A qualitative investigation into the online counselling relationship: To meet or not to meet,that is the question

Background and aim: Online counselling, as a psychotherapeutic approach, provokes debate amongst practitioners and researchers concerning its efficacy and validity. This reflexive study extends existing research into the nature of the online counselling relationship when it is conducted asynchronously (by email) and explores the possibility this approach may facilitate both online and face‐to‐face therapeutic engagement. Method: Semi‐structured interviews were conducted electronically with ten former email counselling clients of a university counselling service and six counsellors delivering email counselling in other higher education settings, to explore, in depth, their experiences of the online therapeutic relationship and its impact on the counselling process and outcomes. These were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four areas of focus emerged relating to: (1) the importance of the structure and processes involved; (2) their impact on thinking and feeling; (3) their impact on self and relationships (within and outside counselling), and (4) changes that followed email counselling. Having ‘time to think’ within the asynchronous exchanges, the anonymity and disinhibition afforded by the online medium, the creation of transitional space and the rich use of metaphor, visualisation and imagery all contributed to a sense of empowerment and relational depth for individuals who might have otherwise avoided seeking help. This led to positive change in many cases and for some, facilitated subsequent face‐to‐face counselling. Implications: The findings support the provision of counselling and therapy online and particularly its integration within existing face‐to‐face services.     

Exploration of counsellors' perceptions of the redesigned service pathways: a qualitative study of a UK university student counselling service

To address the mental health needs of students, UK universities offer bespoke student counselling services. Economic pressures have led services to find innovative ways of redesigning their service pathway. Few studies have investigated staff perceptions of these changes. The aim of this study was to investigate perceptions of staff employed as counsellors at a student counselling service at a UK university that underwent service delivery changes. Face-to-face interviews were conducted with counsellors (n = 5). Framework analysis was used to identify themes and meta-themes. Five meta-themes were identified: the overarching service ethos and service working style; change in the university context; impact of change on working practice; recording and perceived impact on confidentiality; acceptability and effectiveness. Changes to the service resulted in a more efficient service that is perceived to be more acceptable to students. Staff perceptions differed regarding how changes have affected their counselling practice. Despite these differences, the increase in workload was consistently expressed. Tensions remain as staff strive to maintain high standards of service in this changing context. Future research should investigate the process of developing and implementing change as student counselling services strive to evolve sustainable ways of working.     

The impact of psychological distress and university counselling on academic outcomes: Analysis of a routine practice-based dataset

Whole university approaches to student mental health and well-being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE-OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE-OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

The effectiveness of UK student counselling services: an analysis using the CORE System

Despite concern surrounding the mental health of students, brought about by the government's policy of widening participation and increasing demands upon students, the effectiveness of student counselling has been a neglected research area. This study examines data from seven UK student counselling services using the CORE System in the routine evaluation of their services. Results indicate that counselling is effective, with 70% (service range 67% to 83%) of clients with outcome measures available showing reliable improvement on the CORE-OM from pre- to post-therapy. However, students who complete a course of counselling show significantly greater improvement, according to practitioner pre- and post-therapy severity ratings of depression and anxiety, than those clients who drop out or have an unplanned therapy ending (effect size 1.03, 0.85, respectively). The stage at which students drop out of therapy is important, with those students dropping out of therapy before the third session being the most vulnerable. The implications of these findings are discussed.     

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups – frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months post-intervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.     

A survey of student counselling in higher and further education in the United Kingdom

All higher and further education institutions who reported having a student counselling service were surveyed, using a postal questionnaire, during 1985. Information from 212 institutions is presented. It describes what services exist, how long they have existed, their staffing and their workload (in terms of numbers counselled and type of service offered). Comparisons between universities, polytechnics and colleges of higher and further education are made. The stated objectives of the counselling services are summarised, together with identified priorities in counselling functions. Some of the characteristics of counsellors are outlined, including hours worked, training and qualifications.     

Dropping-in: the unexamined encounter

The paper seeks to initiate some discussion and debate on the widespread practice within Further Education and Higher Education counselling services of offering brief initial meetings to students during a 'walk in' hour. As counselling services with limited resources struggle to meet the challenge of increasing numbers and increasing severity of disturbance among the student population, this paper puts forward the view that nevertheless, cutting down on a full assessment session may not be the best response. While the author is aware of the considerable thought and ingenuity applied to this area by HE and FE colleagues, and the wide variety of practice which is emerging, the purpose of this paper is to focus specifically on the practice of the 'drop-in'. This term refers to an initial meeting which runs from anything between 5 minutes and half an hour, does not require a prior appointment and is differentiated in this paper from other responses such as emergency slots, duty hours or full initial assessment interviews. A further paper, in collaboration with colleagues from a number of different institutions, will aim to research the impact of a range of pre-assessment interventions on clients, counsellors, the counselling service and the institution. In the light of the generally brief counselling offered within the HE and FE setting, the generally late adolescent client group and the growing concern about student mental health, some clinical and service issues are explored. The paper then discusses the impact of the drop-in at the level of the institution, arguing that it has a powerful symbolic function, albeit in fantasy, of offering staff a quick solution to difficult-to-manage anxiety and distress. Going further, the suggestion is made that the arrival of the drop-in can be seen as part of a much wider unconscious attack on thinking that is taking place within educational institutions generally, where a place for the kind of thought and reflection offered by psychological therapies is being relentlessly squeezed out. A much fuller debate on the largely unexamined practice of the drop-in is called for.     

Measuring, monitoring and managing the psychological well-being of first year university students

This paper profiles the psychological well-being of students in their initial year of university. There were three aims: to measure the impact of arrival at university on the psychological well-being of first year students, to monitor (i.e. profile) the shape of psychological well-being across the first year, and to investigate how students manage their well-being in relation to the use of university counselling services. Data were collected on four occasions, with 84% of all first year students at a UK university (4,699 students) completing the questionnaire on at least one occasion. Psychological well-being was assessed using the GP-CORE, a general population form of the CORE-OM. Results show that greater strain is placed on well-being once students start university compared to levels preceding entry. This strain rises and falls across the year but does not return to pre-university levels. Items tapping depression and anxiety suggest that the first year of university is a time of heightened anxiety but not a particularly depressive time. The findings are discussed in relation to students' experience of higher education and how to match student needs with university counselling service provision.     

A counselling service for nurses in training

An account is given of the inception and development of a counselling service for nurses in training at a large London teaching hospital. The aims of the service are described, as are the evolving role of the counsellor and the use made of the service both by student nurses and other members of the hospital organisation. Some recommendations are made concerning the future development of counselling services within National Health Service hospitals.     

Beyond resolution of presenting issues: Clients' experiences of an in‐house police counselling service

The availability of counselling services for employees has expanded significantly in recent years. However, despite an increase in appreciation of the value of counselling within the police service, there has been little research into the effectiveness of counselling with police personnel. The present study assesses an in‐house counselling service provided by the welfare and counselling department of a Scottish police force. Thirteen former clients (including both police officers and civilian support staff) were interviewed about their views on four areas of the counselling provision: how they entered counselling, the issues they brought, their experiences during counselling, and their assessment of the impact of counselling on their lives. Interviews were analysed using a grounded theory approach, which identified four main categories: initial engagement, learning by participating, experiencing moments of deep self‐examination, and moving beyond resolution of presenting problems. All of those who were interviewed appreciated the provision of a counselling service within their employment, and the majority reported that they had not only been helped to resolve their presenting problems, but had also made important gains in self‐awareness and work effectiveness. Findings are discussed in terms of implications for service delivery and future research.     

Online counselling: learning from writing therapy

Online counselling is new and still contentious, with little UK-based research available to practitioners, providers or potential clients. This article aims to extend an earlier review of some of the research into writing therapy \[Wright &; Chung (2001) Mastery or mystery? Therapeutic writing: a review of the literature, British Journal of Guidance and Counselling, 29(3), 277-291] and to indicate how it could be applied to online counselling. It also refers to some of the literature on online counselling, which, together with the writing therapy research, informed the decision to offer an online service to staff in a university setting.     

“Hello,can you hear me?”: Narratives of online mental health counselling among Filipino adults during the pandemic

Filipinos are often reluctant to seek professional mental health (MH) help. However, literature reveals that online counselling is preferable to face-to-face (F2F) MH services, with the pandemic possibly magnifying technology's anonymity and disinhibiting benefits. To further explore facilitators of online MH help-seeking, this study tapped into the lived stories of Filipino adults who experienced at least one counselling session from March 2020 to March 2022. Among 83 screened respondents, 11 semistructured interviews were transcribed and analysed following Crossley's (2000) method. Findings reveal an overarching online MH counselling narrative composed of three phases and their respective events: (a) Precounselling (Resiliency Narrative versus MH Awareness, Turning Point, and Linking versus Searching); (b) Counselling (Two-way Introduction, Unloading and Untangling, and Decision to Maintain or Terminate); and (c) Postcounselling (Relapse and Journey towards Growth and Advocacy). Three all-encompassing facilitators were embedded throughout the process: Autonomy, Financial Capability, and MH Institutions. Notably, participants attributed their MH help-seeking to autonomy, despite culture and stigma, because of enabling environments that entail heightened MH literacy, positive past experiences with professional MH help, social support and encouragement, and a sense of shared reality. Benefits unique to online counselling were also apparent among participants' narratives, including alleviating geographical boundaries and added financial and personal pressures. Overall, findings posit that Filipino adults consider online counselling as a preferable alternative to F2F counselling, thus necessitating further development and institutional support.     

Outcomes in clients transitioning from in-person counselling to telehealth counselling with trainees

The onset of the 2020 COVID-19 pandemic necessitated a rapid transition of mental health services from in-person to telehealth counselling. Despite the far-reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in-person services delivered (i.e. pre-pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra-pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self-reports would be generally equivalent across in-person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in-person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training.     

Psychosocial response to COVID‐19 pandemic in India: Helpline counsellors’ experiences and perspectives

The COVID‐19 pandemic presents a threat to physical and psychosocial health of individuals. In lieu of the subsequent lockdown and containment measures, helpline counselling becomes a viable method of accessing psychosocial services during the pandemic. The present paper describes experiences of counsellors working with a special COVID‐19 counselling helpline initiated by iCALL, a national‐level technology‐assisted counselling service of the Tata Institute of Social Sciences, India, which aims to address the psychosocial impact of the pandemic and the lockdown. The paper is based on two focus group interviews held with 11 counsellors during the initial two months of the helpline's functioning. Findings of the study highlight the diverse profile of the callers, with individuals belonging to different strata of society and to marginalised communities. The nature of concerns presented by the callers were often a mix of psychological, relational and practical issues. The resultant distress emanated from an interplay of these factors with the relational contexts, their social locations and social structures the individuals were embedded in. This highlighted the need for conceptualising and responding from a psychosocial lens, whereby interventions involved traditional counselling approaches and strategies for addressing determinants of distress by connecting callers to required ground‐level resources. Counsellors’ engagement with this process impacted their professional and personal selves, necessitating the need for structured and continuous training, supervision and support. At a larger level, the counsellors’ narratives asserted the need for adopting a psychosocial paradigm for conceptualising and addressing mental health concerns in India.     

Online counselling: a descriptive analysis of therapy services on the Internet

This study investigated the emerging practice of online counselling. Although the traditional practice of counselling involves face-to-face interaction between counsellor and client, a growing number of practitioners are providing counselling or therapy services via the Internet. In the present study, a total of 67 online counsellors completed a questionnaire exploring the backgrounds, services, fees, and communication technologies of practitioners offering online counselling to the public. Results suggest that online counselling is conducted by relatively experienced, primarily Western-based practitioners and is characterised by the use of email. Online clients are mainly female and receive relatively short-term interventions. Although the field appears to be evolving as its popularity increases, some ethical concerns raised by early research remain inadequately addressed.     

Using phenomenography to unearth factors influencing the delivery of guidance services

Which factors influence the delivery of school guidance services in Colleges of Education (CoEs) in Ghana? The guidance needs of students in the CoEs may not be fully met if the factors that influence guidance service delivery at that level of education are not explored for effective upgrade of service quality. This phenomenographic study therefore explored factors influencing the delivery of guidance services in CoEs in Ghana. We interviewed second-year teacher trainees (n = 24) and counsellors from three randomly selected CoEs in the Volta region of Ghana (n = 3). The findings indicate that material resources and awareness influenced guidance service delivery in the CoEs. It was also found that although students reported that confidentiality and attitude influenced service delivery in the colleges, the counsellors did not agree with this. Finally, the study discovered that human resource does not influence guidance service delivery in the colleges. It was recommended that college authorities should provide the material resources, such as offices, computers, and test batteries, that are needed for counselling, and counsellors should publicise the guidance programme to raise awareness and lead to the development of positive attitudes towards the programme. This study contributes to the guidance and counselling literature by illuminating the factors influencing guidance service delivery in CoEs. This should be of interest to practitioners, policymakers and researchers in school guidance and counselling.     

The Evaluation of Student Counselling: A Review of the Literature 1962-86

A critical review of studies examining the efficacy of student counselling is presented, together with suggestions for how the design of such research might be improved. Complementary investigations of client and employer attitudes towards and expectations of student counselling services are also described. The need to evaluate student counselling in the face of economic cutbacks is discussed.     

One-to-one support for crisis intervention using online synchronous instant messaging: evaluating working alliance and client satisfaction

Young people are increasingly turning to online support, especially when traditional mental health services are not immediately available. Using a cross-sectional design, sociodemographic information and self-reported perceptions of the strength of the working alliance and client satisfaction were collected from a sample of participants (n = 78) who were users of a service providing free online support using synchronous instant messaging. The results reported a significant positive relationship between the strength of the working alliance and client satisfaction, suggesting that the strength of the working alliance remains a key component in counselling, even online. Participants, however, scored significantly lower on both the strength of the working alliance and client satisfaction, compared to participants in offline settings as reported in past studies.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.