E-Counselling: The Potential, Effectiveness and Limitations

Matt Cohen
Memorial University

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School Counsellors are constantly searching for ways in which they can effectively and
efficiently service as many students as possible in a very limited amount of time. According to
the Comprehensive Guidance Curriculum Guide for Nova Scotia, counsellors are required to
spend roughly thirty percent of their time implementing the guidance curriculum. These
activities may include resume writing workshops, team teaching to cover topics such as mental
health or giving classroom presentations. Twenty percent of a junior high counsellors time
should be allocated to life and career planning and another fifteen percent managing programs,
providing professional development and establishing community and stakeholder relationships.
This only leaves roughly thirty-five percent of a counsellors time is supposed to be allotted for
individual and group counselling (Guidance Curriculum, 2010). Unfortunately, with only a one
to five hundred ratio of counsellors to students in the province of Nova Scotia (Guidance
Curriculum, 2010), many counsellors either have a fairly large teaching component or they are
split between a number of different schools, which negatively impacts the effectiveness of
establishing and maintaining a guidance program. In attempts to make individual and group
counselling more accessible and efficient, some schools around the globe have been considering
implementing electronic counselling (e-counselling) where trained counsellors could work with
students through real-time, synchronous chat or asynchronous communication to provide service
(Walley & Grothaus, 2013).

Benefits of E-Counselling
According to Sink and the National Assembly on School-Based Health Care (NASBHC),
approximately one-sixth of adolescents are suffering from mental health issues such as selfinjurous behaviour, anxiety, depression and addictions (as cited in Walley & Grothaus, 2013). As
Erford states, only roughly twenty percent of these students seek professional help and are at a

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much higher risk for dropping out of school, suicide and other long term, mental health related
issues (as cited in Walley & Grothaus, 2013). In an effort to appeal to more students to seek
professional help with regards to mental health, some counsellors and school boards have been
exploring the benefits, legal, ethical and limitations of e-counselling.
Over the past number of years, the internet and computer technology has become an
integral part of how students of all ages communicate with each other and the world around
them. In hopes that by changing the way some counselling services are delivered, some
counsellors are optimistic that students, who would rather remain completely anonymous, could
benefit greatly from e-counselling experience (Glasheen, Campbell, & Shochet, 2013). In
addition, many students who attend rural schools could benefit from such e-counselling
experiences because at the moment, rural schools who generally share a counsellor in Nova
Scotia only receive counselling services for part of a day or one day a week. This system may
only permit the counsellor to work with each client once every few weeks; depending on their
caseload.

Effectiveness of e-counselling
Not surprisingly, many students behave differently in online communities than they
would in real-life situations. For instance, some studies have shown that up to thirty percent of
students self-identify as participating in frequent traditional bullying, some studies have shown
that up to fifty-three percent of students have participated in online bullying behaviours
(Ockerman, Kramer, & Bruno, 2013). While this anonymity and disinhibited behaviour may be
extremely detrimental for these students, Sabella & Halverson and Suler state that some
counsellors see great value as some have commented that online counselling sessions have been
much more productive than telephone interactions (such as KidsHelpPhone) as clients tend to

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disclose more online (as cited in Glasheen et al, 2013). Thus far, the research is fairly
inconclusive as to whether or not online counselling is more effective than face-to-face
interactions with counsellors, but preliminary studies indicate that there is at least potential in ecounselling sessions for students (Glasheen et al, 2013).
Dowling and Rickwood (2014) have found that although many clients prefer the face-toface interactions with counsellors, that there are a growing number of clients that are gravitating
to online counselling. In a study at the University of Athens, throughout a forty-one month
period, 1384 emails were received looking for counselling services, which indicated the
popularity of the service provided by the university. Not only has this service been utilized by
many students attending the University of Athens, but many students surveyed have also
commented on their high levels of satisfaction with the service (Richards, 2009). Dowling and
Rickwood (2014) have also discovered that by using a number of scales and assessments such as
the Kessler Satisfaction with Life Scale and the Childrens Hope Scale during pre-tests and posttests have indicated that, while small, there have been positive results with reducing
psychological distress through online counselling.

Reasons Clients Seek Online Counselling

Dependent on the counselling program at school, the comfort level of students asking for
help, the approachability of the counsellor, and many other factors, many students will not seek
counselling for a myriad of different reasons. As stated above, roughly only twenty percent of
students will seek counselling when faced with mental health issues and the more severe the
issues, the less likely they are to consider counselling (Walley & Grothaus, 2013). Therefore, it
is becoming exceedingly important as mental health related issues continue to rise amongst
school-aged children. In a recent study regarding eating disorders and online counselling, again,

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showed promising results. Unfortunately, people with diagnosed eating disorders generally do
not wish to seek help and generally, the longer one waits to seek treatment, the more difficult the
recovery process can be. Even with effective psychotherapeutic treatment, the recovery rates are
quite unsatisfactory and for many, they will have to battle with their eating disorder for the rest
of their lives (Moessner & Bauer, 2012). Therefore, it is extremely important that people
suffering with an eating disorder or a suspected eating disorder seek professional help as early as
possible.
This study looks at two hundred thirty-eight young adults that had questions, concerns or
diagnosis of eating disorders. There were two different forms of online counselling provided
which were through online forums and emails. When asked to rank the reasons why participants
preferred this type of counselling, a resounding seventy-nine percent said it was because of
anonymity. While results were still positive with sixty-six percent commenting on the ease
access and use, others enjoyed that it was free and counsellors seemed to be quite competent in
dealing with issues and questions (Moessner & Bauer, 2012). Regardless of the reasons for
choosing this form of online counselling, almost eighty percent of the participants that responded
to the survey commented that they were overall satisfied with the experience and would use this
service again (Moessner & Bauer, 2012). Therefore, one of the greatest benefits to online
counselling would be to access potential clients who would not otherwise seek professional help.

Client Experiences
In every counselling relationship, it is important that the client is enjoying the process or
at least getting something from participating in it. In a recent qualitative study, clients were
asked about their recent experiences with online counselling. Aside from the disinhibition effect
and anonymity already mentioned, clients also reported that they felt more comfortable as they

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did not feel judged or had more confidence to disclose important information about themselves
because they felt that they did not have to take responsibility. Others claimed that they were
much more anxious when meeting a counsellor face-to-face and writing emails gave them time
to think about the problem. After writing the emails, many participants also enjoyed reading and
rereading the counsellors response when they wanted to revisit the problem or situation they
were experiencing (Dunn, 2012).

Counselling Apps and Smartphone Usage

The basic counselling process will often include relationship building, a problem
assessment, goal setting, an intervention and then either a termination or referral to an outside
agency. During these sessions, counsellors will often employ many skills and strategies such as
active listening, demonstrating empathy, paraphrasing, reading body language and assigning
homework to enhance the clients chance of success. Although most of the work is done
throughout the counselling sessions, the use of cell phone and mental health apps have also been
increasing in tracking and helping clients complete their homework. While there are thousands
of mental health applications that could benefit clients, apps such as MindShift, PTSD Coach and
Recovery Record can be very useful in helping students deal with anxiety, post-traumatic stress
disorder and eating disorders respectively. Many counsellors are finding it useful to use apps
such as these for clients to use in between counselling sessions to help manage and monitor
problem behaviours, monitor psychological symptomology, record significant instances of
anxiety or depression and use helpful strategies to reduce problem behaviours and thoughts
(Epstein & Bequette, 2013). Thankfully, the applications listed above are researched based and
use cognitive behavioural therapy (CBT) techniques and strategies, which have proven
successful in treating anxiety, depression, PTSD and eating disorders. However, while some

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students find these techniques useful, others do not or may not have the necessary skills to
effectively use such apps. In such cases, the counsellor may wish to use a different technique or
employ a different counselling strategy altogether.
Cell phones have also proven beneficial for use in between counselling treatments. Since
most people who own a cell phone carry them on their person daily, they are an effective tool for
recording thoughts, feelings and behaviours as mentioned above. Cell phones can also have
many applications for students who benefit from guided imagery to reduce stress or problem
solve as the counsellor could record a session on the students cell phone. Similarly, students
who struggle with class presentations could record themselves on their cell phone as they
practice to help reduce stress (Epstein & Bequette, 2013).

Considerations
Confidentiality
Counselling, whether it is face-to-face or online, is confidential. In a school setting, a
counsellor is only permitted to break confidentiality if he/she feels if the student is in danger of
being harmed, might harm his/herself or if may harm someone else. Counsellors must also keep
notes which are logged into a secured, online system called TIENET here in Nova Scotia and
those notes may be subpoenaed at any time. This is all a part of the informed consent process
where clients must be aware that there are limitations to confidentiality. With regards to online
counselling, clients must be aware that there are further limitations to confidentiality that may be
beyond the counsellors ability to protect such as email accounts being hacked or left open,
someone seeing messages on the clients unsecured phone, and all internet service providers
could easily access emails, messages and such. However, if the student is aware of these risks,
then they can consent to online counselling.

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Ethical and Legal Considerations

Adhering to the Canadian Counselling and Psychotherapy Associations (CCPA) Code of
Ethics, counsellors must avoid having dual roles in a counselling relationship (CCPA, 2007). It is
therefore imperative that when participating in an online counselling relationship that counsellors
take into consideration the consequences and repercussions of providing counselling via text on a
personal cell phone or through social media. To avoid situations where this might become an
issue, since it is a relatively new practice, along with more research, there should also be more
inservicing and professional development around the topic of e-counselling.
One of the major flaws with providing anonymous e-counselling to school-aged children
falls within direct conflict with the Code of Ethics for counsellors. According to this code, when
using computer applications, a counsellors identity must be verified, as well as the childs. This
must be done because if a child discloses that he/she is in danger of being harmed or harming
someone else, then it must be reported (CCPA, 2007). In addition, generally school counselling,
cannot begin unless the student gives informed consent, which typically cannot happen until they
are in junior high school. Therefore, it would be possible for young students to access
counselling services when they are well below this age range.

Conclusion
Over the past few years and as discussed above, the use of e-counselling has benefitted
many clients and counsellors. Some clients who typically do not wish to participate in face-toface counselling services find solace in the anonymity, the liberation of time restraints and the
freedom of inhibition to disclose any information they wish (Moessner & Bauer, 2012). There
has also been evidence to show that online counselling has had a positive effect and clients have
made progress (Dunn, 2012). However, one of the more significant findings is that even though

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many clients do prefer the face-to-face interactions that school counselling provides, many other
students may feel more comfortable with an online counselling relationship and therefore
counsellors could potentially work with more students needing support (Moessner & Bauer,
2012). Unfortunately, as it stands at the moment, according to the CCPA (2007), it would be
unethical for a school counsellor to provide e-counselling to students without a disclosure of
identity. However, if certain provisions were made, counsellors received training and schools
and boards followed the Code of Ethics, then in the future e-counselling could help counsellors
reach students in rural areas who would not otherwise have appropriate access to counselling
services.

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References
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Dunn, K. (2012). A qualitative investigation into the online counselling relationship: To meet or
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