelines focusing upon social media use by therapists, current research suggests that therapists are not consistently following these guidelines. Moreover, it is argued that researchers and professional bodies, and their associated good practice guidelines, need to keep abreast of new developments to account for changes in social media usage.

BackgroundDespite the rise in therapist use of social media, current ethical guidelines have not provided clear guidance on how to use social media. Ethical guidelines commonly suggest therapists apply the same ethical principles advised for their offline work, without thorough consideration of differing potential ethical dilemmas online.MethodsA systematic review was conducted to explore the main ethical dilemmas encountered by therapists who use social media. Three databases were searched: PsycINFO, Web of Science and CINAHL Plus. A total of 52 studies were screened by their titles and abstracts, with a subsequent 36 studies analysed against inclusion and exclusion criteria. The remaining 14 studies were assessed using quality standards and included within the thematic synthesis.FindingsData analysis conceptualised three themes: therapist searches risking the therapeutic relationship with subthemes of loss and trust and power imbalance; therapist defensiveness in response to client searches with subthemes of self‐disclosure and self‐protection; and societal normalisation of social media with subthemes of familiarity and ease and blurred boundaries.ConclusionThe societal prevalence of social media use suggests it is now inevitable that therapists will experience some form of ethical dilemma regarding social media. Therapists need an awareness of how online searches for clients may impact the therapeutic relationship. The risk of boundary crossings from clients online can be minimised through increased privacy settings and reflexivity on what therapists self‐disclose online. Ethical dilemmas on social media should be discussed in supervision, with further guidance needed for the ethical use of social media as a therapist.