Cybertherapy or Psychobabble? A Mixed Methods Study into Online Emotional Support Amy Callahan Supervisor: Dr Kay Inckle A thesis submitted in partial fulfilment of the requirements for the degree of Masters of Science in Applied Social Research School of Social Work and Social Policy Trinity College Dublin 1 After all, if people can have sexual relationships online in a chat room, using a keyboard and typing… Then if they can do that, then presumably you can communicate therapeutically. (Eamon, Interview Participant) 2 Declaration This thesis is entirely my own work. It has not been submitted to this university or any other institution for publication. I authorise the University of Dublin to lend this thesis to other institutes or individuals for the purpose of scholarly research. Signature: I further authorize the University of Dublin to reproduce this thesis by photocopying or by other means, in total or in part, at the request of other institutes or individuals for the purpose of scholarly research. Signature: 3 Acknowledgements Dear Reader, I realise you have been waiting (with baited breath) to read this thesis. And while typically the acknowledgements are the most read page, I know you will want to read this work in its entirety. Possibly more than once! Before we start this journey together, I want to thank a few people, without whom, this would be a far inferior piece of research. In addition, they have helped me keep somewhat sane. First, to my participants; in the focus group, Bosco, Molly, Optimus Prime, Superman, and Molly; and the interview participants, Claire, Brian, Darren, Eamonn, Jenny, Linda, Mary, Madeleine, and Natalie. Quite literally this would not have been possible without you. My sincere thanks to Dr. Kay Inckle, who has been so incredibly kind and supportive. Without her suggestions, comments, and thoughts this would not have been possible. I have learned so much and I enjoyed it at the same time! I cannot say enough to express how thankful I am to have met Kay and been able to work with her. I have never failed to be impressed with her ability to find something nice to say and to provide guidance around the parts that have, quite simply, fallen to pieces! Thanks also to Dr. Philip Curry and Professor Robbie Gilligan, for the advice and for the opportunity to work alongside you. And to the Director of the MSc, Dr. Evelyn Mahon - and all the teaching staff: Dr. Brid McGrath, Mark Ward, Jessica Davis-Breen, and Jemimah Bailey. Finally thanks to my friends and family, especially to Connor. 4 Abstract This study uses a mixed-methods approach to investigate the area of online mental health support. A detailed statistical analysis of quantitative data from an Irish Children’s Helpline was combined with in-depth qualitative interviews with a variety of counsellors and other practitioners and a focus group with young people. Quantitative data yielded statistically significant differences in topic of conversation between telephone and online data, with online conversations more likely to be focused on mental health topics, requests for information, or peer relationships. Telephone conversations tended to be focussed on everyday life issues. Practitioners and young people had concerns about online clients concealing their identity or misrepresenting themselves, participants also pointed out how online supports mediate the sense of a power imbalance in a therapeutic relationship, how online supports have a therapeutic quality by simply allowing a client time to express themselves, and how they allow a client increased access to information. However, more research needs to be undertaken exploring the effectiveness of online supports and the types of clients they are most appropriate and helpful in reaching. Online services have great potential, but practitioners need to overcome their fear of technology and become more comfortable online before they begin providing these services. 5 Table of Contents Chapter One: Introduction .................................................................................................................. 9 Chapter Two: Existing Research Regarding Online Mental Health Support ...................................... 13 Overview ....................................................................................................................................... 13 Counselling and Status of Counselling in Ireland ........................................................................... 13 Technologies Used in Mental Health and Emotional Support ......................................................... 16 Lack of Visual / Verbal Cues .......................................................................................................... 18 Anonymity and Confidentiality ....................................................................................................... 19 Ethical Issues / Appropriateness for Clients ................................................................................... 20 Effectiveness of Online Supports ................................................................................................... 22 Summary ...................................................................................................................................... 23 Chapter Three: Methodology Overview and Hypothesis ................................................................... 25 Chapter Four: Results and Discussion ............................................................................................. 37 Overview ....................................................................................................................................... 37 Profiles of Young People Accessing Online Support ...................................................................... 38 Misrepresentation and Identity Concealment ................................................................................. 43 Topic of Conversation ................................................................................................................... 44 Lack of Visual / Verbal Cues .......................................................................................................... 52 Anonymity and Confidentiality ....................................................................................................... 54 Ethical Issues / Appropriateness for Clients ................................................................................... 55 Effectiveness of Online Supports ................................................................................................... 56 Access to Information .................................................................................................................... 57 Time and Space ............................................................................................................................ 58 Summary ...................................................................................................................................... 60 Chapter Five: Conclusion ................................................................................................................. 62 Appendix I: Ethics Approval ............................................................................................................. 71 Appendix II: Participant Information Sheet ....................................................................................... 73 Appendix III: Young Participant Information Sheet ........................................................................... 74 Appendix IV: Participant Consent Form ........................................................................................... 75 Appendix V: Young Participant Consent Form ................................................................................. 76 6 Appendix VI: Parental/Guardian Consent Form ................................................................................ 77 Appendix VII: Parental/ Guardian Consent Form .............................................................................. 78 Appendix VIII: Topic of Conversation as outlined by Child Helplines International ............................. 79 Appendix IX: Interview Schedule ...................................................................................................... 82 Appendix X: Focus Group Schedule ................................................................................................ 84 Appendix XI: Coding for Qualitative Data ......................................................................................... 86 Appendix XII: Boxplot of Age for Sample of Phone Calls to an Irish Children's Helpline .................... 88 Appendix XIII: Frequency and Percent of Topics in an Irish children's helpline - Overall and Broken into Method of Contact ............................................................................................. 89 List of Figures Figure 1. Professional Interventions as a Continuum (Grohol 1999) .................................................. 14 Figure 2. Fictional representation of raw data collected from an Irish Children's Helpline ................... 29 Figure 3. Topic of Conversations in an Irish Children's Helpline (%) .................................................. 45 Figure 4. Topic of Telephone Conversations in an Irish Children's Helpline (%) ................................. 46 Figure 5. Topic of Online Chat Conversations in an Irish Children's Helpline (%) ..............................