'It really is quite a different ballgame'. A qualitative study into the work experiences of remote support professionals

BACKGROUND

Professional support for people with intellectual disabilities is increasingly provided remotely. This study explores what support staff of the Dutch remote support service DigiContact experience as distinctive aspects of their job as a remote support professional.

METHOD

Semi-structured interviews were held with 10 DigiContact support workers. The transcripts were analysed through a qualitative content analysis process.

RESULTS

Six themes were identified that reflect distinct aspects of the participants' work within the DigiContact remote support context: being encouraged to adopt a solution-oriented coaching support style; being limited in one's support options; facing considerable diversity; providing support as one team; dealing with unpredictability; and navigating the dynamic within work shifts.

CONCLUSIONS

The way support is organised and delivered can have substantial implications for support professionals. Working at a service like DigiContact seems to call for specific skills, knowledge, affinities and experience, and for appropriate support and facilitation from organisations.

Couples Therapy Delivered Through Videoconferencing: Effects on Relationship Outcomes, Mental Health and the Therapeutic Alliance

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between 1 to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing.

Outcomes of Career Information System Utilization Among First-Year High School Students

The aim of this study was to examine the effects of Career Information System (CIS) on ninth-grade student’s vocational skills self-efficacy, outcome expectations, work hope, and career decision-making difficulties. CIS is a computer-based career intervention designed to help users become more knowledgeable about themselves and occupational options with career planning support. At the midpoint of fall semester, intervention participants ( n = 194) were assessed before and after a CIS intervention administered during their health class, while ninth-grade students who were not in the health class ( n = 191) served as a nonrandomized control group. Relative to control participants, intervention participants had higher work hope and lower career decision-making difficulties associated with inconsistent information and lack of information. The effects of the intervention did not vary as a function of gender or socioeconomic status. Findings contribute to the scant literature assessing the effects of computer-based career interventions for high school students.

Research on the Characteristics and Usefulness of User Reviews of Online Mental Health Consultation Services: A Content Analysis

Online consultation based on Internet technology is gradually becoming the main way to seek health information and professional assistance. Online user reviews, such as content reviews and star ratings, are an important basis for reflecting users' views on the effectiveness of health services. Here, we used user reviews related to online psychological consultation services for content feature mining and usefulness analyses. We used a professional online psychological counseling service platform in China to collect user reviews that were liked by users as a data sample for a content analysis. An LDA topic model, dictionary-based sentiment analysis, and the NRC Word-Emotion Association Lexicon were used to extract the topic, sentiment, and context features of the content of 4254 useful reviews, and the influence of these features on the usefulness of the reviews was verified by a multiple linear regression analysis. Our results show that the content of online reviews by psychological counseling users presented a positive emotional attitude as a whole and expressed more views on the process, effects, and future expectations of counseling than on other topics. There was a significant correlation between the topic, sentiment, and context features of a user review and its usefulness: reviews giving high scores and containing topics such as "ease emotions" and "consulting expectations" received more user likes. However, the usefulness of a review was significantly reduced if it was in existence for too long. This research provides valuable suggestions for understanding the needs and emotional attitudes of users with mental health problems in terms of online psychological consultation; identifying the factors that affect the number of likes a review receives can help platform users write better consultation evaluations and thereby provide greater usefulness. In addition, the use of online reviews generated by users for content analysis effectively supplements the current research on online psychological counseling in terms of data and methods.

OMG, R U OK? Therapeutic Relationships between Caregivers and Youth at Risk on Social Media

The rising of social media has opened new opportunities for forming therapeutic relationships with youth at risk who have little faith in institutionalized interventions. The goal of this study is to examine whether and how youth care workers utilize social media communications for reaching out to detached adolescents and providing them emotional support. Qualitative in-depth interviews (N = 17) were conducted with counselors, social workers, and clinical psychologists who work with youth at risk. A thematic analysis of the interviews revealed three principal psychosocial usages of social media: (1) Reaching out and maintaining reciprocal and meaningful therapeutic relationships with youth at risk over time; (2) Identifying risks and emotional distress; and (3) "stepping in" and providing psychosocial assistance, when needed. These beneficial practices are made possible through the high accessibility and the sense of secured mediation that characterize social media communication and that complement the psychosocial needs of youth at risk. Alongside these advantages, the analysis yielded several significant challenges in social media therapeutic relationships, including privacy dilemmas and blurring of authority and boundaries. Given that social media communication is a relatively new phenomenon, the applied psychosocial practices are shaped through a process of trial and error, intuitive decisions, and peer learning. Although the main conclusion from this study supports the notion that the advantages of social media therapeutic relationships with youth at risk outweigh their problematic aspects, future research is recommended to establish clear guidelines for youth caregivers who wish to integrate the new media in their daily psychosocial work.

Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study

Videoconferencing is an emerging medium through which psychological therapy, including relationship interventions for couples, can be delivered. Understanding clients’ expectations and experiences of receiving therapy through this medium is important for optimizing future delivery. This study used a qualitative methodology to explore the expectations and experiences of couples throughout the process of the Couple CARE program, which was delivered through videoconferencing. Fifteen couples participated in semi-structured interviews during the first and last sessions of the intervention. The interviews were conducted using the iChat program, with the therapist conducting the first interview and an external interviewer conducting the second. Thematic analysis was used to identify themes from the interview transcripts. Five themes were identified from the pre-therapy interviews, reflecting couples’ initial impressions and expectations: new experience, comparison, practical aspects, connection and dynamics, and distance and space. Couples’ experiences were explored in the eight themes from the post-therapy interviews: technicalities, the idea of “distance,” satisfaction and comfort, confidentiality, comparisons, new experience, expectations change, and working alliance. Overall, the present study found that couples experienced a positive shift in expectations. Despite some initial concerns regarding the therapist’s ability to empathize over a screen and the potential for the technology to break down, many clients noted that videoconferencing allowed them to become fully immersed in the therapeutic process. In fact, many couples felt that videoconferencing created an element of ‘distance’ from the therapist that allowed them to feel a greater sense of control and comfort. Couples consistently described being able to effectively connect with the therapist, and that the video actually enhanced the therapeutic alliance, due to a greater perceived focus on therapy processes. Overall, despite some initial concerns, the majority of couples found the videoconferencing experience to be beneficial and positive.

What Do Patients Talk About? A Qualitative Analysis of Online Chat Sessions with Health Care Specialists During a "Virtual" Cardiac Rehabilitation Program

INTRODUCTION

Cardiac rehabilitation programs (CRPs) are effective at reducing cardiovascular disease (CVD) risk, yet attendance in these programs remains low due to geographic constraints. In a previously conducted randomized trial we demonstrated that a virtual CRP (vCRP) delivered over the Internet reduced risk for CVD. The current investigation has reviewed the online chat sessions between participants and healthcare providers (HCP) to describe the content of discussions during the vCRP intervention.

MATERIALS AND METHODS

Participants were recruited from two geographically isolated areas in British Columbia, Canada without in-person CRP or a cardiologist serving the area. The vCRP, among other elements, included scheduled one-on-one chat sessions with a dietician, exercise specialist, and nurse to mimic standard CRP consultations. The chat sessions were reviewed for content and themes. Multiple chat sessions between participants and a single care provider were also analyzed to describe how chat content progressed through multiple sessions.

RESULTS

A total of 38 participants participated in the vCRP intervention. From the 122 chat sessions between participants and HCP during the vCRP, the main themes identified were Managing Health and Lifestyle, Continuity of Care, and Getting Care from a Distance. Within each theme, sub-themes were also identified.

CONCLUSIONS

The vCRP chat sessions fulfilled the role of face-to-face consultations with HCP that are standard in hospital-based CRP and addressed patient concerns, facilitating remote patient-provider interaction and covering topics on exercise, diet, and positive behavior changes to limit risk factors for future heart problems.

Online Counseling

Mallen, Vogel, and colleagues explore the developing field of online counseling from the unique perspective of counseling psychology. They examine the body of available research and relevant clinical, ethical, legal, and practical issues and make recommendations for counseling psychologists who desire to participate in online counseling. This article provides a critique of their contributions, finds support for much of what they present, offers additional suggestions for counseling psychologists, and makes recommendations for counseling psychology to resolve challenges that at present, limit online counseling’s value, effectiveness, and impact. The author makes recommendations for practical research that studies the actual online-counseling process, establishing additional standards, more effectively disseminating information, enhancing training, expanding access through innovative programs, and increasing advocacy efforts.

Online Counseling

This reaction article extends the research and practice recommendations for online counseling from the Major Contribution to the November 2005 issue of The Counseling Psychologist by prioritizing research and practice in online psychoeducation, self-help, and mutual help. Research suggests that tens of millions of Americans use the Internet for psychoeducation, self-help, and support and that this number far exceeds those who would use the Internet for one-on-one counseling. The purpose of this reaction is to advocate and prioritize a research and practice agenda that will reach the tens of millions of Americans and millions more abroad who are already seeking online mental health information, self-help, and mutual help for mental health problems.

The Online-Counseling Debate

This article responds to some important issues that Mallen, Vogel, Rochlen, and Day raise in “Online Counseling: Reviewing the Literature From a Counseling Psychology Framework.” This reaction reviews the appropriateness of online counseling for underserved populations. The author provides suggestions for better serving historically undeserved populations via the Internet. In addition, she describes the ways in which the Internet is currently useful for psychoeducational purposes.

Online Counseling

The rejoinder responds to the four reactions by Jeffrey Barnett, Tai Chang, Delida Sanchez-Page, and Franz Caspar and Thomas Berger in the November 2005issue of The Counseling Psychologist. In doing so, the authors emphasize the important need for further clarity regarding the effectiveness of online mental and behavioral health services in delivering a wide range of psychoeducation, self-help, and mutual-help facilities as well as direct counseling. The authors also highlight many of the reactants’ important insights, including the comments on the appropriateness of online mental and behavioral health services for the underserved and whether online counseling should be used as a primary or secondary tool in counseling.

The Practical Aspects of Online Counseling

This article addresses the practical aspects of online counseling, including ethics, training, supervision, technology, and competency issues. The authors discuss online counseling’s strengths and limitations and present guidelines for what types of clients and counseling psychologists may be appropriate for online counseling. To illustrate the components and skills associated with online counseling, the authors present and discuss an example of a synchronous-chat online session.

Employee and family assistance video counseling program: a post launch retrospective comparison with in-person counseling outcomes

Background

Access to technologically mediated information and services under the umbrella of mental and physical health has become increasingly available to clients via Internet modalities, according to a recent study. In May 2010, video counseling was added to the counseling services offered through the Employee and Family Assistance Program at Shepell·fgi as a pilot project with a full operational launch in September 2011.

Objective

The objective of this study was to conduct a retrospective post launch examination of the video counseling service through an analysis of the reported clinical outcomes of video and in-person counseling modalities.

Methods

A chronological sample of 68 video counseling (VC) cases and 68 in-person (IP) cases were collected from a pool of client clinical files closed in 2012. To minimize the variables impacting the study and maintain as much clinical continuity as possible, the IP and the VC clients must have attended clinical sessions with any one of six counselors who provided both the VC and the IP services. The study compared the two counseling modalities along the following data points (see glossary of terms): (1) client demographic profiles (eg, age, gender, whether the sessions involved individuals or conjoint sessions with couples or families, etc), (2) presenting issue, (3) average session hours, (4) client rating of session helpfulness, (5) rates of goal completion, (6) client withdrawal rates, (7) no show and late cancellation rates, and (8) pre/post client self-assessment. Specific to VC, we examined client geographic location.

Results

Data analysis demonstrates that the VC and the IP showed a similar representation of presenting issues with nearly identical outcomes for client ratings of session helpfulness, rates of goal completion, pre/post client self-assessment, average session duration, and client geographic location. There were no statistically significant differences in the rates of withdrawal from counseling, no shows, and late cancellations between the VC and the IP counseling. The statistical analysis of the data was done on SPSS statistical software using 2-sample and pairwise comparison t tests at a 95% level of significance.

Conclusions

Based on the study, VC and IP show similar outcomes in terms of client rating of session and goal attainment.

Peer and professional parenting support on the Internet: a systematic review

The Internet offers many opportunities to provide parenting support. An overview of empirical studies in this domain is lacking, and little is known about the design of web based parenting resources and their evaluations, raising questions about its position in the context of parenting intervention programs. This article is a systematic review of empirical studies (n=75), published between 1998 and 2010, that describe resources of peer and professional online support for parents. These studies generally report positive outcomes of online parenting support. A number of recent experimental studies evaluated effects, including randomized controlled trials and quasi-experimental designs (totaling 1,615 parents and 740 children). A relatively large proportion of the studies in our sample reported a content analysis of e-mails and posts (totaling 15,059 coded messages). The results of this review show that the Internet offers a variety of opportunities for sharing peer support and consulting professionals. The field of study reflects an emphasis on online resources for parents of preschool children, concerning health topics and providing professional support. A range of technologies to facilitate online communication is applied in evaluated Web sites, although the combination of multiple components in one resource is not very common. The first generation of online resources has already changed parenting and parenting support for a large group of parents and professionals. Suggestions for future development and research are discussed.

Impact of exchanges and client-therapist alliance in online-text psychotherapy

The impact of exchanges and client-therapist alliance of online therapy text exchanges were compared to previously published results in face-to-face therapy, and the moderating effects of four participant factors found significant in previously published face-to-face studies were investigated using statistical mixed-effect modeling analytic techniques. Therapists (N=30) and clients (N=30) engaged in online therapy were recruited from private practitioner sites, e-clinics, online counseling centers, and mental-health-related discussion boards. In a naturalistic design, they each visited an online site weekly and completed the standard impact and alliance questionnaires for at least 6 weeks. Results indicated that the impact of exchanges and client-therapist alliance in text therapy was similar to, but in some respects more positive than, previous evaluations of face-to-face therapy. The significance of participant factors previously found to influence impact and alliance in face-to-face therapy (client symptom severity, social support, therapist theoretical orientation, and therapist experience) was not replicated, except that therapists with the more symptomatic clients rated their text exchanges as less smooth and comfortable. Although its small size and naturalistic design impose limitations on sensitivity and generalizability, this study provides some insights into treatment impact and the alliance in online therapy.

Access to, Use of, and Attitudes Toward Telecommunication Among Rural VR Clients

Telecommunication offers rural vocational rehabilitation (VR) clients a method of communicating with their VR counselor between face-to-face visits. Unfortunately, certain telecommunication methods may not be available to many rural VR clients or may pose barriers in the rehabilitation process. This article describes findings from an exploratory survey of 225 rural VR clients recruited from seven VR agencies across the United States. The mail-based survey explored client access to telecommunication, current telecommunication use during the VR process, and client attitudes about using telecommunication to receive VR services. Although 61% of respondents said they had personal access to a computer with Internet and 63% reported that email would be a “very” acceptable or “somewhat” acceptable method of communicating with their counselors, only 39% reported communicating via email with their counselors. Although a variety of factors play into the effectiveness of telecommunication as a VR service delivery mode, email communication might increase the frequency and productivity of VR client and counselor interactions.

The therapeutic relationship in e-therapy for mental health: a systematic review

Background

E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues.

Objective

Our objective in this study was to systematically review the therapeutic relationship in e-therapy.

Methods

We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form.

Results

From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome.

Conclusions

Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

Evaluation of the Dutch AIDS STI information helpline: differential outcomes of telephone versus online counseling

OBJECTIVE

Health information helplines have an important function in health education, prevention and counseling. Information and help services are increasingly provided online. This study focuses on the differences and similarities between online help services and telephone services.

METHODS

The telephone service of the Dutch AIDS STI helpline was compared to its e-mail equivalent. After consulting the helpline service, both callers and e-mailers (N(tot) = 455) were asked to participate in a survey that evaluated their background characteristics, contacting reasons, and satisfaction with the specific service and information received. The survey also included questions regarding the advice received from the helpline. A follow-up measure 4 weeks after the baseline survey evaluated to what extent clients acted upon the advice.

RESULTS

The study shows that both services are positively evaluated and are equally persuasive in their counseling. Differences between callers and e-mailers were found regarding background characteristics, content of the consultation, satisfaction, and the advice received.

CONCLUSION

It can be concluded that online health information services are an important addition to, but not a replacement for, the traditional telephone helplines.

PRACTICE IMPLICATIONS

In order to provide an optimal health service to a wide public, both online and telephone counseling should be offered.

Volunteer and user evaluation of the National Sexual Assault Online Hotline

PURPOSE

The National Sexual Assault Online Hotline (NSAOH) is a new model for delivery of rape and sexual assault crisis services through a secure, confidential chat-based online hotline. This paper presents a program evaluation drawn from volunteer counselor and user perceptions and experiences during the second year of operation of the NSAOH.

METHOD

Outcome data are presented from 731 session evaluations submitted by 94 volunteers and session evaluations from 4609 user sessions collected between June 1, 2008 and May 30, 2009. Evaluation includes ratings of usefulness, topics discussed, length of sessions, services provided, and session difficulties.

RESULTS

The results indicate that the model is viable and useful, and the majority of volunteers and users are satisfied. Volunteer knowledge and skills are strongly associated with satisfaction with the hotline. Nevertheless, one-fifth of volunteers rate their session as not useful and users rate 8.2% of volunteers low in knowledge and skills.

DISCUSSION

NSAOH is reaching many who have not previously sought services or did not resolve issues through other means. Findings suggest the importance of preparing volunteers in both crisis intervention and a wide variety of long-term issues related to sexual assault. Recommendations for program development, evaluation, and further research are presented.

PowerON: the use of instant message counseling and the Internet to facilitate HIV/STD education and prevention

OBJECTIVE

In recent years, Internet-based or online counseling has emerged as an effective way to assess psychological disorders and discuss destructive behaviors with individuals or groups of individuals. This study explores the application of online counseling to HIV/STD risk-taking behavior among men who have sex with men (MSM).

METHODS

PowerON, an organization that provides sexual health information to MSM exclusively online, used instant message technology to counsel MSM in real time through computer-mediated means. A sample of 279 transcripts of instant message exchanges between PowerON counselors and Gay.com users were recorded and qualitatively analyzed.

RESULTS

Approximately 43% of the instant message sessions discussed information about HIV/STD testing. Risk-taking behaviors were addressed in 39% of the sessions. Information about HIV/STDs and general counseling were given in 23% and 18% of the counseling sessions, respectively.

CONCLUSION

The data showed these instant message sessions to be a potentially feasible forum for HIV/STD counseling.

PRACTICE IMPLICATIONS

Information ordinarily disseminated at health clinics could be successfully distributed through the Internet to MSM.

Primary-care patients' expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study

OBJECTIVE

To explore expectations and experiences of online cognitive behavioural therapy (CBT) among primary-care patients with depression, focusing on how this mode of delivery impacts upon the therapeutic experience.

DESIGN

Qualitative study, using repeat semi-structured interviews with patients before and after therapy. The study was conducted in parallel with a randomized controlled trial examining the effectiveness and cost-effectiveness of online CBT for patients with depression.

PARTICIPANTS

Twenty-four patients with depression recruited from five general practices in southwest England, who were offered up to 10 sessions of CBT, delivered via the internet by a psychologist.

RESULTS

Most participants accessed the therapy from their home computer and found this to be a major advantage, in terms of convenience and fitting therapy into their daily routine, with any technical problems quickly resolved. Two key themes regarding expectations and experiences of online CBT were: developing a virtual relationship with a therapist, and the process of communicating thoughts and emotions via an online medium. Online CBT seems to be acceptable to, and experienced as helpful by, certain subgroups of patients with depression, particularly those who are familiar with computers, feel comfortable with writing their feelings down, enjoy the opportunities to review and reflect that written (or typed) communication offers are attracted to the 'anonymity' of an online therapeutic relationship and are open to the proactive requirements of CBT itself. However, on-line CBT may feed into the vulnerability of depressed people to negative thoughts, given the absence of visual cues and the immediate response of face-to-face interaction.

CONCLUSIONS

Online CBT has the potential to enhance care for patients with depression who are open to engaging in 'talking' (or typing) therapies as part of their treatment. If online CBT is to be provided via the NHS, it is important to establish patient preferences regarding this mode of delivery and ensure that referral practices are appropriately targeted. The results of our main trial will provide evidence regarding the effectiveness and cost-effectiveness of receiving therapy via this modality.