Information and communication technologies (ICT) become indispensable parts of daily lives and have diffused to almost every area of our lives such as education, trade, entertainment, socialization, art, sport, and health. Similarly, mental health disciplines expose to change and transformation with the integration of ICT; and online counseling (OC) has emerged as a new modality of counseling. Distance counseling, e-therapy, and cybertherapy, are other terminologies using interchangeably for OC (American Counseling Association [ACA], 2014; Manhal-Baugus, 2001; Suler, 2000). OC is defined as “any delivery of mental and behavioral health services, by a licensed practitioner to a client in a non-face-to-face setting through distance communication technologies such as the telephone, asynchronous e-mail, synchronous chat, and videoconferencing” (Mallen & Vogen, 2005, p. 764).
Formerly face-to-face counseling is the predominant way of receiving counseling but now OC is being used as an alternative. Mallen et al. (2005), indicated that OC might be a feasible service especially for people who are typically isolated. During 2020, after the breakout of worldwide COVID-19 pandemic, this situation seems to be applying to millions of people around the globe (World Health Organization [WHO], 2020). The study conducted in Spanish speaking countries in March 2020 revealed that more than half of the internet users are willing to consult online mental health services (Yanhaas, 2020a; 2020b). Wellness and remote health consultation applications are considered in the fast-growing zone in mobile app categories. (Ericsson Consumer & IndustryLab, 2020). At the time being, while the percentage of mental health practitioners who offers online services before COVID-19 was only 36%, in May 2020, 85% of the respondent practitioners indicated that they use online services with more than ¾ of their clients (American Psychiatric Association [APA], 2020).
OC has become increasingly popular but there isn’t a consensus on the effectiveness of it. Although OC has many pros, it is criticized for cons such as not fulfilling the counseling process requirements and violation of ethical principles. One of the widely accepted advantages of OC is accessibility. OC removes physical distance barriers to reach out the experts, provides more flexible time slots and also gives opportunity to people with disability or phobia (Pollock, 2006). In addition, some types of OC are cheaper compared to face-to-face counseling (Sampson, Kolodinsky, & Greeno,1997). Although it has benefits, it has raised concerns especially in ethical principals. Providing confidentiality, security, privacy, maintaining therapeutic alliance, dealing with technical problems, losing nonverbal clues are some of the reported concerns (Tanrikulu, 2009).
While all these discussions and critics on OC are going on, OC continues to be used in different areas such as marriage and family counseling (Jencius & Sager, 2001), career counseling (Balke, Kruzic, & Way, 2017), tobacco-cessation program (Mallen, Blalock, & Cincirpini, 2006), depression (Christensen, Griffiths, & Jorm, 2004) and etc. Its usage has been expected to widespread and increased (Tanrikulu, 2009). At this point, it is important to examine the views of those who will take OC service. The largest portion of this potential group constitutes of university students. OC usage has been increasing among university students because they are familiar with ICT (Maples & Han, 2008).
In this context, the purpose of the study is to examine the university students’ views, preferences and suggestions for improving OC services. The research questions of the study were:
1) What are the opinions of university students’ regarding the advantages and disadvantages of OC?
2) Which formats of OC do university students prefer to use?
3) What subjects do university students prefer to receive OC?
4) What do university students suggest to improve the effectiveness of OC services at universities?
In the current study, a phenomenological qualitative research design was utilized. Researchers conducted two studies with the same purpose and method by considering the effect of COVID 19 on participants’ views and experiences. In study 1, data were collected before the COVID 19 pandemic. In study 2, data were collected during COVID 19 pandemic. In total, 21 university students (Study 1: 6 females, 4 males, age range 19-25; Study 2: 6 females, 5 males, age range 19-27) participated in the study.
In order to collect data, researchers developed a semi-structured Online Counseling Interview Form (OCIF) by reviewing the literature. After generating the interview questions, three cognitive interviews were conducted with university students and two expert opinions were received. OCIF has two sections. The first section includes questions related to demographic information such as gender, age, faculty. The second section includes questions on students’ views, preferences and suggestions regarding the OC. Some sample questions are: “What could be the advantages of OC?”, “What are your suggestions for increasing the effectiveness of OC services at universities?”
After taking the approval of the ethics committee of the university, participants were invited to study by email or phone. Before the interviews, each volunteer participant read the written consent forms and signed it. In study 1, all of the interviews were face to face and recorded with a tape recorder. But in study 2, interviews were online and recorded by the videoconferencing programs. Interviews lasted approximately thirty minutes.
Recorded interviews were transcribed verbatim and data were analyzed by descriptive analysis method. In order to increase the internal reliability, coding was done by two researchers independently. Afterwards, the consistency of the coding was checked and it was seen that they were compatible with each other to a great extent. After clarifying the common codes and themes, the quotations that best express these themes were selected.
Participants of Study 1(n1) and Study 2 (n2) reported advantages of OC as cheaper cost (n1, n2 = 7, 5), increased accessibility (n1, n2 = 7, 2), saving time and energy (n1, n2 = 6, 10), flexible scheduling (n1, n2 = 6, 7), sense of comfort/ easier self-disclosure (n1, n2 = 5, 6), anonymity (n1, n2 = 4, 4), providing opportunity for reaching specialists that are far away (n1, n2 = 5, 5), having access to counseling services without leaving their comfort zone (n1, n2 = 3, 5), and privacy (n1, n2 = 2, 4). Disadvantages of OC were reported as lack of face to face communication (n1, n2 = 10, 10), problems with technology (n1, n2 = 7, 10), the probability of recording sessions without consent (n1, n2 = 6, 2), and violation of privacy (n1, n2 = 2, 9). Most of the participants in Study 1 and 2 preferred to use synchronous format [video call (n1, n2 = 6, 11) and phone call (n1, n2 = 6, 9)] as their first two choices, and asynchronous formats [text-message (n1, n2 = 5, 8) and e-mail (n1, n2 = 7, 9)] as their last two choices. They did not prefer OC for their personal problems which required in-depth self-disclosure such as sexual abuse, family problems, substance use but they preferred to use it in more common problems such as career planning, academic concerns, and Internet addiction. For improving the effectiveness of OC in universities participants made suggestions about announcement, format and administration of OC. Some of their suggestions were preparing announcement which built students’ trust in the efficacy of OC, providing OC services in multiple format, developing programs to categorize students’ problems, increasing the number of counselors who can give OC services, creating phone line for urgent problem areas.