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Effectiveness of Telephone Counseling: A Field-Based Investigation


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The use of the telephone has become an increasingly popular mode for providing counseling. However, little is known about its effectiveness. This study is an initial effectiveness study on telephone counseling. Participants ( N=186) who had received counseling from a telephone counseling service rated the effectiveness of telephone counseling and the quality of their counseling relationship. Generally, respondents indicated that telephone counseling was helpful for both global and speck improvement and that they were satisfied with the counseling they received. Respondents also rated the counseling relationship and level of interpersonal influence similarly to face-to-face counseling studies measuring the same attributes. The telephone counseling results are given in the context of face-to-face counseling data from other studies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Effectiveness of Telephone Counseling: A Field-Based Investigation
Robert J. Reese
Abilene Christian University Collie W. Conoley and Daniel F. Brossart
Texas A&M University
The use of the telephone has become an increasingly popular mode for providing counseling. However,
little is known about its effectiveness. This study is an initial effectiveness study on telephone counseling.
Participants (N186) who had received counseling from a telephone counseling service rated the
effectiveness of telephone counseling and the quality of their counseling relationship. Generally,
respondents indicated that telephone counseling was helpful for both global and specific improvement
and that they were satisfied with the counseling they received. Respondents also rated the counseling
relationship and level of interpersonal influence similarly to face-to-face counseling studies measuring
the same attributes. The telephone counseling results are given in the context of face-to-face counseling
data from other studies.
Technological advances and emphasis on time-limited, inexpen-
sive treatment has ushered in psychotherapy through use of tele-
communications and the Internet (Rosenfield, 1997). The utiliza-
tion of technology and telecommunications for health care
purposes is commonly referred to as “telehealth,” which has in-
creased in popularity and usage in clinical practice (Jerome et al.,
2000). The Internet and the use of video transmission have re-
ceived more attention for the provision of telehealth services, but
the telephone is overwhelmingly the most popular telehealth me-
dium for delivering clinical services among licensed psychology
practitioners (Williams, 2000). Little research exists, however, on
whether the effectiveness of psychotherapy extends to telephone
counseling. Additionally, the ethics of providing telephone coun-
seling services is questioned in the literature (Haas, Benedict, &
Kobos, 1996).
Telephone counseling has received attention in the literature as
an attractive alternative to traditional face-to-face counseling. The
four strengths that have been attributed to telephone counseling are
as follows: It is less expensive compared to face-to-face counsel-
ing, it allows anonymity, it gives a sense of control, and it is
convenient (Mermelstein & Holland, 1991; Ranan & Blodgett,
1983; Shepard, 1987; Zhu et al., 1996). These strengths are be-
lieved to make counseling possible for some who would not
otherwise seek or receive counseling services.
For example, telephone counseling may be an attractive option
for individuals who cannot afford traditional psychotherapy. Peo-
ple of low socioeconomic status and rural residents have been
underserved in the mental health system (Mays & Albee, 1992).
Although low socioeconomic status individuals are underserved,
evidence indicates that increased psychological distress is related
to low income (Ulbrich, Warheit, & Zimmerman, 1989). Clearly,
if telephone counseling could fulfill some of its promise in pro-
viding effective mental health counseling for underserved people,
it is worth investigation.
Telephone counseling has been found to be effective for certain
circumscribed problems, such as smoking cessation (Orleans et al.,
1991; Zhu et al., 1996), but the research has not been extended to
address adequately the effectiveness of telephone counseling for
general mental health concerns. The research supporting the ef-
fectiveness of telephone counseling for general mental health
concerns consists of case examples that reflect authors’ favorable
experiences (e.g., Fish, 1990; Hines, 1994). Likewise, negative
reactions to telephone counseling have been based on suppositions
and intuitive reasoning (e.g., Buie, 1989; Haas et al., 1996).
The most accepted method to establish that a model of psycho-
therapy works is by clinical trials that use monitored, manualized
treatments, random assignment of participants, and a control/
comparison group—that is, an efficacy study (Howard, Moras,
Brill, Martinovich, & Lutz, 1996). Alternately, a study that focuses
more on whether psychotherapy works as it is practiced in the field
in its unaltered state is referred to as an effectiveness study
(Howard et al., 1996). In an effectiveness study, individuals
choose the type of treatment they prefer and the nature of treatment
is not controlled. Consumer Reports (CR; 1995) conducted an
effectiveness study that received a great deal of attention, both
positive and negative (e.g., Brock, Green, Reich, & Evans, 1996).
Criticism of the CR study has primarily centered on the lack of
controlled clinical trials. However, Seligman (1995), a consultant
to the CR study, heralded the study as the most extensive psycho-
therapy effectiveness study ever conducted and felt that the study
provided solid evidence for psychotherapy’s effectiveness.
Just as there was a need to know whether face-to-face psycho-
therapy as it is done in the field is effective, telephone counseling
as currently provided needs a similar effectiveness study, a goal we
pursued in this study.
Another issue in psychotherapy research is the dose–effect
response curve. There appear to be different results depending on
Robert J. Reese, Department of Psychology, Abilene Christian Univer-
sity; Collie W. Conoley and Daniel F. Brossart, Department of Educational
Psychology, Texas A&M University.
Correspondence concerning this article should be addressed to Robert J.
Reese, Box 28180, Abilene Christian University, Abilene, Texas 79699, or
to Collie W. Conoley, Department of Educational Psychology, 704 Har-
rington Education Center, Texas A&M University, College Station, Texas
77843-4225. E-mail: or
Journal of Counseling Psychology Copyright 2002 by the American Psychological Association, Inc.
2002, Vol. 49, No. 2, 233–242 0022-0167/02/$5.00 DOI: 10.1037//0022-0167.49.2.233
the methodology and the sample (e.g., CR, 1995; Howard, Kopta,
Krause, & Orlinsky, 1986; Salzer, Bickman, & Lambert, 1999;
Steenbarger, 1994). A doseeffect response curve has appeared
when studying an adult sample with general mental health prob-
lems using a general outcome measure at the end of therapy. For
example, the CR study and the Howard et al. (1986) meta-analysis
found that greater number of sessions received was associated with
better client outcome. Both of those studies had a mixture of
psychotherapy models included in their sample. However, the
doseeffect curve may be different depending upon the therapy
model (Steenbarger, 1994). Therefore, examining the doseeffect
response for different models of psychotherapy may yield impor-
tant information for evaluating the model efficiency.
In addition to investigating effectiveness, discovering if the
same psychotherapeutic processes exist in telephone counseling
that have been associated with the successful outcome in face-to-
face counseling is crucial. Understanding the processes allows for
the development of efficient, effective psychotherapy and training.
Two important process issues in the psychotherapy literature are
the therapeutic alliance and the counselors social influence.
From the early psychotherapy theories of Freud and Rogers,
therapeutic alliance has been central. Even though disagreement
about the function and definition of the therapeutic alliance has
flourished, researchers have consistently found it to be an impor-
tant component within the therapeutic process (Martin, Garske, &
Davis, 2000). Martin et al. found a consistent, strong relationship
between therapeutic alliance and outcome. The collaborative and
affective bond between therapist and client is considered pantheo-
retical (Horvath & Luborsky, 1993), or a common core aspect of
psychotherapy (Wampold, 2001). The research to date suggests
that therapeutic alliance should be considered mandatory for all
therapeutic approaches, including telephone counseling.
Social influence has been an important counseling process issue
since translated from social psychology to become the social
influence theory of psychotherapy (Strong, 1968). In this concep-
tual framework the psychotherapist must gain influence with the
client to be therapeutic. Like the therapeutic alliance, social influ-
ence appears to become pantheoretical because psychotherapy
requires the therapist to have some influence, notwithstanding
Strongs two-stage model of change. The bulk of the social influ-
ence research has been analogue, which may only be relevant to
the very early psychotherapy sessions (Heppner & Claiborn,
1989). The social influence of the telephone counselor seems
important because nothing is known about the clients perceptions
of the counselors influence. Additionally, the use of brief therapy
over the telephone might not give the telephone counselor much
time to create a power base for influence.
Several authors have asserted that the telephone modality pro-
vides no roadblock to interpersonal communication. For example,
Grumet (1979) postulated that telephone clients could project what
they needed or wanted onto the therapist given the absence of
visual cues. Miller (1973) asserted that telephone communication
creates the feeling of intimacy because the speaker is seemingly
only inches away from the listeners ear. Spiro and Devenis (1991)
reported mixed experiences from the reports of psychodynamic
psychotherapists regarding the amount of transference generated
on the telephone. They reported that some clinicians found less
transference over the telephone, whereas others experienced in-
creased transference given the clients need to fantasize to fill in
the visual gaps. With the variety of opinions, a researched inquiry
into the influence the telephone has on therapeutic processes seems
The purpose of this study was to investigate whether telephone
counseling as used in the field is effective for providing general
mental health counseling and to investigate two important process
variables. For the purposes of this study, effectiveness was defined
as (a) the clients self-reported satisfaction with telephone coun-
selings treatment of problems; (b) the clients self-reported im-
provement in specific work, social, and emotional issues; and (c)
the clients self-reported global improvement in emotional state.
Second, counseling process was investigated by examining the
counseling relationship and counselor influence in telephone coun-
seling. For the purposes of this study, the counseling relationship
was measured by the clients perceptions of the therapeutic bond
between the client and telephone counselor, and the counselors
influence was measured by the clients self-reported perceptions of
the counselors social influence in the telephone counseling.
Specifically, this study asks five questions: (a) Do telephone
counseling clients perceive counseling to be effective? Effective-
ness is defined as the clients self-reported satisfaction with tele-
phone counselings treatment of problems, the clients self-
reported improvement in specific work, social, or emotional issues,
and the clients self-reported global improvement in emotional
state. (b) Do telephone counseling clients perceive a therapeutic
relationship bond with the counselor? (c) Do telephone counseling
clients perceive their counselors to have social influence (i.e., to be
expert, attractive, and trustworthy)? (d) Do the process variables of
social influence and the therapeutic relationship bond predict the
telephone counseling clients perceived outcome? (e) Is there a
doseresponse relationship in terms of the relationship between the
amount of time in telephone counseling and the general outcome
measure? The telephone counseling results in this study are com-
pared to face-to-face counseling results from other studies in the
literature to provide a context for the telephone counseling clients
responses. Comparative face-to-face studies were selected based
upon their use of the same measures and use of actual clients.
When several studies were available in the literature, the studies
with the more positive results were used for comparison to this
The nonrandom sample was composed of 186 adult clients; 500 ques-
tionnaires were sent out, resulting in a response rate of 37.2%. This return
rate was considered acceptable because it was similar to the CR (Seligman,
1995) study. When CR sent out their initial questionnaire they received a
return rate of 13%. When compensating the respondents in their validation
study, they received a return rate of 38%. The CR validation study con-
sisted of comparing the answers from the two samples. They found no
differences between the data gathered from the two sets. Because our study
achieved a similar return rate as the CR study and used a similar procedure,
we argue that our responses are likely to be nonbiased as well.
The sample in this study was drawn from clients who received services
from a private telephone counseling agency that serves as an employee
assistance program for several large corporations. There were 136 female
participants (73.1%), 43 male participants (23.1%), with 7 (3.8%) not
indicating gender. The ethnic composition of the sample was as follows:
African American (n14, 7.5%), Hispanic (n10, 5.4%), Native
American (n6, 3.2%), White (n142, 76.3%), other (n7, 3.8%),
and 7 (3.8%) who did not indicate ethnicity (Mdn age 36 years, SD
10.18, range 1860).
The majority of the respondents (n117, 62.9%) reported a family
income of less than $30,000 a year, with 55 (29.6%) making less than
$15,000 annually. Seventy-four (39.8%) of the respondents had a high
school education or less, 70 (37.6%) had attended some college, 21
(11.3%) had completed college, 10 (5.4%) had attended graduate school, 4
(2.2%) had completed graduate school, and 7 (3.8%) did not provide
The respondents reported a variety of presenting problems, including
depression, anxiety, panic attacks, marital/relationship problems, family
problems, drug/alcohol, job-related/career problems, grief, eating disor-
ders, anger, and stress. The majority of the sample (n131, 70.4%)
reported having more than one presenting problem, and the median number
of presenting problems for the entire sample was four (M3.77,
SD 2.34). Respondents also reported their level of functioning prior to
counseling: 29% said their emotional state was very poor (I barely
managed to deal with things); 30.6% reported a fairly poor emotional state
(Life was usually pretty tough); 34.9% reported a so-so emotional state;
4.3% reported that life was quite good; and 1.1% reported that life was very
The samples median number of sessions was 3, ranging from 1 to 99
sessions (M11.82, SD 15.66); 46 (24.7%) respondents had only
received 1 session; 63 (33.9%) had received 2 to 4 sessions; 29 (15.6%)
had received 5 to 10 sessions; 39 (21%) had received 11 or more sessions,
and 9 (4.8%) did not specify. Most of the respondents were still receiving
telephone counseling at the time the questionnaire was completed (n
138, 74.2%).
In comparing the sample to the population using the service, the agency
had a total of 15,525 people who used the service in 1998, with 67.1% of
clients being female and 32.9% being male. Approximately 79% of the
clients were first-time callers. The average number of sessions per client
was 1.5 sessions.
Telephone Counseling Agency
The telephone counseling agency provides free counseling for the em-
ployees of three large Fortune 500 companies as well as other smaller,
regional companies. The agency provides counseling for individuals across
the United States, Canada, and parts of Mexico, with over 2 million people
having access to these services. Any employee or employees immediate
family member has access to the agencys toll-free number. A caller
initiates counseling by talking with an intake worker to provide initial
information and to set an appointment time with a counselor. The coun-
selor, who is not the intake worker, then calls the person back at a
scheduled time for the session. At the end of the session the client is
transferred back to the intake worker to schedule the next appointment with
the same counselor. There is no limit to the number of sessions a client may
have; the average session lasts 30 min.
The agency provides counseling for a variety of issues including, but not
limited to, depression, anxiety, marital and relationship problems, grief,
and work-related difficulties. Callers with problems that are more severe or
chronic in nature are encouraged to seek local mental health services and
are advised on how to obtain appropriate help. Although the service
provides crisis intervention for callers, it is primarily considered a coun-
seling service and not a crisis line.
The agency provides their telephone counselors with training and su-
pervision in the use of solution-focused therapy (SFT; De Jong & Berg,
1998). SFT, based on the work of de Shazer (1985) and Berg (1995), is a
brief, strength-based model. This approach focuses on the individuals
strengths rather than on the problematic behaviors or their causes. SFT
focuses on times when the problematic behaviors are not occurring to
discover a persons strengths in promoting change (de Shazer, 1985). SFT
claims to respond to individual differences (Robbins, Alexander, Newell,
& Turner, 1996) while taking into consideration the systemic whole (Beye-
bach & Carranza, 1997). The length of SFT has been typically around six
sessions (Lee, 1997; Zimmerman, Jacobsen, MacIntyre, & Watson, 1996;
Zimmerman, Prest, & Wetzel, 1997). Counselor adherence to SFT was not
All counselors working for the telephone counseling agency have a
masters degree and are licensed in the field of psychology, counseling,
marriage and family therapy, or social work. Each counselor receives
training in SFT and live supervision to ensure that he or she is capable of
implementing the solution-focused approach with clients. All counselors
receive weekly supervision.
Consumer Reports Annual Questionnaire (CRAQ; CR, 1994). The
CRAQ was used in the CR (1995) effectiveness study and was chosen for
this study so that comparisons could be made for therapeutic effectiveness.
This study used the 10 mental health questions of the CRAQ, which were
totaled for an overall effectiveness score and can be used as three sub-
scales: Specific Improvement (How much did treatment help with the
specific problem that led you to counseling?), Satisfaction (Overall how
satisfied were you with the counselors treatment of the problems?), and
Global Improvement, or how respondents described their overall emo-
tional stateat the time the questionnaire was completed compared with at
the start of treatment (Seligman, 1995). The Specific Improvement sub-
scale uses a 5-point Likert-type response, the Satisfaction subscale uses a
6-point Likert-type response, and the Global Improvement subscale uses a
5-point Likert-type response. The three subscales are weighted on a 0100
scale and combined for a composite scale of 0300 for total effectiveness.
The methodology for score transformation is identical to that of the CR
study (M. Kotkin, personal communication, September 1998).
No information on reliability or validity is available on the CRAQ from
the CR (1995) study. However, reliability using the total effectiveness data
from our sample achieved a coefficient alpha (internal consistency coeffi-
cient) of .72. Although there is no validity study as such, construct validity
of the CRAQ can be inferred because the measure responds as expected in
the CR study. Perhaps the most persuasive finding for validity purposes
was the doseresponse curve that was found in the CR (1995) study using
the CRAQ, where the rate of improvement was found to be a function of
length of treatment. The CR finding paralleled the doseresponse curve of
general mental health services that used other measures of outcome
(Howard et al., 1986).
A confirmatory factor analysis using these data supports the validity of
the CRAQ Specific Improvement subscale. (The Global Improvement and
Satisfaction subscales each had only one item so they were not included in
the factor analysis.) The eight items that make up the Specific Improve-
ment subscale of the CRAQ had a comparative fit index (Bentler, 1990)
coefficient of .993 (the closer to 1, the better the fit). The correlation
coefficients between the Specific Improvement subscale score and the
scale items ranged from .67 to .83 (intercorrelations between the items of
the Specific Improvement subscale are .33.69). The intercorrelations
between the CRAQ subscales are: Global Improvement and Satisfaction,
.28; Global Improvement and Specific Improvement, .42; and Specific
Improvement and Satisfaction, .43.
In summary, the CRAQ Specific Improvement subscale appears to be
made up of items that measure a similar construct. All of the CRAQ
subscales have a strong correlation with each other, but they also appear to
include some unique parts of the construct. Therefore, the psychometric
properties of the data are consistent with a valid measure.
Working Alliance Inventory—Bond Scale (WAI–B). The client version
of the WAIB (Horvath & Greenberg, 1986) consists of 12 questions
referring to the strength of the interpersonal relationship. It is one of three
subscales from the WAI, which has 36 questions, 12 each for the Tasks,
Goals, and Bond subscales, respectively. The questions are rated on a
7-point Likert-type response scale ranging from never (1) to always (7).
The WAIB was used to assess the interpersonal aspect of the therapeutic
Reliability estimates for the WAIB have been generally adequate.
Internal consistency coefficients have ranged from .68 to .92 in previous
studies, as measured by Cronbachs alpha (e.g., Horvath & Greenberg,
1989; Plotnicov, 1990). The Task, Goal, and Bond subscales have had
strong intercorrelations in previous studies, ranging between the low .60s
to the high .80s (e.g., Horvath & Greenberg, 1989). Coefficients for
testretest reliability have ranged between .66 and .74 for each of the
subscales (Plotnicov, 1990). Using coefficient alpha, the internal consis-
tency for our sample was .69.
Previous studies have provided evidence of convergent validity for the
WAIB (e.g., Horvath & Greenberg, 1989; Safran & Wallner, 1991). For
example, the Bond subscale possessed a correlation of .72 with the Cali-
fornia Psychotherapy Alliance Scales, demonstrating reasonable conver-
gent validity (Safran & Wallner, 1991). Results for discriminant validity,
however, are mixed. Discriminant validity has been investigated by con-
trasting the WAI to other inventories that measure the therapeutic alliance
differently, such as the Counselor Rating Form (CRF; LaCrosse, 1980) and
the Empathy subscale of the Relationship Inventory (Barrett-Lennard,
1962). Horvath and Greenberg (1989) constructed a multitrait
multimethod matrix with the WAI subscales and the Empathy subscale.
The WAIB and the Empathy subscale had a correlation of .83, suggesting
little discriminant validity. In a second study, however, evidence for
discriminant validity was found with correlations of .38, .28, and .05
between the WAIB and the CRF subscales of Attractiveness, Expertness,
and Trustworthiness, respectively (Horvath, 1981).
Counselor Rating FormShort Version (CRFS). The CRFS (Cor-
rigan & Schmidt, 1983) measures the clients view of the counselors
influence. The measure consists of 12 adjectives that are subsumed under
the factors of Expertness, Attractiveness, and Trustworthiness. The adjec-
tives are rated on a 7-point Likert-type scale ranging from not very (1) to
very (7). Each factor makes up a four-item subscale on the CRFS.
Reliability for the CRFS has generally been shown to be acceptable,
with the three subscale coefficients ranging from .82 to .94 (Mdn .91;
Corrigan & Schmidt, 1983). Epperson and Pecnik (1985) reported more
conservative estimates of internal consistency for the subscales with coef-
ficients ranging from .63 to .89 (Mdn .82). Using coefficient alpha, the
internal consistency for the Expertness, Attractiveness, and Trustworthi-
ness subscales for the current sample was .95, .96, and .96, respectively.
Construct validity findings for the CRFS are mixed. Initially, Corrigan
and Schmidt (1983) found three factors utilizing factor analysis that re-
flected the hypothesized constructs of expertness, attractiveness, and trust-
worthiness. Subsequent validation studies have only found two factors
(AttractivenessTrustworthiness and ExpertnessTrustworthiness) indi-
cated by factor-analytic methods (Tryon, 1987; Wilson & Yager, 1990).
Demographic questionnaire. Participants were asked questions regard-
ing their gender, ethnicity, age, length of time in counseling, and whether
counseling was completed. An additional CR (1995) question was asked
regarding emotional state prior to counseling.
The telephone intake worker asked each agency client to participate in
the study for approximately 3 weeks. Some of the clients received the
questionnaires prior to completion of telephone counseling. Both first-time
callers and established clients were included. The telephone counseling
clients received the questionnaires through the mail after receiving at least
one telephone counseling session. A first-time caller speaks with the intake
worker just prior to telephone counseling with the ongoing counselor. An
established client speaks with the intake worker after the telephone coun-
seling session to schedule the next appointment. The only stipulation for
client inclusion was that he or she must have been calling about a problem
related to mental health, relationships, or job/career and been at least 18
years old.
A packet containing the questionnaires was mailed by the telephone
counseling service to each participant. The packet was received about a
week after the recruitment session. The participants filled out the packet,
indicated a return address, and mailed the completed packet to Robert J.
Reese, who is not associated with the telephone counseling agency. The
packet took clients approximately 2025 min to complete. Participants
who returned the completed questionnaires were eligible for a prize draw-
ing (one $100 prize and two $50 prizes).
Several analyses were performed to explore the structure of the
data. At the time of responding to the questionnaires some clients
(26%) had completed telephone counseling, but the rest had not.
Analyses were performed to determine if completion of telephone
counseling made a difference in the perception of effectiveness,
social influence, or therapeutic bond. A multivariate analysis of
variance (MANOVA) was computed comparing individuals who
had completed counseling to those who had not on the three
effectiveness subscales and the total effectiveness score (Wilkss
.99), F(3, 178) .263, p.85,
.004, and the WAIB
and the CRF (Wilkss
.98), F(2, 164) 1.405, p.25,
.017. No statistically significant differences were found. The re-
sults indicate that clients who had finished telephone counseling
did not answer differently than those who were continuing coun-
seling. Combining the sample was justified, and comparing this
data to data from studies with clients who had completed coun-
seling also was justified based upon this analysis.
Question 1: Client Perceptions of Telephone Counselings
To aid in understanding the effectiveness ratings of the tele-
phone counseling sample of this study, we used the CRAQ data
from the CR (1995) face-to-face counseling study for comparison
to the current telephone counseling data. The CR study was se-
lected as a comparison study because of the similarities between
the CR study and our telephone counseling study. Both studies
used actual clients as the sample, the CRAQ for measuring effec-
tiveness and data gathered through the mail. The CR study was
different because it had a higher socioeconomic sample (middle vs.
lower), a sample that probably included only clients who finished
contact with their counselor and clients who reported a higher level
of functioning prior to counseling (see Figure 1). The level of
functioning was significantly worse in the telephone counseling
sample (Somerssdfor ordinal data .113, p.000, Spearman
r.154). Statistical options are limited because Consumers
Union, the publisher of CR, was unwilling to provide standard
deviations. The telephone sample means and standard deviations
as well as the CR (1995) means for the three effectiveness sub-
scales and the total effectiveness scores are reported in Table 1.
Specific improvement. When asked about the specific problem
that led to telephone counseling, 30% endorsed feeling a lot
better,53% reported doing somewhat better,and 15% reported
no difference.Over 80% of the participants felt the specific
problem that led them to counseling had improved. The Specific
Improvement mean scores reported by the telephone counseling
group were slightly lower than the face-to-face counseling scores
(77.4 to 82.0). Figure 2 displays the frequency of response com-
parisons between the telephone counseling data and the CR (1995)
percentages for responses in the categories that CR supplied. Using
the frequency data the CR face-to-face counseling results were
statistically significantly higher than the telephone counseling
data, but the effect size was small (Somerssdfor ordinal data
.068, p.003, Spearman r.096).
Global improvement. When the telephone counseling clients
were asked how they felt at the time they completed the question-
naire compared with how they felt before therapy, 25.1% of the
participants indicated that they were doing quite good,
with 4.4% doing very good.The majority of clients reported
doing so-so(52.5%), and 18.1% of the sample reported feeling
poor.The Global Improvement mean scores reported by the
telephone counseling group were slightly lower than the face-to-
face counseling scores (61.5 to 64.0; see Table 1).
Satisfaction. Over two thirds of the telephone counseling sam-
ple (68%) reported being either very satisfiedor completely
satisfiedwith telephone counseling. Another 27% were fairly
well satisfied,and 5% indicated dissatisfaction. The Satisfaction
mean scores reported by the telephone counseling group were
slightly higher than the face-to-face counseling scores (79.4
to 75.0; see Table 1). Figure 3 contains the comparative percent-
ages between the telephone counseling and the CR (1995) re-
sponses. Using the frequency data, the telephone counseling re-
sults were statistically significantly higher than the CR face-to-face
counseling data but the effect size was small (Somerssdfor
ordinal data .051, p.042, Spearman r.064).
Effectiveness Initial Functioning. The telephone counseling
clients were asked to rate their level of functioning before they
began counseling. An analysis of variance (ANOVA) was used on
the CRAQ total effectiveness scores to compare the three groups
of initial functioning (very poor, M231, SD 37.5; fairly poor,
M214, SD 38.7; so-so or better, M205, SD 30.7). The
differences were statistically significant, F(2, 182) 8.99, p
Figure 1. Comparison of the telephone counseling and the Consumer
Reports (1995) percentile responses to level of functioning prior to
Table 1
Descriptive Statistics of the Telephone Counseling and
Consumer Reports Samples Using the Consumer Reports
Annual Questionnaire (CRAQ) Measures of
Psychotherapeutic Effectiveness
Telephone counseling Consumer
Specific Improvement 174 77.40 19.13 2,606 82
Global Improvement 183 61.50 13.93 2,606 64
Satisfaction 185 79.35 18.99 2,606 75
Total Effectiveness 171 218.32 39.00 2,606 221
Figure 2. Comparison of the telephone counseling and the Consumer
Reports (1995) percentile responses to how much counseling helped the
problem that led to counseling.
Figure 3. Comparison of the telephone counseling and the Consumer
Reports (1995) percentile responses to overall satisfaction with counseling.
.09. Telephone counseling clients who judged them-
selves to be doing the poorest prior to counseling rated total
effectiveness higher than the fairly poor or the so-so or better
groups, using the Tukey post hoc statistic.
Comparing the telephone counseling to the CR (1995) respon-
dentsspecific problem improvement that led to counseling by
their level of functioning data reveals a shortcoming in the tele-
phone counseling (see Figure 4). For respondents who rated their
functioning at the very poor level, the CR data had more responses
at the counseling helped a lotand helped somewhatlevels than
did the telephone counseling sample (Somerssd.052, p
.000, Spearman r.12). Similarly, for respondents who rated
their functioning at the fairly poor level, the CR data had more
responses at the counseling helped a lotand helped somewhat
levels than did the telephone counseling sample (Somerssd
.020, p.009, Spearman r.047).
Question 2: The Counselors Social Influence
The second question addressed how telephone counseling cli-
ents perceived their counselors social influence characteristics of
expertness, attractiveness, and trustworthiness as measured by the
CRFS (Corrigan & Schmidt, 1983; Table 2 presents the descrip-
tive statistics).
To aid in the interpretation of the telephone counseling data, we
compared the social influence scores of this study to those of
another study with individuals who received traditional, face-to-
face therapy. The face-to-face counseling study utilized for com-
parison was the original Corrigan and Schmidt (1983) study con-
taining 155 clients who saw experienced community counselors.
Their study was chosen because it had the highest mean scores
compared with the other studies reviewed, which sets the highest
standards for comparison purposes. Four independent ttests and
effect sizes were computed to compare telephone counseling and
face-to-face counseling for differences in mean scores on the
Expertness, Attractiveness, and Trustworthiness subscales and the
total score on the CRFS. Telephone counseling respondents rated
their counselors no differently than did individuals who saw ex-
perienced therapists face-to-face in community health centers.
None of the ttests were statistically significant (p.05) and
standardized effect sizes were very small (Cohen, 1988), as seen in
Table 2. All of the CRFS scores in Table 2 are near the maximum
positive scores for Expertness, Attractiveness, and Trustworthi-
ness; the possible range is 4 to 28 for these subscales.
Lawson, Gaushell, McCune, and McCune (1995) provided an-
other manner of understanding the level of social influence that the
telephone counseling CRFS scores represent. In their study, the
counselors in the highest credibility group were those who re-
ceived CRFS total scores between 72 and 82. The telephone
counselors would be members of the highest credibility group,
with 76.66 as the mean CRFS score.
Question 3: Counseling Relationship
The purpose of the third question was to assess whether a
therapeutic bond was perceived by the telephone counseling client.
To aid in the interpretation of the telephone counseling data, we
compared the WAIB scores of our study with those from another
study with individuals who received traditional face-to-face ther-
apy. The face-to-face counseling study used for comparison was
the Mallinckrodt, Coble, and Gantt (1995) study because it pro-
vided a mean and standard deviation for the Bond subscale, pro-
vided data from real sessions, and had the highest mean of the
other studies reviewed, which provided the highest standard for
comparison. The sample was composed of 76 women who re-
ceived, on average, eight sessions either at a university counseling
center, a community college counseling center, an outpatient hos-
pital clinic, or a training clinic for a graduate program.
The mean Bond score for the telephone counseling sample
(M72.14, SD 9.79) was a little higher than the normative
sample mean (M70.34, SD 9.58), but the difference was not
statistically significant, t(245) 1.33; the standardized effect size
was small (d.14).
Question 4: Therapeutic Alliance, Social Influence, and
The fourth question addressed the relationship between the
therapeutic alliance, social influence, and outcome. Multiple re-
gression was used to examine the ability of the CRFS total score
and the WAIB (Bond) score to predict the criterion variable, the
Total Effectiveness score from the CRAQ.
Both the WAIB and the CRFS were moderately correlated
with the Total Effectiveness score, r.49, (p.001) and r
.34, (p.001), respectively. The two predictors also were highly
correlated with one another, r.56 (p.001). Both variables in
the regression equation were statistically significant in predicting
total effectiveness, F(2, 152) 22.69, p.001. The R
was .23
(adjusted R
.22), which is considered a medium-to-large effect
size. Both variables accounted for nearly a quarter of the total
variance. The standardized beta weights and structure coefficients
indicate that both predictors do well, especially as indicated by the
structure coefficients, .79 for the CRFS and .94 for the WAIB.
When the structure coefficients are squared, the amount of vari-
ance that each predictor accounts for in the predicted criterion can
be seen (Thompson, 1992). The WAIB explains .88 of the total
criterion variance and the CRFS accounts for .62 of the variance.
Figure 4. The telephone counseling and the Consumer Reports (1995)
percentile responses to how much counseling helped the primary present-
ing problem for two initial levels of functioning prior to counseling.
Each of the predictors is correlated with each other, which explains
why the sum of the predictorssquared structure coefficients
exceeds 100%.
Question 5: Effectiveness Treatment Length
Clients who received telephone counseling for a year or longer
reported more improvement than clients receiving less time in
treatment. Clientsmean total effectiveness score was 213.97
(SD 37.02) for those in counseling 2 months or less, 215.21
(SD 33.61) for those in counseling 3 to 6 months, and 220.38
(SD 36.74) for those in counseling 7 to 11 months. The effec-
tiveness score increased to 243.53 (SD 33.22) for those who had
been in counseling 12 months or longer. An ANOVA indicated a
statistically significant difference, F(3, 178) 4.48, p.01. A
Scheffe´post hoc analysis found a statistically significant differ-
ence for respondents who had been in counseling 12 months or
longer compared with respondents who had received counseling
for shorter periods of time.
The results of the study support the utility of telephone coun-
seling for general mental health concerns using an SFT model.
Telephone counseling tended to be viewed by clients as effective
and satisfactory. The telephone counseling clients tended to per-
ceive the counselors influence and relationship bond as strong.
The more successful telephone counseling outcomes were associ-
ated with higher estimations of counselors social influence and
higher estimations of the counseling relationship bond. Finally,
there is evidence that SFT telephone counseling that lasts longer
than 12 months is more beneficial than shorter term counseling.
Treatment Effectiveness
The most important finding was that respondents reported sat-
isfaction with their telephone counseling experience and believed
that telephone counseling helped them improve their lives. The
positive findings are consistent with case studies of telephone
counseling (e.g., Grumet, 1979) and the few empirical studies
available (e.g., Lynch, Tamburrino, & Nagel, 1997; Zhu et al.,
This study begins to answer some of the concerns about tele-
phone counseling. The ethical concerns (e.g., Haas et al., 1996)
about outcome that have haunted telephone counseling perhaps
now will evolve into investigations addressing more specific out-
come questions and process questions. Although telephone coun-
seling has been used for limited applications (e.g., crisis counsel-
ing), telephone counseling for general mental health concerns may
open up new vistas for counseling services. Telephone counsel-
ings natural niche may be to help individuals who may not
otherwise receive counseling. In this study approximately two
thirds of the respondents indicated that their total family income
was under $30,000, with only 35% of the respondents in the study
having insurance for mental health services. Probably most of the
respondents would not have been able to receive face-to-face
counseling because of the cost.
The comparisons of telephone counseling with face-to-face
counseling revealed some strengths and concerns. In compari-
son to the CR (1995) data, the telephone counseling received
statistically significant higher satisfaction scores but the effect
sizes were small. The face-to-face counseling received statisti-
cally significant higher scores on improvement for the specific
problem that led to counseling but the effect size was small.
Because the effect sizes were small these results are seen as
tenuous and needing further research support, and they are not
discussed here.
A concern surfaced about the effectiveness for clients who
began counseling feeling very poorly. When compared to the
face-to-face counseling (CR, 1995) results, the telephone counsel-
ing respondents who reported functioning very poorly at the be-
ginning of counseling reported significantly less improvement
(based on the Specific Improvement subscale). This finding was
accompanied by a small-to-moderate effect size.
The poorer results of telephone counseling suggest the need for
assessing a clients level of functioning to determine the suitability
for telephone treatment. The finding also indicates the importance
of a referral network of face-to-face counseling in conjunction
with, or instead of, telephone counseling. Additionally, this finding
highlights an area in which telephone counseling may need to
Effectiveness Treatment Length
The telephone counseling clients who used the service for over
a year reported higher functioning than those who used it for less
time. Our results can be considered as similar to the doseresponse
curves found by Howard et al. (1986) and in the CR (1995) study,
where the rate of improvement was found to be a function of
treatment length.
Table 2
Descriptive t-test Statistics Comparing the Telephone Counseling and the Corrigan
and Schmidt (1983) Samples Using the Counselor Rating FormShort Version (CRFS)
Measure of Counseling Social Influence
CRFS measure
Telephone sample Face-to-face sample
Expertness 183 24.87 4.63 155 24.82 3.46 0.11 .02
Attractiveness 185 25.92 3.64 155 25.42 3.85 1.25 .13
Trustworthiness 181 25.76 4.25 155 25.96 3.56 0.48 .05
Total 181 76.66 11.97 155 76.19 9.76 0.40 .03
Counseling Processes
The telephone counseling processes examined in this study
appeared to function no differently than traditional psychotherapy
processes. The telephone counselor was viewed as emotionally
invested and influential in the counseling relationship. When we
compared the telephone counseling data gathered in this study to
face-to-face studies, there was no difference in amount of thera-
peutic bonding or social influence. These findings are important
because the most consistent predictor of outcome has been the
therapeutic relationship between the client and counselor. Addi-
tionally, these findings suggest that the process measures of ther-
apeutic bond and social influence can be meaningfully used to
investigate telephone counseling further.
The lack of visual cues could change counselor training tech-
niques for telephone counseling as compared with face-to-face
counseling. For example, Heppner and Claiborn (1989) surmised
that the variables influencing clientsearly ratings of social influ-
ence were nonverbal behaviors, most of which were visual. The
telephone removes many of the counselors opportunities for
amassing social influence through visual means. The voice of the
telephone counselor communicates what an office, clothes, and
physical appearance typically offer a counselor. Training the tech-
niques of telephone counseling may provide extra focus on use of
the voice. Future research may find that focus on the use of voice
may have a salutary effect on face-to-face counseling as well. Or,
future research may find that with the visual stimuli removed, the
telephone client becomes more focused on what the therapist says.
Limitations of Study
An effectiveness study examines psychotherapy in the field,
which contributes to external validity. An effectiveness study
provides valuable information about how counseling is actually
performed and provided to clients who have a wide variety of
problems. However, effectiveness studies are known for weak-
nesses in internal validity. This study attempted to remedy some of
those inherent limitations.
The central limitation of this study is the lack of a treatment
integrity measure. We have no evidence that the telephone coun-
selors provided SFT adequately beyond the assurances of the
supervisors. However, this study did investigate telephone coun-
seling as actually performed when not controlled by researchers.
The counselors were supervised once a week.
Other limitations inherent to an effectiveness study were ad-
dressed to ameliorate their negative influences: potential sampling
bias, the lack of a control group, and the number of people sampled
who had not completed therapy. Survey studies suffer from the
threat of sampling bias because random sampling does not occur.
In this study every individual who called to use telephone coun-
seling, except crisis callers and persons under age 18, was given
the opportunity to participate in the study; only 8 persons initially
declined to participate. Seligman (1995) described the CR proce-
dure to test the validity of their sample. In their initial uncompen-
sated response questionnaire, they received a return rate of 13%.
When compensating the respondents in their validation study they
received a return rate of 38% and there were no differences
between the data gathered from the two sets. Our return rate was
a similar 37% using a similar approach to that of CR.
Other indications that the responders were similar to the typical
users of the telephone counseling service were the demographic
comparisons. The similarities are in the female to male respon-
dents, the breadth of the presenting problems, and the high fre-
quency of clients using telephone counseling two or fewer times.
A second concern is the lack of control groups. This is an
inherent flaw for an effectiveness study in comparison to an
efficacy study. However, we dealt with that limitation by compar-
ing our results to those of similar studies. In the case of the process
variables, the highest scoring comparison groups from the litera-
ture substituted for control groups.
Our sample may systematically differ from the comparison
groups in some way other than face-to-face and telephone coun-
seling that influenced the assessment scores. An obvious differ-
ence was the income level of the clients. Our sample was com-
posed primarily of people earning less than $30,000 a year and
with less than a college education. The CR study sampled persons
who were likely to be college graduates and have higher incomes.
These issues should have made for conservative claims for tele-
phone counseling. If socioeconomic status did effect treatment or
measures, the literature suggests that lower socioeconomic status
places more hardships on persons, which may suppress their ability
to use therapy effectively.
Another characteristic of this sample was the mix of individuals
who had completed (26%) and not yet completed (74%) telephone
counseling. However, as noted previously, there was no statistical
difference and only a small effect size when comparing the scores
of respondents who had completed counseling with those who had
not. Therefore, the mix of individuals who had not completed
counseling does not appear to be a limitation.
Further research is necessary to substantiate the findings pre-
sented here. Future outcome studies need to focus on the level of
initial functioning when comparing telephone counseling to face-
to-face counseling. The telephone counseling data presented in this
study reveal that clients starting with a poorer level of functioning
gained more from counseling. However, the data show that face-
to-face counseling (CR, 1995) is more helpful for poor functioning
clients than telephone counseling.
Process studies examining the techniques used in telephone
counseling seem especially important because of ethical issues.
Our ethical standards require us to provide service only in areas in
which we are competent; process studies could identify skills that
are necessary and possibly unique to telephone psychotherapy. It
may be that certain techniques should be avoided in telephone
Examining the theoretical orientation used in telephone coun-
seling could be important. Perhaps some counseling approaches
are not suitable to telephone counseling if they contain techniques
that could endanger the therapeutic alliance. For example, it may
be that a psychodynamic therapist may have difficulty with a client
when interpretations are received negatively by the client.
Another area of future research is the possible interaction of
client socioeconemic status and telephone counseling. Wark
(1982) noted that a potential advantage of telephone counseling
was the absence of visual biases for both the client and the
counselor. For example, neither the physical characteristics of the
therapist or the client could negatively influence the counseling
relationship over the telephone. Also, the office surroundings (e.g.,
diplomas on the wall, a nice office) or clothing could negatively
influence the relationship, based on a perceived inequality in
power, values, or socioeconomic status. The removal of these
potential biases may have been important in this study, given the
low socioeconomic status of the sample.
In conclusion, the good news about telephone counseling is that
over 82% of the respondents reported specific improvement on
their presenting problem. Clients reported strong levels of satis-
faction with telephone counseling. Therapeutic relationships and
influence processes appear to occur at efficacious levels over the
telephone. The therapeutic outcome of counseling was predicted
by the process variables that are predictive for face-to-face coun-
seling. The final good news is that persons of a socioeconomic
status that does not typically have money or insurance for face-
to-face counseling used telephone counseling. We are uneasy
about the fate of persons who view themselves as doing very
poorly prior to treatment. Telephone counseling clients who rated
themselves as doing very poorly prior to treatment did not report
that counseling was as helpful as did clients in face-to-face coun-
seling. Clearly, the processes involved in telephone counseling
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Received November 14, 2000
Revision received August 20, 2001
Accepted August 21, 2001
... During phone and home visit follow-up, patients were educated on how to manage symptoms, provide encouraging words to maximize health, and most importantly ensure calorie and protein requirements achieve. These beliefs to be drivers for dietary manipulation as well (9,10). ...
... Phone counseling is feasible and helpful in improving the outcome of the treatment, whereby the respondent rated counseling relationship and level of interpersonal influence similar to face to face counseling (9,10). The rapport developed during phone counseling also believes to facilitate on-going participation in the study (10). ...
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Short-term nutritional optimization before surgery and Enhanced Recovery After Surgery (ERAS) protocol aimed to achieve early recovery after surgery by maintaining preoperative organ function and reducing the profound surgical stress response. Case presentation: A 83-years-old female patient with Rectal Adenocarcinoma with Locoregional Infiltration of Uterus was started intensive nutritional intervention fortnight pre-operation. The patient was cachexia with 33 kg; loss of 2 kg within 1 month; PG-SGA score 13 (severe malnourished); She experienced very poor oral intake for the past 1 month. Total intake was 770 kcal and 33 g/day protein. Oral nutritional support (extra 500kcal) was given. The phone call and home-visit were conducted to ensure compliance of the nutritional intervention. Upon admission, the patient gained 0.9 kg; increased intake 1542 kcal/day with 76g/day protein. ERAS protocol with preoperative carbohydrate loading and postoperative early oral feeding was implemented. Length of hospital stay was 6 days 16 hours, clear fluid toleration was 20 hours, solid food toleration was 5 days and gastrointestinal function (flatus and bowel open) was 3.5 days. Discussion: Advanced age is a proven risk factor for postoperative complications. Intensive nutrition support, which involved phone call and home-visit, was proven to facilitate compliance towards nutrition counselling. Integrating nutritional support following perioperative ERAS protocol showed combination outcomes where increased nutrition intervention compliance and shorten length of hospital stay without compromise complications for the malnourished elderly patients. Conclusion: Nutrition support following the ERAS protocol was beneficial for malnourished cancer elderly patients.
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... 25 An online review survey of 1396 users of the Samaritans in 2012 found that perceived helpfulness was high with 64.7% being moderately or very satisfied. 25 Case histories of disasters demonstrate that basic support can be delivered by well-trained volunteers. 17 However, helpline volunteers experience high levels of emotional impact and burnout leading to a high level of dropout in these services. ...
Background: This study describes the design, implementation and evaluation of a national bereavement helpline developed as proactive tiered response to immediate be reavement care during the COVID pandemic, operated in partnership between a national charity and the National Health Service. The service was based on Psychological First Aid principles adapted to integrate bereavement education. Its aim was to provide asupportive compassionate listening service, education advice resources and sign posting to community services. Methods: Two independent psychologist were commissioned to undertake a retrospective service evaluation of six months of the operation of the line, using a volunteer survey, interviews and line usage data. Results and conclusions: Results show that the line is meeting a need, PFA + Bereavement is providing a useful framework for service delivery, and there is good adherence to the model. Volunteers are experiencing working on the line as challenging but rewarding. Supervision and debriefing are essential for volunteer well being and confidence. Approximately 10% of callers were referred onto other services. Management report that they good oversight of governance issues and are planning for the future development, and funding of the line for the next two years.
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The effect of personal and perceived stigmatization on attitudes towards counseling in face-to-face and online modalities, as well as the intent to seek school counseling, was investigated in this study. The researchers used a descriptive correlational and quasi-experimental research design to come up with a structural equation model. 439 participants completed the survey measuring self-stigma, perceived stigma, attitudes in face-to-face and online counseling, and counseling-seeking intentions. Results indicated that self-stigma and perceived stigma were negatively associated with attitudes toward face-to-face and online counseling, as well as intentions to seek counseling. Attitudes toward counseling in face-to-face modality were positively related to intentions to seek counseling, while attitudes toward online counseling did not significantly affect intentions. From this, a structural equation model was generated. It indicates that stigmatization by others predicts the stigmatization by self and influences how comfortable adolescents are with counseling in both online and face-to-face modalities. This stigmatization by self and discomfort then predicts the way adolescents place importance on the two counseling modalities which in turn predicts the level of school counseling-seeking intention they have for various concerns. These findings highlight the importance of addressing stigma to promote positive attitudes toward counseling and increase help-seeking intentions.
... Theoretically, counseling service is originated from various psychological-based theories (Kabir, 2018). Reese et al. (2002) figure out that effectiveness in counseling is the satisfaction of clients in overall situations such as the resolution of psycho-social troubles, academic distress, emotional and related personal problems. On the other hand, counseling service effectiveness is determined by clients' characteristics such that motivations, interest, trust, or belief in getting satisfied with given services (Musika & Bukaliya, 2015a). ...
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This study was aimed at understanding students’ academic self-concept, academic help-seeking behaviors, and beliefs in counseling service effectiveness. Based on a correlational research design, a closed-ended questionnaire was administrated to 182 college students. Independent-sample t-test revealed that male students’ average score was significantly higher than female students’ average score in academic self-concept, help-seeking behavior, and belief in counseling effectiveness. Analysis of relationship confirmed that academic help-seeking behavior, belief in counseling service effectiveness, and academic self-concept significantly correlated each other. This study also revealed that the variance of academic self-concept and belief in counseling service effectiveness contributed to 36% of the variance in academic help-seeking behavior. Therefore, enhancement projects on academic self-concept and female students’ belief in the effectiveness of counseling services should be taken as an agenda by teachers, college administrators, academic advisors, and counselors.
... A review of 14 studies by Leach and Christensen (2006) indicated that telephoneadministered therapy was effective in reducing symptoms of mental illness. Telephone interventions have been effective in reducing depression, anxiety, eating disorders, alcohol use, and rehospitalization for schizophrenia (King, Bambling, Reid, & Thomas, 2006;Leach & Christensen, 2006;Reese, Conoley, & Brossart, 2002). Telephone helplines have been found to be particularly efficacious in dealing with issues pertaining to children and adolescence (Christogiorgos et al., 2010;Fukkink & Hermanns, 2009). ...
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Counseling and psychotherapy training in countries around the world have been imbued with theories and models developed in the Euro-American perspective. This chapter looks at the role of the therapist, therapist competence, and development as integral to therapy process and outcomes, from the perspective of developing countries in Asia. Training and education for counselors and therapists with reference to models of training, entry points, content of training programs, supervision, personal therapy, and deliberate practice have been examined. The lack of regulation and licensing and their impact on the professionalization of the field have been commented on. Encouraging open communication and dialogue across countries can help facilitate a culturally grounded approach to the training and supervision of therapists. Creating national bodies with the mandate of examining pedagogy and curriculum development in counseling training institutes across Asia may further help to establish common goals as well as enable sharing unique sociocultural specific practices and insights. Recommendations have been laid out for meeting the challenges to global mental health resulting from the sociopolitical changes of the twenty-first century. The need to develop multicultural sensitivity and locally relevant codes of ethical standards is paramount.
... Theoretically, a counseling service originated from various psychological-based theories (Kabir, 2018). Reese et al. (2002) figured out that effectiveness in counseling is the satisfaction of clients in overall situations, such as the resolution of psychosocial troubles, academic distress, and emotional and related personal problems. On the other hand, counseling service effectiveness is determined by clients' characteristics such as motivations, interest, trust, or belief in getting satisfied with given services (Musika and Bukaliya, 2015). ...
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This study aimed at understanding students’ academic self-concepts, academic help-seeking behaviors, and beliefs in counseling service effectiveness. Based on a correlational research design, a closed-ended questionnaire was administrated to 182 college students. An independent-sample t-test revealed that the average scores of male students were significantly higher than average scores of female students in academic self-concept, help-seeking behavior, and beliefs in counseling effectiveness. An analysis of the relationship between them confirmed that academic help-seeking behaviors, beliefs in counseling service effectiveness, and academic self-concepts significantly correlated with each other. This study also revealed that the variance of academic self-concept and belief in counseling service effectiveness contributed to 36% of the variance in academic help-seeking behavior. Therefore, enhancement projects on academic self-concept and female students’ belief in the effectiveness of counseling services should be taken as an agenda by teachers, college administrators, academic advisors, and counselors.
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The study aimed to investigated the effect of online counseling to cabin fever phenomenon of students in SMP Negeri 1 Tanjung Morawa . The research used a q u a n t i t a t iv e m e th o d . T h e ty p e o f t h is r e s e a r c h w a s q u a s i exp e r i m e n ta l w i t h p r e te s t a n d p o s t t e s t design. The data collection technique used a questionnaire of cabin fever scale. The sample of this research was 10 students which was taken by purposive sampling technique. The data analyzed used Wilcoxon test. The result showed that the wilcoxon signed rank test obtained Jcount = 77 and Jtable = 5.Therefore, Jhitung> Jtable . The level of significance for test α=0.05. It could be concluded that there is the effect of the online counseling to cabin fever phenomenon of students in SMP Negeri 1Tanjung Morawa
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Öz Son yıllarda yaşanan teknolojik ilerleme ve gelişmeler çoğu alanı olduğu gibi ruh sağılığı alanını da önemli derecede etkilemektedir. Bunun en önemli göstergesi ruh sağlığı alanındaki telesağlık hizmetlerinin yaygınlaşmasıdır. Telesağlık uygulamalarından birisi de telekonsültasyondur. Telekonsültasyona ilişkin tıp alan yazınında çok sayıda klinik uygulama ve araştırma mevcut iken okul temelli telekonsültasyon çalışmaları henüz başlangıç aşamasındadır. Ulusal alan yazında ise okul temelli telekonsültasyona ilişkin herhangi bir akademik çalışma bulunmamaktadır. Bu nedenle araştırmada okul temelli telekonsültasyon hizmetinin ne olduğunu, uygulamada ne gibi ekipmanlara ve koşullara ihtiyaç duyulduğunu, uygulama sürecinde nelere dikkat edilmesi gerektiğini, avantajlarını ve sınırlılıklarını, alan yazındaki ilgili araştırmaları ve sonuçlarını ortaya koymak amaçlanmaktadır. Abstract Technological advances and developments in recent years have a significant impact on mental health as well as most other fields. The most important indicator of this is the widespread use of telehealth services in the field of mental health. One of the telehealth practices is the teleconsultation.. While there are many clinical applications and researches in the medical literature regarding teleconsultation, school-based teleconsultation studies are still in their infancy. There is no academic study on school-based teleconsultation in the national literature. For this reason, it is aimed to reveal what school-based teleconsultation service is, what equipment and conditions are needed in implementation, what should be considered in the implementation process, its advantages and limitations, and the relevant researches and results in the literature.
Objectives: The COVID-19 pandemic and associated 'lockdown' confinement restrictions have resulted in multiple challenges for those living with eating disorders. This qualitative study aimed to examine the lived, psychosocial experiences of individuals with anorexia nervosa from within COVID-19 'lockdown' confinement. Methods: Audio-recorded semi -structured interviews were conducted online during the first wave of the COVID-19 pandemic during confinement with a purposive sample of 12 participants who identified as having Anorexia Nervosa. Interviews were transcribed and anonymous data analysed using Thematic Analysis (Braun & Clarke, 2006). Results: Three key themes with six contributory subthemes were identified. Key themes were: loss of control,supportduring confinement, and time of reflection on recovery. Theme content varied according to stage of recovery and current clinical management. Availability of 'safe' foods, increases in compensatory exercise and symptomology, and enhanced opportunities for "secrecy" were described. Conclusions: These findings provide a unique insight for a vulnerable group from within COVID-19 confinement. The data demonstrated that the impact for individuals with anorexia nervosa has been broadly negative, and participants voiced concerns over the long-term effects of the pandemic on their recovery. The findings highlight the risks of tele-health support and an important role for health professionals in enhancing targeted support during, and after confinement.
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The article traces the development of the concept of the therapeutic working alliance from its psychodynamic origins to current pantheoretical formulations. Research on the alliance is reviewed under four headings: the relation between a positive alliance and success in therapy, the path of the alliance over time, the examination of variables that predispose individuals to develop a strong alliance, and the exploration of the in-therapy factors that influence the development of a positive alliance. Important areas for further research are also noted.
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A principal components analysis with direct oblimin rotation of the Counselor Rating Form- Short Version (CRF-S) yielded two factors. The first is composed of attractiveness and trustworthiness items and the second is composed of expertness and trustworthiness items.
Initial validation data on the Counselor Rating Form—Short Version (CRF—S; J. D. Corrigan and L. D. Schmidt; see record 1983-09385-001), a revised version of the Counselor Rating Form (CRF; A. Barak and M. B. LaCrosse; see record 1976-07806-001), were positive. The present study, with 215 college students, largely replicated the methodology, and simultaneous collection of data on the CRF and the CRF—S allowed for direct comparisons between the 2 instruments. Results generally add to the validation of the CRF—S, but it was not successful in facilitating greater use of the lower end of the 7-point rating scale. Differences in counselor ratings suggest that the 2 instruments might be measuring slightly different constructs. (8 ref)
Smokers requesting self-help materials for smoking cessation ( N = 2,021) were randomized to receive (1) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (2) the same self-quitting guide with a support guide for the quitter's family and friends, (3) self-quitting and support guides along with 4 brief counselor calls, or (4) a control guide providing motivational and quit tips and referral to locally available guides and programs. Ss were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control Ss achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-mo quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article discusses the findings of a descriptive study on solution-focused brief family therapy in a children's mental health facility. Findings indicate a 64.9% success rate for an average of 5.5 therapy sessions over an average of 3.9 months. In addition, findings provide initial support for the applicability of solution-focused brief family therapy to a wide range of families from diverse backgrounds as well as to the practice of working with whoever comes to therapy. The study also introduces thought-provoking theoretical and clinical issues regarding helpful versus unhelpful therapy processes and the influences of problem nature and selected goals on therapy outcomes.
In this study, significant relationships were found between several dimensions of intergenerational family relationships and supervisor ratings of counselor behavior.