Scrolling for sanity, performing for the algorithm: Theratainment and the governance of care on TikTok

Drawing on 42 semi-structured interviews with US-based clinicians, this study examines how licensed mental health professionals navigate TikTok’s governing infrastructures while attempting to educate and care for audiences within an algorithmically curated attention economy. It identifies three interlocking pressures: (a) engagement-optimisation systems that reward affectively charged, trend-aligned posts, making clinically nuanced communication difficult to sustain; (b) the emergence of ambient caregiving, an always-on, low-intensity form of audience support that generates emotional labour without institutional scaffolding; and (c) opaque, automated moderation practices that disproportionately suppress content addressing trauma, structural inequality and marginalised identities. Conceptually, the article develops theratainment to describe the fusion of therapeutic language with entertainment aesthetics and entrepreneurial self-branding that clinicians must negotiate under platform logics and elaborates ambient caregiving as a domain-specific extension of affective labour in short-form video. The findings reframe clinicians not only as educators but also as subjects of platform governance who continually balance visibility, credibility and ethical responsibility within engagement-first infrastructures. The article concludes with policy and design implications, including verification, trauma-informed and anti-bias moderation practices, and potential public-platform partnerships to support evidence-based care. This article forms part of the European Journal of Cultural Studies Special Issue on Digital Mental Health.