Online counselling: An initial examination of the process in a synchronous chat environment

Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study

BACKGROUND

Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality.

OBJECTIVE

Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context.

METHODS

We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke's reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention.

RESULTS

A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person's post and emojis to further conversations and build rapport.

CONCLUSIONS

The findings highlight the importance of the counselor's role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person's experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively.

Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

PURPOSE

This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19.

METHOD

Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence.

RESULTS

Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners.

DISCUSSION & CONCLUSION

The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists' Technological Perspective

BACKGROUND

The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised.

OBJECTIVE

This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists' therapeutic work through augmented VCP.

METHODS

In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model.

RESULTS

The analysis resulted in the generation of 9 themes (input themes: psychologists' attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship.

CONCLUSIONS

Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions.

"I Kind of Bounce off It": Translating Mental Health Principles into Real Life Through Story-Based Text Messages

Adopting new psychological strategies to improve mental wellness can be challenging since people are often unable to anticipate how new habits are applicable to their circumstances. Narrative-based interventions have the potential to alleviate this burden by illustrating psychological principles in an applied context. In this work, we explore how stories can be delivered via the ubiquitous and scalable medium of text messaging. Through formative work consisting of interviews and focus group discussions with 15 participants, we identified desirable elements of stories about mental health, including authenticity and relatability. We then deployed story-based text messages to 42 participants to explore challenges regarding both the stories' content (e.g., specific versus generalized) and format (e.g., story length). We observed that our stories helped participants reflect on and identify flaws in their thinking patterns. Our findings highlight design implications and opportunities for mental wellness interventions that utilize stories in text messaging services.

Lifeline Crisis Chat: Coding form development and findings on chatters' risk status and counselor behaviors

OBJECTIVE

This study aimed to develop a reliable tool for the abstraction of data from crisis chat transcripts; to describe chatters' suicide risk status and selected counselor behaviors; and to examine the relationship of chatters' self-reported pre-chat suicidal thoughts to counselor behaviors and to chatters' disclosures of suicide risk during the chat conversation.

METHODS

Coders used an instrument developed for this study to abstract data from 1034 crisis chats handled by the National Suicide Prevention Lifeline Crisis Chat network in 2015. The relationship of transcript coding data to data from an automated pre-chat survey (PCS) was examined.

RESULTS

Lifeline Crisis Chat serves a young (median age = 21), high-risk population: 84.0% of chats (869/1034) came from chatters endorsing current or recent suicidal thoughts on the PCS. Counselors engaged in rapport-building on 93.3%, problem-solving on 70.1%, and suicide risk assessment on 67.7% of these 869 chats. Counselor risk assessment behavior, and the availability of information on suicide risk in the chat transcript, varied significantly by the chatter's PCS response.

CONCLUSION

Crisis counselors are able to implement keystones of Lifeline's crisis intervention model over the medium of online chat. Additional efforts are needed to ensure that suicide risk is assessed on every chat.

Digitizing Social Counseling-Insights for Workplace Health Management

Working digitally can lead to changes in work organization and social interactions, as well as work pace and workload. Online counseling is more and more integrated in social counseling. Research exists on employees' and users' attitudes towards online counseling as well as on the advantages and disadvantages of online counseling. There is a lack of studies on the stressors and strains caused by the increasing digitalization and the associated health consequences in this context. With an interview study, we investigated the general work situation of counselors, with a focus on stressors, strain, and resources caused by online counseling. Consecutively, we discuss the results in relation to their impact on workplace health management. Twenty-two explorative interviews with counselors from a German welfare organization were conducted in 2019 and 2020. Qualitative content analysis according to Mayring was used for analysis. Counselors' use of online devices depends on their own digital affinity and is likely to be used when advantages for clients are seen. Difficulties were mentioned in establishing a relationship of trust with the clients. Good teamwork and regular informal exchanges among colleagues contribute to job satisfaction. Overall, we found only few health-related effects. Results of the study suggest that digitization can have positive effects on the job satisfaction of counselors, if the associated changes are supported by organizational measures.

Exploring Mental Health Professionals' Perspectives of Text-Based Online Counseling Effectiveness With Young People: Mixed Methods Pilot Study

BACKGROUND

Population-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups.

OBJECTIVE

This pilot study aimed to explore and confirm e-mental health professional's perspectives about various domains and themes related to young service users' (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities.

METHODS

Participants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness.

RESULTS

A total of 4 domains and various subthemes were confirmed and identified to be related to YSUs' characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors).

CONCLUSIONS

Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor's interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation.

Stimulating the problem-solving abilities of users in an online environment. A study of a Dutch online social casework intervention

Despite the growing interest of users in online services, social workers are still reluctant to offer their services in an online environment. Moreover, little is known about online working methods and their contribution to an effective online session. This paper reports on the findings of a Dutch case study of the online intervention "Clickforhelp". The first aim of this paper is to explore whether social workers believe that they are able to stimulate the problem-solving abilities of the users in an online working environment. The analysis pertaining to this question was based on the results of a qualitative online survey completed by 26 online social workers. The second aim is to examine how social workers implement the five essential components of a solution-focused approach in a chat and email environment. A qualitative content analysis of 50 online cases was carried out based on analytical questions derived from the problem-solving method. The findings illustrate that the social workers of "Clickforhelp" believe that they are able to stimulate the problem-solving abilities of users in an online environment, but prefer a face-to-face setting. They rarely implement all five components of a solution-focused approach. They predominantly stimulate the self-esteem and the power position of the user, while relatively little attention is given to the strengths of the user and the social support system. Neither do they translate the problem-solving process into concrete and achievable steps or evaluate the progress and the user's experience. It is necessary to further develop knowledge relating to online working skills and methods.

The Diagnostic Validity and Reliability of an Internet-Based Clinical Assessment Program for Mental Disorders

Background

Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders.

Objective

The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system.

Methods

Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion.

Results

With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS’ sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87).

Conclusions

The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders.

Trial Registration

Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).