This thesis by published works contributes to knowledge of the processes and effectiveness of online individual synchronous chat counselling. Through a series of qualitative and quantitative studies it explores the implementation of eheadspace, a youth focussed online mental health service for young Australians aged 12 to 25 years. The goal of the research was to further investigate this relatively under-researched treatment modality to identify factors that may affect treatment outcomes and thereby improve online counselling for young Australians. The research used a sequential exploratory mixed methods design comprising five studies, including: a systematic review of the literature; a qualitative analysis of online clinician experiences; a cross-sectional study of online youth clients; a six-week pre- and post-test of client treatment outcomes; and a mixed qualitative/quantitative analysis of the relationship between counselling processes and treatment outcomes. Study 1 was a systematic review of the literature that aimed to identify previous studies regarding the effectiveness of online counselling. The main finding of the systematic review was that only six previous studies had examined the effectiveness of online chat, producing mixed, but generally positive, results of effectiveness. Study 2 was a qualitative exploration of 19 online clinicians’ experiences of providing mental health care online. The aim of the study was to develop hypotheses regarding processes and effectiveness by exploring the experiences of online clinicians. This study found that online clinicians described performing various roles and using a variety of skills online, but favoured person-centred techniques. Study 3 was a cross-sectional analysis of 1,033 online youth clients aged 16 to 25 years. The study aimed to identify the characteristics of young people who seek help from eheadspace. The main findings of the study were that online clients reported high levels of psychological distress, low levels of life satisfaction, and low levels of hope, but held high expectations of treatment outcome. Study 4 investigated six-week treatment outcomes for 152 clients, and aimed to examine the effectiveness of online counselling. After six weeks, psychological distress and life satisfaction were shown to be not significantly affected by the amount of online counselling received nor by having sought additional treatment. However, those who attended one or more online sessions reported significantly higher levels of hope six weeks later compared with those with no online counselling. The fifth study analysed and rated the progress and depth of counselling from a sample of 49 session transcripts. This study aimed to determine the psychotherapy activities and processes used in online counselling for young people and how these related to client outcomes. This study found that online clinicians generally did not progress through all the stages of counselling in any great depth, but did find an association between greater progress and depth and improved treatment outcomes. This thesis contributes significantly to our understanding of online counselling for young people. It is one of few comprehensive studies of an online service that explores online clinicians’ experiences, client characteristics, treatment processes, and treatment outcomes. The results extend knowledge of how to improve the provision of mental health care online. Based on the research findings a brief online chat counselling model is proposed. The implications of the findings for online clinicians and online service delivery, and future directions for research, are discussed.
|Date of Award||2015|
|Supervisor||Debra Rickwood (Supervisor), Peter Chamberlain (Supervisor) & Janie Busby Grant (Supervisor)|