Distance psychological counseling is becoming a phenomenon of increasing relevance. The following study aims to understand the characterization of the users of such online services. In particular, data taken from the online help desks on Facebook and Skype provided by the Italian Service for Online Psychology (Servizio Italiano di Psicologia Online [SIPO]). Data regarding 2013 logins through two channels were analyzed, keeping the results which emerged differentiated. The questionnaires administered online to users whom had requested a consultation indicate how different and peculiar the two instruments are and how each reaches different targets. Behind a substantial difference in its users and in the content treated by the two channels, there is however a common element: the awareness and trust with which the subjects turn to the online psychologist, witnessed also by the motivation to begin psychotherapy following the encounter with the professional psychologist online.
The first online psychological consultations were born in the 90s, when the spreading of technology (especially in the USA) allowed for a growing number of potential users. Various researchers have attempted to give a univocal definition, however to date there is no existing universally accepted taxonomy (Perle, Langsam, & Nierenberg, 2011). The concept of "telepsychology" includes both online interventions as welluch as the telephone, email, chat and videoconference" (Dielman et al., 2010, p. 13)1.
Following the first applications of psychoeducation on iPhones regarding anxiety, parenting, and sexuality, the team of psychologists has steered towards supplying psychological consultations through the webcam, with the intent of meeting the needs of users while taking advantage of new technologies and their potential. Going in this direction, the Italian Service for Online Psychology has instituted a free helpdesk on Facebook and more recently, on Skype.
The research was conducted on this initiative, with a different focus for each channel, due to their different scopes with which they were developed: while the helpdesk on Facebook was designed as a means to offer a first welcome and an orientation towards a professional who may offer help and whom one may contact to commence a path towards change, the helpdesk via Skype was added to offer the possibility to undertake brief cycles of psychological consultation, also through webcam.
In some clinical situations, the use of simple cognitive behavioral techniques can be greatly beneficial, as well as be more convenient than face to face therapy (Perleet al., 2011). For more severe clinical situations, a four year long study was conducted on a group of Vietnam veterans suffering from post-traumatic stress symptoms focused on anger. The study compared an anger management therapy of the “traditional” kind with the same approach, but conducted through webcame. The results of the reseach indicate how both methods were equally efficacious in the reduction of symptoms connected to anger (Gould, 2010).
To date however, few studies have empirically investigated in systematic way the chracteristics and the efficacy of online psychological counseling (Rochlen, Zack, & Speyer, 2004). This paucity of data may depend on the relative novelty of such practices. Furthermore, the use of online psychological counseling is still debated on a theoretical level (Alleman, 2002), making it difficult to isolate salient variables in the evaluation of the process and its efficacy.
Among the benefits of online psychological counseling emerges the possibility of meeting the needs of persons with limited mobility, with limited time, and with difficulties in accessing mental health services, motivated by also, for example, physical impediments or long periods of time away from home. Moreover, it is possible to overcome the social stigma, which may help reduce initial resistance, by removing the social masks and facilitating in this way disinhibition and self-reflection even through the act of writing. In light of this evidence, the aim of this present study is to understand the value of distance online interventions and counseling through the use of new technologies. In this study, data deriving from the online chat service and the video counseling service will be compared, to define the different profiles of users who request psychological help in both cases.
The sample is constituted exclusively by adult subjects with ages ranging from 18 to 60 years of age, on volantary basis, who responded to a questionnaire administered at the end of an interview. Concerning the helpdesk through chat, there are 38 subjects, while the video counseling sample is composed of 45 subjects, out of 123 users who had requested access for the service.
The data were collected by asking each user, in the moment of their first login, to complete a questionnaire upon entry and upon exit which allowed to monitor the course of the services and the level of the satisfaction of users who accessed the services. The moments of logins were two per week for the service via chat, while for the interview in the videoconference the contact was established by appointment.
For the chat channel, the selection was undertaken following these steps: the interested users had added as a Facebook friend the profile “SIPO Helpdesk”, to which they then sent a private message and were invited to complete a module to login into the service. The day of the meeting, the psychologist had 30 minutes available to listen to the requests of the users and to collect the necessary information to either give an outside reference to contact or begin the process of taking responbility for the case. At the end of every interview, every user was asked to fill out a brief questionnaire.
To login into the video consultation, differently with respect to the Facebook helpdesk, it was possible to ask users to fill out a form on the website of the Italian Service for Online Psychology. The requests were distributed amongst the SIPO consultants after they had proposed a date for a meeting (for free). They then invited the user to fill out a module to access the service. The day of the meeting the psychologist had 30-40 minutes available to listen to the users' questions and to collect information necessary to decide whether to indicate a local reference to contact or propose a cycle of interviews of psychological support (with charge in accordance with the fee of the psychologist taking care of the case). In this case as well, at the end of the interview the users were asked to complete a questionnaire.
Subjects were asked to complete a questionnaire online regarding the expectations that had brought them to contact a professional using the chosen digital channel. Some examples of questions present in the questionnaire are: motivation for the choice to turn to a psychologist, what were the reasons for choosing an option at a distance, the spheres associated with the disorders, and the delays of the obtained consultation.
The data were analyzed using the statistical software SPSS18.
For an indepth dissertation it is necessary to report separately the results concerning the two channels through which the services were accessed. In the section dedicated to the discussion of the results, commonalities will be discussed.
Profile of the chat user
The service, tailored exclusively to Italian adults, saw a greater participation of users in the age range between 18 to 25 years and a majority of women who represented 91% of users (Figura 1). With regard to past year data, this confirms the growing trend of women as the majority of users.
From the analyses regarding geographical data, users are concentrated between north and south, while there is a noticeable imbalance regarding educational level: 60% of participants concluded middle-high schools while 31% completed university.
Numerous requests came from professionals (employees, teachers) but also from unemployed individuals; the clear majority were students (Figura 2).
The push to seek help is represented by heterogenous motivations: 31% of users declare not knowing where to turn to for help (a percentage which has doubled compared to the available data from 2012), while 29% admit to having chosen online counseling for convenience, as well as because of the need for immediate support (Figura 3).
The difficulties reported by users are mainly problems with mood and anxiety, family problems, a prevalence which has tripled compared to data which emerged in 2012 (Figure 4).
For 51% of users who were asked, the chat helpdesk represents the first encounter with a psychologist. The encounter is accompanied by expectations associated primarily with the opportunity to understand better the problem one is going through. Confirming an already noted trend, a discrete percentage of cases have made unrealistic requests of solving a problem immediately (Figura 5).
A very significant finding concerns the willingness to undertake psychotherapy: the majority of people after the first encounter stated that they were surely intent on turning to a psychologist. The virtual encounter can be considered a first step towards establishing responsibility for a case which brings on subsequent meetings of the traditional kind. Half of the users contacted (N=13) had completed the questionnaire at follow-up, meant to investigate the efficacy of the intervention. The data collected showed that 58% of them has effectively looked for professional psychological support following the chat. This finding as well reflects an increasing trend, however it is contradictory compared to the last available information. Indeed in 2012, the percentage of affermative responses was equal to 46%, while the negative responses were given by 54%.
Concerning the type of services chosen, the prevailing option is the private face to face service (17% public); it is revealing that 33% of users opted for an online counseling service.
Profile of users of the video-conference service
The service, designed for Italian adult users, has involved subjects between the ages of 18 and 59 years old. The peak of usage is between 32 and 41years old, but substantial portion of users are up to 26 years old.
57% of users are men (Figure 6), very different with respect to the chat users.
Geographically speaking, there is a larger distribution of users in Northern Italy (51%) and a balanced diffusion in the center and south, respectively 23% and 26% of users.
Subjects with middle school-high school educational levels represent over half of the sample; the other portion have a college degree (32%), while the rest ,17%, have finished elementary school (Figure 6).
In terms of professional occupations, many are employees (34%), others are blue collar workers, free lance professionals, managers and artisans, although in small percentages. The number of users who are unemployed is equal to 17%, housemakers represent 5% , and in contrast with the data from the Facebook helpdesk users, students represent only 8% of users (Figure 7).
The main way through which users found out about the service was through search engines and online articles. Printed newspapers and word of mouth were less relevant as contributions (Table 1).
More than half of the Skype helpdesk service users that were interviewed were enacting their first request ever of psychological support, while the rest had already utilized psychological consultation services. About 50% of these stated that they had undergone more than 10 sessions (Figure 8). This indicates that even users who had undergone a course of more consistent psychological support, turn trustingly to distance online counseling.
The choice of distance counseling was mostly due to the need of immediate support and convenience of a service offered online: 31,4% stated both motivations; no one stated a preference for this channel of communication because of embarrassment in meeting a psychologist (Figure 9).
The need that moves more than half of users of the Skype service (54%) is the necessity to understand one's past experiences, followed by a push to resolve the issues presented, which represents 40% of subjects. A minority instead turns to psychologists for a need to talk.
The spheres of issues for which the subjects have turned to the service are primarily due to anxiety. The issues immediately following anxiety are couple issues, followed by depression symptoms (Figure 10). A minority of the users had mixed disturbances, followed by eating disorder issues, relational issues and dependence issues.
The subjects who turn to Skype consultations are motivated to continue, indeed over 70% of the users interviewed state an intense intent on pursuing psychotherapeutic support (Figure 11).
As a means to pursue psychological support, 86% of the users interviewed prefer online consultation, confirming the choice of the channel they had used to utilize the service.
It is interesting to note that among those who had stated being more motivated (over 50% of users if you consider only the values over 4), 83% would pursue the online option, while 17% would undertake the in person option. This finding supports the interpretation that there is a tendency to trust the online instrument.
In comparing the data, several common elements emerged in the users' tendencies in their choice of either channel, while other aspects may be considered unique to each channel.
For example, the main motivation which pushes users to ask for help online, both via chat and via webcam, is the need to understand one's own personal experiences and the desire to intervene on a problem. An interesting difference, instead, is given by the setting of the potential continuation of the psychological counseling: the chat users are more motivated to pursue a face to face option, while the video consultation users prefer to continue using the online platforms, probably reflecting the usefulness of the already received support.
From the analyses of the data we find that the majority of chat users are female and young (between 18 and 25 years old) with problems related to anxiety, family issues and mood issues. Regarding the Skype service, the users are distributed equally in terms of the sex, while the age of such users is generally higher compared to chat users, and the issues presented concern anxiety, depression and couple problems.
The choice of the online instrument, in the chat service users, represents a first step towards a problem, frequently due to not knowing whom to turn to (in 31% of cases). Indeed this is a problem present in only half of that percentage in users who choose Skype (17%).
The motivation to continue a more structured psychotherapeutic support service after the first encounter doesn't differ between the channels (chat or webcam). However, those who initiate contact via Skype are more motivated to continue an online counseling service compared to those who initiate via chat, that instead prefer a face to face contact as a means to continue receiving counseling.
It is feedback such as this which pushes psychologists to invest in Psychology 2.0 with the objective to educate and improve the psychologist community so that it may be equipped to relate to a not so simple context which however, is increasingly utilized.
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Published online: 22 November 2015.
Copyright: © 2015 Sara Gabri, Luca Mazzucchelli, Davide Algeri. This is an open-access article distributed under the terms of the Creative Commons Attribution License. The use, distribution and reproduction of this article is permitted, provided the original authors and licensor are credited and that the original publication in E-Journal of Psychotherapy Research is cited in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.