Online counselling and therapy

Exploring student mental health and intention to use online counseling in Hong Kong during the COVID-19 pandemic.

Participation in online support and counseling constitutes an essential but often overlooked second step in the Lodder–Zeleznikow (Harv Negot Law Rev 10:287–337, 2005, Enhanced dispute resolution through the use of information technology. Cambridge University Press, Cambridge, 2010) model of online dispute resolution; dialogue techniques. This paper highlights the potential role that online support and counseling can play in avoiding extreme family conflict and potential hazardous litigation. The research centers on a case study organization, Relationships Australia Victoria, who provide counseling and support services and who are moving toward online service delivery. It analyzes this case and contrasts it with relevant international cases to identify key considerations and approaches for those developing, enhancing and evaluating online support and counseling sites in the future. The goal of this research is to assist Relationships Australia Victoria to construct online support and counseling services for isolated men, who have lost day-to day contact with their children and have diminished social networks, so that they might enhance the quality of life of both their children and themselves. The lessons learned in this research are relevant for the wider use of online support and counseling services by separating parents.

This study aimed to understand how young people with first-episode psychosis experienced online therapy on a Moderated Online Social Therapy (MOST) platform known as Horyzons. Semi-structured in-depth qualitative interviews were conducted with 12 young people who had previously participated in Horyzons, a randomized controlled trial (RCT) of a long-term digital intervention for first-episode psychosis. Interviews were analysed using a phenomenological approach. This study found that the online therapy experience for first-episode psychosis was idiosyncratic, taking on different meaning for different users. The relatively fixed therapeutic content led to experiences that included on-demand help-seeking, positive distraction, revision, generalization and translation, and normalization. We also found that although the experience of online therapy was motivating to some, it was overwhelming for others. The self-directed and flexible nature of the Horyzons online therapy gave some young people a sense of welcomed control over their mental health journey, and others felt overwhelmed by the high level of choice. Feeling overwhelmed by the level of choice appeared to interrupt their engagement with the platform, and thus their overall ability to use the intervention meaningfully. We also found that on-demand help-seeking and positive distraction were two functions unique to young people through online therapy and may have been related to the significant reduction in the number of overall presentations by young people to emergency departments and a non-significant trend for lower hospitalizations due to psychosis in the intervention group of the Horyzons RCT. Young people used online therapy for on-demand support to help deal with distress. Young people used online therapy to distract themselves from distress in a positive way. Some young people valued the flexibility of online therapy, which increased their motivation to engage with it. Some young people were overwhelmed by the amount of choice available to them via online therapy, which decreased their motivation to engage.

BackgroundHospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability.ObjectiveThis qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration.MethodsWe conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems.ResultsAnalysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration.ConclusionsIntegrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation.

This study examined the prospects and challenges of online guidance and counselling services at the Obafemi Awolowo University, Ile-Ife, Nigeria. It considered students' views on the nature of and preferences for online services, and the problems that might potentially be presented in that context. It also surveyed staff in regard to assessing the human and material resources available for offering such services. Two hundred students were selected by random sampling at the eight cybercafes on the University campus. Also, one hundred staff members were purposively selected, consisting of technical experts, trained counsellors and other academic and non-academic staff members. Data were collected through separate questionnaires for students and staff on the ‘Prospects of Online Guidance and Counselling services at OAU’. Data were analyzed using descriptive analysis, Relative Significance Index, factor analysis and cluster analysis. The results showed that students identified potential online guidance and counselling needs as being mainly related to academic/educational interests; specifically, career planning, problem-solving skills and acquiring effective study skills. Sexual issues as well as dating and relationship issues came last on the list of the 12 potential online counselling needs identified. Most of the students (89.5%) had favourable perceptions towards the possible establishment of online guidance and counselling services in the University. Results from staff responses identified some significant limitations in terms of current human and material resources, with these needing to be rectified if the University was to offer online counselling and guidance services.

There is a concerning prevalence of self-harm in young people and most young people who self-harm do not seek help. Little is known about what facilitates help-seeking in this population but evidence suggests that many do go on-line to talk about their experience. One-to-one internet ‘chat’ sessions with an adult counsellor are an increasingly accessible and popular form of help but this type of support is under-researched and the evidence base for its effectiveness is weak. Help-seeking for mental health problems is not a linear process and young people have to navigate complex interpersonal and intrapersonal barriers in order to take up a help-seeking position. Qualitative research that pays close attention to the dynamic negotiation of the help-seeking process between on-line counsellors and young people who disclose self-harm can increase our understanding of these complex and highly sensitive interactions. The aim of this study is to investigate how counsellors respond to disclosures of self-harm by using critical discursive psychology to analyse archived transcripts of 19 separate counselling interactions from an on-line counselling service for young people aged 18 or younger. The Foucauldian concepts of governmentality and pastoral power are used to explore on-line counselling sessions as a potential site for the regulation of risky behaviours and for encouraging young people to find safer ways of managing themselves. The tools of interpretative repertoires, ideological dilemmas and subject positions are utilised to examine some of the ways in which competing discourses of mental health are negotiated at the local interactional level. I identify three key interpretative repertoires (“opening up,” “the divided self” and “keeping yourself safe”) and analyse the ways in which these repertoires create different subject positions for the counsellors and young people. The analysis demonstrates that the pastoral power of the on-line counsellor does not act uniformly on the self-harming subject and suggests that tensions and contradictions in counselling interactions may lead to some help-seeking interactions getting stuck. I conclude that the ways in which these repertoires are negotiated can produce or shut down important help-seeking opportunities. This thesis is the first study to look at on-line youth counselling through a Foucauldian lens and adds to our understanding of how pastoral power operates through on-line sites of governmentality. The findings have important consequences for on-line counselling practices and, more broadly, for our understanding of youth help-seeking for self-harm.

A 24-hour online youth emotional support: Opportunities and challenges

A substantial group of young people experience mental health problems, which impact their educational development and subsequent wellbeing. Of those who do suffer from mental health issues, a minority of these seek appropriate professional assistance. This paucity of help seeking behaviours among young people is a challenge for counsellors. Whereas adults who suffer mental health issues have increasingly turned to the internet for assistance, it is interesting that when young people, whose social lives are increasingly dependent on the communication technologies, are not catered to as much as adults by online counselling. One small online counselling pilot program conducted at a Queensland secondary school for three years (from 2005-2007) (Glasheen & Campbell, 2009) offered anonymous live-time counselling from the school counsellor (via a secure chat room) to students through the school’s website. Findings indicated that boys were more likely to use the service than girls. All participants transitioned to face-to-face counselling, and all reported it was beneficial. This pilot study attested to the potential of online counselling. However, school counselors, as a professional group, have been hesitant to utilise online counselling as part of their service delivery to young people in schools. This chapter concludes by identifying reasons for this reluctance and possible initiatives to increase online support for young people in schools.

The rise in popularity and use of computer-mediated modes of communication such as email and synchronous chat have resulted in the potential for new delivery methods of mental health services. The present study investigated the dynamics of an initial counseling session held in a synchronous chat environment between therapists-in-training at various graduate programs across the country and a trained confederate posing as a client. Transcripts from the online sessions were analyzed to investigate therapist responses and interventions in the online environment. Therapists-in-training were also asked to respond to questions concerning their satisfaction with the experience, the relationship they were able to form with the client, and previous online experience. Participants gave an assessment of the client and responded to statements about online counseling. Results demonstrate that the therapists-intraining expressed more positive views about online counseling after they had conducted the session in terms of the potential for a therapeutic alliance and desire for future training; however, participants expressed more negative views about the amount of work that could be accomplished during online counseling sessions. Therapists-in-training were also able to accurately diagnose their client's presenting concerns at the conclusion of the session. The implications for the future directions of online counseling research and practice are

The central thesis of this chapter has three main components. Initially, the authors propose that online counselling can be of benefit to Kenyan children and young people in providing access to psychological help and support. Furthermore, specific technological support can be developed to provide opportunities for Kenyan children and young people to derive the same benefits as those in countries in which youth online counselling has already become established. Secondly, the authors outline how online counselling has the potential to address four of the eight United Nations (UN) Millennium Development Goals (MDGs). Finally, the chapter reflects on how technology to support online counselling for use with Kenyan children and young people needs to develop so that it can be utilized to meet its full potential. In particular, appropriate technological advances need to occur to enable those in remote areas to benefit, thus providing the infrastructure for online counselling to become a realistic means of supporting Kenyan children and young people.

Online therapy has increasingly been utilised during the COVID-19 pandemic by many, including working populations. However, few qualitative studies have explored how online therapy is experienced in practice and discussed its implications for those working clients. Semi-structured interviews attended by nine integrative psychotherapists practising in California, the United States, were conducted. Thematic analysis of the transcripts identified three themes: (i) ‘Positive experiences of online therapy’, (ii) ‘Challenges experienced by therapists and clients in online therapy’, and (iii) ‘Preparation and training for online therapy’. Online therapy was assessed as being helpful, particularly in terms of mitigating against previous geographical and temporal barriers to uptake. However, due to technological disruptions and potential blurring of professional boundaries, online therapy may detract from the emotional salience of therapy, negatively impacting the therapeutic relationship and containment. Considering these positive experiences, participants expected that the demand for online therapy would continue to increase. Particularly in the occupational context, online therapy can offer interventions without fostering shame regarding mental health. The findings provide preliminary qualitative evidence that online therapy can be a useful adjunct to traditional forms of face-to-face therapy. However, therapists require more explicit training in implementing online therapy. Results are discussed in particular regarding the utility of this therapy for working clients.

Chapter Ten - Counseling Groups Online: Theory and Framework

"Staying power:" Determining what keeps online counselors devoted to their jobs.

Exploring hope and expectations in the youth mental health online counselling environment

With the COVID-19 pandemic, people have become inclined to seek online counseling help in addition to face-to-face counseling. For individuals who need mental health services, social-physical isolation and quarantine decisions have rendered online counseling a necessity rather than an option. In this process, individuals needing mental health services may avoid seeking help due to their self-concealment tendencies or inadequate self-perceived social support. The present research explores whether online and face-to-face counseling are predicted by self-concealment level, multidimensional perceived social support, age, gender, and previous experience with face-to-face/online counseling. The study group comprises 508 adults aged 18 or above living in Turkey. The data were collected with the help of "Online and Face-to-Face Counseling Attitudes Scale", “Self-Concealment Scale”, “Multidimensional Scale of Perceived Social Support”, and a “Personal Information Form”. Data analysis was based on Pearson’s Product-Moment Correlation Coefficient and Multiple Regression Analysis. The results demonstrate that attitudes toward online counseling are predicted by self-concealment, perceived social support, age, and previous experience of online counseling. The findings also show that attitudes toward face-to-face counseling are predicted by self-concealment, perceived social support, gender, and previous experience with online and face-to-face counseling. With the COVID-19 pandemic, people have become inclined to seek online counseling help in addition to face-to-face counseling. For individuals who need mental health services, social-physical isolation and quarantine decisions have rendered online counseling a necessity rather than an option. In this process, individuals needing mental health services may avoid seeking help due to their self-concealment tendencies or inadequate self-perceived social support. The present research explores whether online and face-to-face counseling are predicted by self-concealment level, multidimensional perceived social support, age, gender, and previous experience with face-to-face/online counseling. The study group comprises 508 adults aged 18 or above living in Turkey. The data were collected with the help of "Online and Face-to-Face Counseling Attitudes Scale", “Self-Concealment Scale”, “Multidimensional Scale of Perceived Social Support”, and a “Personal Information Form”. Data analysis was based on Pearson’s Product-Moment Correlation Coefficient and Multiple Regression Analysis. The results demonstrate that attitudes toward online counseling are predicted by self-concealment, perceived social support, age, and previous experience of online counseling. The findings also show that attitudes toward face-to-face counseling are predicted by self-concealment, perceived social support, gender, and previous experience with online and face-to-face counseling.