This chapter covers the broad range of online counselling work, using the COVID-19 era as a point of reference. It provides an overview of online applications of counselling and psychotherapy at pre-COVID-19 time and informs the reader of how online counselling provision has been accelerated during the pandemic. A theoretical overview of the key counselling and therapeutic processes as conceptualised in the cyberspace which considers six distinct modes of online communication are provided. An evaluation and the review of the latest efficacy and effectiveness research evidence of online counselling is also provided. The key benefits and challenges of digitalised therapeutic interventions from the clients' and therapists' perspectives covering pre and during COVID-19 are identified. Attention is drawn to existing studies on counselling engagement, adherence, outreach, non-stigmatising counselling practices, power imbalances in the counselling process, and therapy outcomes.
TopIntroduction
We expect that this “black swan” moment (Blumenstyk, 2020) - an unforeseen event that changes everything - will lead to a partly, though robust, shift in mental health care provision towards online prevention, treatment, and care in the near future. We also need to consider the role of psychological processes and fear that may cause further harm on top of the pandemic (Asmundson and Taylor, 2020). Wind et al., 2020, p. 1
The COVID-19 pandemic has accelerated what may be described as the digital-turn in mental health counselling provision. In their recent article Wind et al. (2020) characterised the COVID-19 period as the ‘black swan’ of mental health provision as it has accelerated the adoption of digitalised interventions, thus overcoming the barriers of hesitation, scepticism and resistance that have been at play over the last two decades. These authors have noted the lack of acceptance, limited knowledge of the effectiveness and myths around the possibility of a therapeutic alliance for digitalised intervention (Wind et al. 2020). Historically, literature has highlighted that a large proportion of service providers (both in the private and public sectors) have viewed the possibility of offering counselling online as a critical dilemma based on the concerns around its effectiveness and especially, the viability of the process in comparison to Face to Face (FtF) delivery (Wind et al., 2020; Hanley & Wyatt, 2021). Others, however, have been able to override this dilemma and derived motivation from the commonly cited key benefits of online counselling associated with flexibility, accessibility, client empowerment, non-stigmatising access to therapy, disinhibited communication and space for reflection. At the dawn of the ‘black swan’ era of COVID-19, clients and therapists alike found themselves with the need to transit into the digital world and today seem to appreciate the unique benefits and challenges that digital technology has to offer. For instance, the National Health System (NHS) in England, United Kingdom has focused its resources and efforts in pursuing a swift digitalisation of its services across mental health provision and by August 2020 reported that 95% of IAPT services were delivered online yielding a steady increase in recovery rate and accessibility of service. While this initial statistic is tentative it shows that, indeed digital interventions can make a positive contribution to traditional FtF mental health services. In the current chapter we aim to explore this position in greater detail exploring how online counselling and digitised inventions are utilised, evaluated and received by clinicians and clients alike.
Scope of the Chapter
The current chapter aims at reviewing current and future directions in online counselling and the changes the digital turn is expected to bring in the profession of counselling and psychotherapy. It also takes a critical stance on the key theoretical and practical considerations that govern online counselling provision. On this basis, a comprehensive review of the theoretical and research developments in the field of online therapy is provided, drawing on chronological synthesis spanning from pre to post COVID-19 periods as points of reference. The discussion is structured around three main topics, exploring how online counselling is utilised from a theoretical and practical standpoint, accounting for guided and non-guided approaches, digitalised approaches of interventions, as well as relational psychotherapeutic and online counselling interventions. The evidence supporting the effectiveness and efficacy of digitalised interventions are then presented. Finally, an in-depth account of how online counselling has been received by clients and therapists alike is provided. The chapter ends with the discussion of relevant theoretical frameworks and research findings and concludes with key recommendations for mental health professionals on how to maximise the prospect of their counselling practice online.