AN EMPIRICAL EXAMINATION OF THE INFLUENCE OF PERSONALITY, GENDER ROLE CONFLICT, AND SELF-STIGMA ON ATTITUDES AND INTENTIONS TO SEEK ONLINE COUNSELING IN COLLEGE STUDENTS A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Nicholas Joyce August, 2012 AN EMPIRICAL EXAMINATION OF THE INFLUENCE OF PERSONALITY, GENDER ROLE CONFLICT, AND SELF-STIGMA ON ATTITUDES AND INTENTIONS TO SEEK ONLINE COUNSELING IN COLLEGE STUDENTS Nicholas Joyce Dissertation Approved: Accepted: ______________________________ ______________________________ Ingrid K. Weigold, PhD Department Chair Advisor Dr. Karin B. Jordan ______________________________ ______________________________ David B. Baker, PhD Dean of the College Committee Member Dr. Mark D. Shermis ______________________________ ______________________________ Renee R. Mudrey-Camino, PhD Dean of the Graduate School Committee Member Dr. George R. Newkombe ______________________________ _______________________________ James R. Rogers, PhD Date Committee Member ______________________________ Charles A. Waehler, PhD Committee Member ii ABSTRACT This study investigated the relationship of personality, gender role conflict, and self-stigma on the attitudes of college students toward internet counseling and their intentions to use such services. Previous literature has shown that online therapy can be ethically provided and has effective outcomes. Theorists have wondered if online counseling would minimize the negative impact of masculine gender roles and self- stigma of receiving counseling services; neither of which has been empirically tested. Data were analyzed from 494 college students. Results indicated that self-stigma is more positively related to attitudes and intentions to seek help for online counseling than it is for face-to-face counseling. The gender role conflict aspect of Restrictive Emotionality was positively associated with attitudes toward online counseling. No aspects of gender role conflict were related to intentions to seek online help for interpersonal or academic concerns while Conflicts Between Work and Family Life was positively related to intentions to seek help for drug concerns. The Five Factor Model aspect of Openness was found to be significantly related to attitudes toward online counseling and intentions to seek online counseling, whereas Extraversion was not. Post-hoc analyses explored gender differences in these relationships. Results indicated that online counseling may be a favorable option for people experiencing high levels of self-stigma toward mental health services, men with certain aspects of gender role conflict, and people who are high in the personality aspect of Openness. Future directions for research and implications for practice are discussed. iii TABLE OF CONTENTS Page LIST OF TABLES.…………………………………………………………………........vii CHAPTER I. INTRODUCTION……………………………………………………………………... 1 Statement of the Problem…………………………………………………………. 1 Importance of the Study…………………………………………………………. 16 Definitions……………………………………………………………………….17 II. BACKGROUND OF THE STUDY………………………………………………... 19 Introduction……………………………………………………………………… 19 Online Counseling: What is it?.............................................................................. 20 Counseling Psychology and Online Therapy………………………………….... 28 History and Background of Online Counseling…………………………………. 35 Online Therapy as Part of Growth in Field of Telehealth/Telemedicine………... 40 Ethics……………………………………………………………………………..51 Online Therapeutic Relationships……………………………………………….. 59 The Counselor Experience………………………………………………………. 75 The Client Experience…………………………………………………………... 82 Online Support Groups………………………………………………………….. 87 Outcome Studies………………………………………………………………… 97 iv Research on College Students…………………………………………………. 118 Individual Differences…………………………………………………………. 127 III. METHOD…………………………………………………………………………...162 Introduction……………………………………………………………………. 162 Participants and Procedure……………………………………………………... 162 Measures……………………………………………………………………….. 164 Statistical Analyses…………………………………………………………….. 173 IV. RESULTS………………………………………………………………………….. 176 Introduction………………………………………………….………………… 176 Preliminary Analyses…………………………………………………………... 176 Main Analyses…………………………………….…………………………… 180 Post-hoc Analyses……………………………………………………………… 193 V. DISCUSSION………………………………………………………………………. 205 Introduction…………….……………………………………………………… 205 Hypotheses……………………………………………………………………... 207 Trends………………………………………………………………………….. 219 Limitations……………………………………………………………………... 222 Future Research………………………………………………………………... 225 Implications for Practice……………………………………………………….. 227 Conclusion……………………………………………………………………... 230 REFERENCES………………………………………………………………………… 232 APPENDICES…………………………………………………………………………. 248 v APPENDIX A. ONLINE COUNSELING ATTITUDES SCALE….………… 249 APPENDIX B. GENDER ROLE CONFLICT SCALE……………………….. 252 APPENDIX C. SELF STIGMA OF SEEKING HELP SCALE…….……….... 254 APPENDIX D. INTENTIONS TO SEEK COUNSELING INVENTORIES………………………………………………………………... 255 APPENDIX E. INTERNATIONAL PERSONALITY ITEM POOL- FIVE FACTOR MODEL……………………………………………………… 257 APPENDIX F. DEMOGRAPHICS……………………………………………. 259 APPENDIX G. INFORMED CONSENT FORM……………………………... 261 APPENDIX H. DEBRIEFING FORM………………………………………... 263 APPENDIX I. MANIPULATION CHECK…………………………………… 264 APPENDIX J. IRB APPROVAL FORM……………………………………… 265 vi LIST OF TABLES Table Page 1 Means, Standard Deviations, Skewness, Kurtosis, and Alpha Values for Scales…………….………………………………………………………… 181 2 Correlations between Online Communication Comfort, Attitudes, and Intentions to Seek Help……………………………………………………. 183 3 Correlations between Self-Stigma, Attitudes, and Intentions to Seek Help……………………………………………………………………. 185 4 Correlations between Gender Role Conflict Scale Constructs, Attitudes, and Intentions Variables……………………………………………. 188 5 Summary of Regressions for Online Variables………………………………... 192 6 Correlations between Online Communication Comfort, Attitudes, and Intentions to Seek Help for Males and Females…………………………... 197 7 Correlations between Self-Stigma, Attitudes, and Intentions to Seek Help for Males and Females…………………………………………………… 199 8 Summary of Regressions for Online Variables for Males……………………... 202 9 Summary of Regressions for Online Variables for Females…………………... 203 vii CHAPTER I INTRODUCTION Statement of the Problem Technological advances are changing the way psychology can be delivered. Although distance counseling has been used since Freud’s psychoanalysis (Skinner & Zack, 2004), the internet is ushering in a new period of distance counseling provided via the internet. Little research has examined the role of individual differences in client attitudes toward or intentions to use internet counseling, despite calls for such research (Rochlen, Zack, & Speyer, 2004). Counseling Psychology has a long tradition of individual differences research (Dawis, 1992) and could answer this call. At the same time, forces are changing the traditional role of college counseling centers. College counseling centers are experiencing an influx of more students who are reporting more serious psychological problems (CSCMH, 2009; Stone, 2008). This is straining the services being provided as many centers are not able to expand staff or services to meet this need (ACCA, 2010). College students are among the most frequent internet users (Nie, Simpser, Stepanikov, & Zheng, 2005; UCLA World Internet Project, 2004), and the internet may be one way to outreach and provide services while at the 1 same time minimizing clinician time (Lintvedt, Sorensen, Ostvik, Verplanken, & Wang 2008). Counseling Psychology has begun to get involved in e-therapy research and practice. The Counseling Psychologist published a special issue devoted to the subject in 2005 (Mallen & Vogel, 2005). The articles in this special issue outlined the nascent research in the field and rightfully called for more attention to many unknown areas (Mallen, Vogel, & Rochlen, 2005; Mallen, Vogel, Rochlen, & Day, 2005). The reactions to these articles focused on future areas of research and practice for this new modality. These possibilities included psychoeducation (Chang, 2005), outreach to diverse and underserved populations (Sanchez-Page, 2005), online therapy as a new entity altogether (Barnett, 2005), and new ways to conduct research on process and outcomes (Caspar & Berger, 2005). The special issue produced more questions than it answered, but it did provide a foundation for Counseling Psychology becoming involved in this area of professional practice. The current project seeks to understand if there are individual differences among college students that predict their attitudes toward and intentions to use internet-based services for a variety of different, commonly occurring psychological problems. The following will briefly discuss the development of distance counseling technologies, an overview of internet counseling services, online support groups, ethical issues in the provision of online counseling, the online therapy relationship, outcomes of online therapy, and individual differences focusing on self-stigma, masculinity, and the five factor model of personality. 2 Development of Distance Counseling Distance counseling became more prevalent with the advent of the telephone. This technology ushered in the new modality of telephone counseling and telephone hotline/crisis services. Telephone services went from an untested means of therapy to a robust part of