Since first training as a counsellor over a decade ago, I’ve always thought that, in terms of support, it’s important to try to meet people where they are, and, where possible, in a way that works for them. Much of my work has been trying to make that a reality, and I’ve counselled people in a variety of locations, such as in their own homes with Cruse Bereavement Care, at the end of a telephone with Samaritans and, since September 2015, with pupils in a group of schools, face to face (f2f), but also via email, Instant Messenger and video.
In an endeavour to improve the existing school-based counselling service, the staff carried out a pupil survey back in 2012, asking questions about access, stigma and any ideas for improvement. The results suggested a demand for an option of online counselling support, alongside the f2f provision. I must admit that, at the time, I was really unsure about working in this way, believing that working therapeutically online could not possibly begin to compete with f2f therapy. I had a smartphone, regularly used email, Facebook and all the most common apps and didn’t consider myself a ‘techno dinosaur’, but I also couldn’t see how therapy could possibly work online, without all the face-to-face cues and relationship in ‘real’ time that traditional therapy prioritised.
I asked around among my professional networks, and this produced similar responses to my own – there was definite interest, yet much scepticism, and even fear, of what seemed to be unknown territory. At that point, I became more aware that leading national mental and emotional health organisations (Childline, Relate, YoungMinds etc) were offering help in this way, and I wondered how this development seemed to have passed me by professionally. I had been so busy delivering counselling in the way that I’d been trained to, that I had not been aware of changes that seemed to be very fast developing in the profession, or had already occurred. More worryingly, I had no idea how I could begin to even think of how I might bring this into a school-based service.
So I took a little more time to dig deeper into what was going on in terms of the development of online therapy practice in the UK, the ethics of online practice, online trainings such as those at the Online Therapy Institute and read up on some academic research – and all this really challenged and changed my initial expectations and doubt, and I began to get excited about the potential to increase access for pupils in a way that might offer them more flexibility and control and, more importantly, counselling on their terms.
I was acutely aware that some young people find the idea of stepping across the threshold and coming into a counselling room in their school environment too embarrassing or stigmatising, and so I could therefore clearly see the potential for this way of counselling in school. Clients could be counselled online if they lacked confidence to work f2f, and could then progress to f2f counselling if they wished – this would offer a clear advantage over the national organisations offering online support from therapists, because young people would probably never be able to meet their online therapist f2f if and when they wanted to. One of the larger doubts that held me back, however, concerned the effectiveness of working in this medium. But I found a rapidly growing evidence base for this,1–3 and also for the other aspects of working online that I believe are central to successful therapy, such as the working alliance4,5 and client attitudes.6
A final obstacle was trying to find a way to give clients the same high level of confidentiality in the online therapy room that they would get if they came into the school offline therapy room. From my research, the answer lay in finding a platform that was encrypted to a high standard, that operated software in line with best-practice guidelines in this area,7 that offered a variety of online options (email, Instant Messenger, video and audio), and was both simple to access on a number of devices and easy to navigate for both young people and those of us not so digitally native.
I wondered, too, if other practitioners might be interested in developing their practice in this way, and what they might need specifically in terms of training, information and research, so I took this ‘exploration’ into some research of my own. The results turned into a study that won the BACP New Researcher 2015 Award8 and gave me a clearer idea of what my professional school-based peers might want to know about this potential development. It turned out that they wanted to see what a working model of online counselling in a school looked like, understand which pupils might use it and why, and, finally, they wanted to see evidence of its effectiveness. Alongside this, since the initial suggestion had come from pupils themselves, I also wanted to investigate experiences of using online counselling from their perspective.
And so – the school experiment
From September 2015, pupils in Years 10–13 in my group of schools in Hertfordshire have been offered the option of accessing counselling online only, f2f only, or a blend of both. The good news is that clients are now accessing the same high-quality, school-based counsellors via a number of different channels, and the majority of those who use the online service opt to blend it with f2f work – mostly due to the convenience and flexibility that it offers.
However – and this is perhaps additional good news for my peers who may have worried that online counselling would somehow replace f2f counselling – I offer here a summary of the current results of two years’ worth of data and research (which have yet to be published):
- Some 76 per cent of pupils who access school counselling still prefer f2f contact only. Many of them reported f2f counselling as a better enabler of emotions that would ‘work’ quicker than the typing of text used for counselling via Instant Messenger (the preferred option for those who worked online).
- At least 50 per cent of pupils were concerned about security online (we have obviously taught them well to be wary of who they are talking to online), even though it was regularly explained that the platform was encrypted to the highest levels and counselling was with the school-based counsellors they already saw regularly around school and not some unknown, untrustworthy set-up.
- Online counselling was often seen as a ‘step’ up, or a build up, to f2f counselling for those who initially experienced a barrier to walking into the school counselling room: ‘Face to face was just a step too far, and being able to go online was the bridge that I needed to step across to get the support that I needed.’ (Female, Y13)
- Pupils stated they wanted more choice and flexibility to fit around their increasingly busy school lives – as mentioned, of those who sought the online option, most blended f2f with online working.
- The flexibility of online counselling can work for counsellors and schools too – saving on valuable room space, increasing access hours during term time and with the ability to offer some provision during school holidays or absences that are unexpected, as this example from one school counsellor suggests: ‘I’ve come to realise that, as a psychodynamically trained counsellor, the medium of technology actually could provide the same strength of boundary as f2f counselling, and I experienced this sooner than I expected. I sustained a back injury and was unable to meet a client f2f, but we were able to meet online at the same time and place as usual, thus keeping important boundaries strong in difficult circumstances.’
One concern that my peers had expressed in the first part of this research was about the additional workload that online counselling might bring. However, the schoolbased online counselling service can be as controlled as any f2f provision is. That is: only operate within specified hours, have confidentiality limits clearly specified and contracted, and have an agreed protocol for any safeguarding concerns. Waiting lists could operate in both online or f2f services, with the practitioner prioritising and managing their workloads as required. The online service continues to be used by pupils in 2018, and from September was also extended to staff, as they, too, sometimes find it difficult to access in-house f2f services. And having their own experience of working therapeutically online has helped them to have more informed conversations with pupils about the variety of ways to access our school counselling in a timely manner.
I’m glad that I challenged my own resistance to working in this way, in order to meet more young people in schools in a way that worked for them. From the current results, it seems that online counselling did not ‘kill’ f2f school-based counselling, just as video didn’t kill radio – though I believe radio not only survives but also thrives because it listened to its listeners and adapted well to the changing environment. The time may have come when we counsellors need to do so too, as this closing thought from a pupil involved in this research suggests: ‘I think it just made it so much easier for me to be able to speak online first and then step up to f2f. It’s a really good thing to offer and to give that flexibility to students. If schools can offer it, why wouldn’t they?’ (Male, Y12)
Jeanette Hennigan is director of pupil wellbeing at Berkhamsted Schools Group in Hertfordshire and about to graduate from the DPsych (Professional Studies) programme at Metanoia Institute and Middlesex University. She is an accredited BACP therapist and an accredited BABCP CBT therapist, a coaching psychologist and also co-tutor of the Certified Cyber Therapist with Young People course at The Online Therapy Institute.
References
1 Barak A, Hen L, Boniel-Nissim M, Shapira N. A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services 2008; 26(2–4): 110–160.
2 Dowling M, Rickwood D. Online counseling and therapy for mental health problems: a systematic review of individual synchronous interventions using chat. Journal of Technology in Human Services 2013, 31(1): 1–21.
3 Goss S, Hooley T. Online practice in guidance and counselling. British Journal of Guidance and Counselling 2015; 43(1): 1–8.
4 King R, Bambling M, Reid W, Thomas I. Telephone and online counselling for young people: a naturalistic comparison of session outcome, session impact and therapeutic alliance. Counselling and Psychotherapy Research 2006; 6(3): 175–181.
5 Lewis J, Coursol D, Herting W. Researching the cybercounseling process: a study of the client and counselor experience. In: Bloom JW, Walz GR (eds). Cybercounseling & cyberlearning: an encore. Greensboro, NC: CAPS Press; 2004 (pp307–325).
6 Robinson P, Serfaty M. Getting better byte-by-byte: a pilot randomized control trial of email therapy for bulimia nervosa and binge eating disorder. European Eating Disorders Review 2008; 16: 84–93.
7 Anthony K, Goss S. Guidelines for online counselling and psychotherapy (3rd edition). Lutterworth: BACP; 2009.
8 Hennigan J, Goss SP. UK secondary school therapists’ online communication with their clients and future intentions. Counselling and Psychotherapy Research 2016; 16(3): 149–160.