online counselling thesis

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Qualitative Investigation into Therapists’ Experiences of Online Therapy: Implications for Working Clients

Yasuhiro kotera.

1 College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK; [email protected] (G.K.); [email protected] (C.L.); [email protected] (A.-M.E.)

Greta Kaluzeviciute

2 Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge CB2 8AH, UK

Christopher Lloyd

Ann-marie edwards, akihiko ozaki.

3 Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan; pj.ca.nimu@ykt-ikazoa

4 Medical Governance Research Institute, Tokyo 108-0074, Japan

Associated Data

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions.

Online therapy has increasingly been utilised during the COVID-19 pandemic by many, including working populations. However, few qualitative studies have explored how online therapy is experienced in practice and discussed its implications for those working clients. Semi-structured interviews attended by nine integrative psychotherapists practising in California, the United States, were conducted. Thematic analysis of the transcripts identified three themes: (i) ‘Positive experiences of online therapy’, (ii) ‘Challenges experienced by therapists and clients in online therapy’, and (iii) ‘Preparation and training for online therapy’. Online therapy was assessed as being helpful, particularly in terms of mitigating against previous geographical and temporal barriers to uptake. However, due to technological disruptions and potential blurring of professional boundaries, online therapy may detract from the emotional salience of therapy, negatively impacting the therapeutic relationship and containment. Considering these positive experiences, participants expected that the demand for online therapy would continue to increase. Particularly in the occupational context, online therapy can offer interventions without fostering shame regarding mental health. The findings provide preliminary qualitative evidence that online therapy can be a useful adjunct to traditional forms of face-to-face therapy. However, therapists require more explicit training in implementing online therapy. Results are discussed in particular regarding the utility of this therapy for working clients.

1. Introduction

1.1. emergence of online therapy.

In 2013, the American Psychological Association published ‘Guidelines for the Practice of Telepsychology’. Analogous to this, within the UK, the British Association for Counselling and Psychotherapy (BACP) recently published good practice guidance for therapeutic working online [ 1 ] Both developments underscore the rising interest in online therapy in the counselling and psychotherapy professions. They have paved the way for formal recognition of ‘telepsychology’, also known internationally as online therapy, e-therapy, e-counselling, computerised cognitive behavioural therapy (cCBT) and electronic cognitive behavioural therapy (eCBT) [ 2 ]. The term ‘online therapy’ (online therapy) in this paper predominantly refers to live video therapy. However, we also acknowledge that this term can include other online and integrative therapeutic support types, including asynchronous (email) and synchronous (instant messaging) communication, alongside live video therapy. Additionally, the terms ‘psychological therapist’ and ‘counsellor’ are used interchangeably and inclusively to refer to a range of trained practitioners who provide talking therapies and psychological intervention to individuals experiencing psychological and emotional distress.

Although online therapy is a relatively recent and emerging means of therapeutic working, using technology for therapeutic means is not new [ 3 ]. As early as the 1970’s, tape-recorded self-help approaches and computerised programs, which imitated person-centred therapists, were integrated into therapeutic approaches [ 4 ]. More recently, cCBT, a form of treatment during which clients receive pre-programmed responses based on CBT, has received significant scholarly attention, and has long been championed within the National Institute for Health and Care Excellence (NICE) guidelines for good practice, for both mild to moderate depression, and the treatment of phobias [ 5 ]. By contrast, however, online therapy, such as that provided through video or telephone technology, has received less attention in the literature, suggesting the need for further evaluation [ 6 , 7 ].

1.2. Strengths and Limitations of Online Therapy

At a broad level, findings from several large-scale meta-analyses have provided strong support for the adoption of online psychological interventions as legitimate standalone therapeutic interventions [ 8 ]. Indeed, Carlbring et al. [ 9 ] found that in-person versus eCBT were broadly equivalent in outcomes.

On a more idiographic and experiential level, however, the results are more mixed. Online therapy is generally recognised as having several benefits. One of the most important arguments in favour of online therapy is that it may assist in meeting a demand for psychological support that traditional face-to-face therapeutic interventions cannot always provide [ 10 ]. Second, online therapy may also offer individuals increased anonymity and privacy and may be offered at a reduced cost due to lower therapist overheads. These cost benefits may simultaneously open up access to previously disenfranchised and minority populations, who may have been excluded from therapeutic support due to economic status [ 11 ]. Beyond some of these pragmatic benefits, it has been suggested that online therapies may encourage more emotional expression and self-reflection [ 12 ]. However, the relational impact of these factors is more variable, and there are several challenging aspects to online therapy, which necessitate further exploration.

First, it is posited that online therapy may make it more challenging for therapists to identify and repair alliance ruptures [ 13 ] or cultivate a therapeutic presence with clients [ 14 ]. Here, one of the most obvious challenges is the lack of non-verbal or behavioural cues. Prior to the COVID-19 pandemic, [ 15 ] identified several important challenges to therapeutic relationships caused by the digital space and social media, including issues of therapist privacy (clients frequently search for therapist/counsellor personal information online, which inevitably impacts the therapeutic dynamic), virtual impingements (through which online discoveries alter the physical therapeutic relationship) and a desire to internalise digital versions of the therapist or digital communications (e.g., developing transference through email exchanges). Whilst these are all important aspects, it seems prudent to explore how therapists themselves have experienced the shift to online therapy during the COVID-19 pandemic.

1.3. Increased Demand for Online Therapy in Occupational Groups during the COVID-19 Pandemic

Among many populations that have benefitted from online therapy, the working population has particularly enjoyed greater benefits of online therapy [ 16 ]. While these findings illustrate clients’ experiences receiving online therapy, therapists’ perspective regarding online therapy during the COVID-19 pandemic remains to be evaluated. Such an appraisal will help to inform workforces to better understand how they can benefit from using online therapy. Accordingly, this study evaluates the perception regarding online therapy from a qualified therapist’s perspective. Specifically, online therapy allows individuals and groups to access psychotherapeutic services on demand. This is especially significant, as research indicates that nearly two-thirds of all people with diagnosable psychological disorders do not seek treatment [ 17 , 18 ]. Likewise, the low rate of help-seeking is salient among working populations, caused by various factors including shame regarding mental health problems, as identified in various working groups [ 19 , 20 , 21 , 22 , 23 ]. Online therapy is recommended, as a working client can access therapy more privately, bypassing their mental health shame; however, this has not been discussed in relation to therapists’ perspectives.

1.4. The Present Study

Despite theoretical and anecdotal consideration of the helpful and unhelpful aspects of online therapy, there is a general lack of in-depth qualitative exploration from the therapist’s perspective. Whilst some qualitative research has used broad surveys to explore therapists’ attitudes to online therapy during the COVID-19 pandemic [ 24 ], this has often not been carried out in an idiographic and inductive manner. Despite a growing body of research and the increasing normalisation of online therapies in the last decade, there is little qualitative research that attempts to explore how psychological therapists experience and make sense of their online therapeutic work with their clients. Hence, this paper aims to (a) appraise the perception towards online therapy from the therapist perspective (Aim 1) and offer suggestions for future therapeutic practice (Aim 2) through qualitative investigation, then (b) discuss how working clients can benefit from online therapy (Aim 3). Aim 3 was added post hoc, considering the ever-increasing demand of online therapy for this population, and to inform the readers for this Special Issue.

2. Materials and Methods

In this qualitative study, we sought to assess experiences of conducting online therapy during COVID-19 based on nine licensed and qualified therapists’ work conducted in California, the United States (US). Participants were recruited via social media through professional clinical networks. Online individual semi-structured interviews were the main data collection method, in addition to demographic questions presented to each research participant. Data were analysed using the thematic analysis method [ 25 , 26 ]. GK and YK held and transcribed the interviews; GK analysed the data and extracted the main themes emerging from the interviews; and all authors contributed to the discussion of the findings and further recommendations for online therapy practice. The study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines [ 27 ]. All participants only knew the gender of the interviewers (GK or YK) before the interview. The details of the study method are explained below.

2.1. Study Design

Ethical approval for this study was granted by the University of Derby Research Ethics Committee 06-15-YK. The study used qualitative semi-structured interviews [ 28 ]. This method consists of a dialogue between the researcher and the participant, guided by a flexible interview schedule and supplemented by additional follow-up questions and probes [ 29 ]. The semi-structured interview method is appropriate for studies with as few as 8-12 participants, as it promotes the inclusion of multiple complex datapoints through iterative interactions between the interviewer and participant (and, as such, the goal is to qualitatively capture a complex phenomenon within its context rather than to measure an average parameter across a representative population, as in, for example, statistical studies) [ 30 ]. Experiential accounts of conducting online therapy before and during the COVID-19 pandemic are scarce. Our study sought to capture the potential strengths, limitations, and unique components of digital therapeutic exchanges (e.g., accessibility due to a lack of geographical constraints, online containment processes, flexibility with regard to time, experiencing therapy at one’s home location, and cost-effectiveness), which are experienced differently by each practising counsellor/therapist.

A pre-designed semi-structured interview schedule (see Appendix A ) was developed and sent to all research participants in advance of the interview to provide some guidance. Our interview questions were guided by a similar study conducted by [ 31 ] on attitudes toward online therapy among therapist trainees in Turkey, which also used the semi-structured interview method. In addition to the questions used in Tanrikulu’s study, we developed additional questions idiographic in nature (e.g., concerned with the meaning of online therapy and its significance for specific patient populations/symptoms). Interviews were held online by using the MS Teams software established in the university system. All interviews were recorded and transcribed verbatim with the consent of the participants, who later confirmed the accuracy of the transcription. All participants were required to read the participant information sheet and sign a consent form. Participants were able to withdraw from the study at any time.

2.2. Recruitment

Purposive and snowball sampling techniques were used to recruit the participants, who practised in California, US. According to APA data [ 32 ], the State of California has the highest number of licensed psychologists in the country who are trained in various therapeutic modalities (in CBT, Gestalt, Transpersonal therapy, etc.). Nine licensed therapists/counsellors participated in an online interview. The details of the participants are reported in the results section.

2.3. Analytic Procedure

The study used thematic analysis to systematically identify and organise meaningful patterns across a dataset [ 26 ]. Since our study seeks to identify unique and/or divergent idiosyncratic experiences pertaining to online therapy, this method of analysis was deemed appropriate. Thematic analysis was carried out in the following order to identify the relevant themes: (i) Familiarisation, (ii) Generating initial codes, (iii) Searching for themes, (iv) Reviewing themes, and (v) Defining and naming themes [ 25 ] (each thematic analysis process is described below).

2.4. Reflexivity

It is important to acknowledge the role played by researchers’ ideas, thoughts, and feelings in thematic analysis [ 25 ]. Our study approached the research process from a critical realist standpoint [ 33 ]. Although critical realism acknowledges that our world is largely socially constructed (i.e., we cannot think about the world independently of our beliefs), it also nurtures the idea of developing realistic and causally meaningful interpretations for complex social phenomena. According to Outhwaite [ 34 ], one way to arrive at a realistic interpretation is immediately acknowledging the researcher’s vehicular social and epistemic role in the research process (reflexivity). Therefore, tracing how our social and linguistic practices influence and change research findings and analytic procedures is part of a critical realist analysis. In our study, a psychotherapy researcher (GK) who held some of the interviews coded the transcripts and developed master themes; the themes were then reviewed by a researcher in counselling and an accredited psychotherapist (YK), who also held some of the interviews, and a researcher and practising chartered psychologist in counselling psychology (CL), who was not involved in the interview process. This enabled a ‘cut and come again’ disposition [ 35 ], ensuring that no single causal account, theme or interpretation was accepted uncritically and that researchers were able to assess and compare contrasting research findings. All themes and data interpretations were checked and agreed upon by the researchers.

2.4.1. Familiarisation

Interview data were read repeatedly to formulate initial interpretations, patterns, and themes [ 26 ]. Similarly, audio and video footage of interviews was viewed again to draw out initial thematic maps [ 25 ].

2.4.2. Generating Initial Codes

The coding process in this study was ‘theory-driven’ [ 25 ], with a set of research questions that were identified before the interviews ( Table 1 ) as well as focus areas identified through the interview schedule (online therapy, therapeutic relationship, the online medium, and client perspective) ( Appendix A ). This enabled a more comprehensive coding process. In total, 78 codes were identified from nine interview transcripts. Some of the example codes are included in Table 2 below.

Generating initial codes—example codes.

Themes, corresponding aims, and example comments.

Aim 1: Perception towards online therapy. Aim 2: Suggestions for future practice. Aim 3: How employees can benefit from online therapy.

2.4.3. Searching for Themes

The previously identified codes ( Table 1 ) were attached to theme-piles using Braun and Clarke’s mind map process in order to categorise the data at a broader level of analysis [ 25 , 26 ]. Specifically, codes across all four interview focus areas were compared in terms of similarity and overlap (code clusters). During this process, we identified the following themes ( Table 2 ).

2.4.4. Reviewing Themes

During this phase of the research, themes were analysed against the coded data as well as the entire dataset for coherency and relevance (details of which are available in the ‘Results’ section). Specifically, the identified themes ( Table 2 ) were checked in relation to the study’s research questions [ 26 ]. The data were organised in the following manner: reports of good practice in online therapy, including the suitability of online therapy for specific clients and, in particular, clients in employment who may have time and/or geographical limitations which may otherwise pose barriers to receiving psychotherapy (corresponding to Theme 1, addressing research aims 1 and 3); challenging and problematic aspects of online therapy for both therapists and clients (corresponding to Theme 2, addressing research aim 1); and therapist experiences of training and guidelines for online therapy, including gaps in available information about online therapy ethics, digital platforms and suggestions for future training (corresponding to Theme 3, addressing research aim 2).

2.4.5. Defining and Naming Themes

The collated data extracts were refined to ensure that each theme was consistent with the accompanying narrative [ 26 ]. Lastly, during the revision process, sub-themes were presented to enhance the clarity of our findings. Theme 1: ‘Positive therapist and client experiences of online therapy’ encompassed T1-1 ‘Beyond expectation’, T1-2 ‘Quality assurance’, 1-3 ‘Accessibility’, and 1-4 ‘Control over therapy’. Theme 2: ‘Challenges experienced by therapists and clients in online therapy’ contained T2-1 ‘Technological disruption’, T2-2 ‘Lack of containment’, T2-3 ‘Disruptive environment’ and T2-4 ‘Severe psychopathology’. Lastly, Theme 3: ‘Preparation and training for online therapy’ included T3-1 ‘Lack of training’, T3-2 ‘Lack of guidance’, T3-3 ‘Need for helpful online community’ and T3-4 ‘Need for evaluation’. Table 3 summarises the themes and sub-themes.

Themes and sub-themes.

The demographic information of the nine participating therapists/counsellors is as follows: seven females and two males, age M = 44.5, SD = 9.8 years, a high level of experience in both providing and receiving therapy (M = 14.2, SD = 6.6 years), and complex theoretical and clinical differences given the variety of therapeutic modalities practised by each participant (psychodynamic, humanist/existentialist, person-centred, gestalt, eclectic, CBT, attachment, etc.). Further demographic participant information is provided in Table 4 .

Participant demographics.

3.1. Theme 1: Positive Experiences of Online Therapy

The majority of the participants reported that online therapy worked, or, at the very least, worked better than expected, leading to favourably shifting attitudes and openness toward online therapy post-pandemic (T1-1: Beyond expectation).

Participant 8: [Online therapy] was not part of my master’s program or my supervision. It’s something that I’ve learnt more about, now that I’m doing it since COVID. … and it works! And it’s better than I thought it was going to be.

Participant 7 : Until August, I was thinking of online therapy as a poor substitute for in-person [therapy], and a limitation. … I think that there is a slight decrease in presence within therapy, and the quality of work I can do in this medium. Lately, in the last couple of months, I feel as I’ve settled more into the pandemic life in general, and also because I had some new clients come in and I’ve had some successes with them […] I’ve been considering more possibility of just maintaining an online practice for a couple of years, especially if I move. I notice myself being more open to it.

Participant 5: I see [online therapy] as an adequate substitution. It seems to be working okay, and in that sense, I feel really grateful that I can keep working.

In addition, some technological benefits were acknowledged for the quality assurance, including supervision as well as the development and sharing of therapeutic knowledge within therapists’ professional network and training (T1-2: Quality assurance).

Participant 3 : I think it offers some additional benefits in terms of the digital technology, like the ability to record. That can be used for quality purposes, for supervisory purposes, to enhance the experience of the provider, knowledge. Some of the other technology-related benefits are being able to take notes, share the screen, show a video on the spot, certain things that we can always do by ourselves, but that can be a part of the shared space in therapy.

Participating therapists also reported positive aspects of online therapy from the client’s perspective, including geographical and temporal flexibility, increased access to therapy, increased number of providers (as well as the ability to choose a therapist based on their expertise/suitability rather than geographical proximity) and reduced costs (T1-3: Accessibility).

Participant 8: I think that online therapy does help with access to care because some people who, for example, don’t have childcare and they need help, but they can’t get away from home, they’re more easily able to access services or they’re able to find low-cost services. There seems to be more opportunity and availability online because they can be seen by providers from all over California instead of their town. So, I think there are some good pieces regarding access and equity and fairness.

Participant 3 : The biggest benefits, I think, are the obvious ones: the flexibility that you have, the possibility of doing therapy from your own home, well, from both ends. It increases flexibility from the provider and the client. […] It’s shifting the landscape of therapy, and it’s coming on the heels of the movement where mental health is becoming a recognised field and an important aspect for the masses, not just the traditional psychoanalytic thinking in the Victorian times where patients were from higher socioeconomics. So, there’s that—the shifting in landscape where therapy is becoming more mundane, more accessible. Online therapy has accelerated it.

Online therapy is the only option for some clients due to geographical limitations (e.g., lack of available counsellors and therapists or time spent travelling) or other circumstances (such as illness or caretaking/parenting responsibilities). These aspects are particularly important for clients in employment who, in the past, did not have time or lacked geographical proximity to attend face-to-face therapy:

Participant 7: [My patient] was living across the bay from me, and she’s a mom also, so with traffic and parking and everything, it was taking her between 60 and 80 min to get here. So, for her it was really just like, “I can’t do this for therapy”. I think if she hasn’t had the online therapy, she would have probably stopped working with me.

Participants also offered some interesting reflections about having more control over the therapeutic situation and being less affected by potentially difficult and/or negative therapeutic experiences with clients (T1-4: Control over therapy).

Participant 7 : If somebody’s got a lot of energy, you can shrink the window a little bit. You can turn down the volume if someone’s voice is very abrasive. And I actually am somebody who gave up on doing couples therapy, because I find that my system, my body cannot take the amount of stress and conflict that couples bring in. Like, I just want to shut down and run away screaming! So, I have actually recently thought about doing it online because I’m not feeling that tension with my body.

Overall, participating therapists evaluated online therapy more positively than expected (T1-1), and reported several advantages related to the quality assurance (e.g., use of recording for supervision; T1-2), increased accessibility from both therapist and client perspectives (T1-3), and having more control over therapy (e.g., adjustable size of screen and volume of sounds; T1-4).

3.2. Theme 2: Challenges Experienced by Therapists and Clients in Online Therapy

The most significant limitation of online therapy identified by all participants is limited physical contact and body language, both of which can be further diminished by technological disruptions (T2-1) (e.g., bad connection, poor video quality or lack of knowledge on how to operate a specific software or set up a camera). This was found to have a direct impact on the development of therapeutic relationships as well as containment processes (T2-2: Lack of containment).

Participant 1: When there are glitches with technology, it definitely affects the sense of containment. It is hard to rewind and get back to where a client had been, or what they had been expressing after a disruption—especially if they were crying.

Participant 3: [The fact] that it requires the technology itself, it’s not equally accessible by everyone who may not have the bandwidth for the required Internet speed, good Wi-Fi, computer, some knowledge of how to set up lighting around the cameras and some technical aspects that are, you know… it falls on the provider and the client, as opposed to coming to a room where things are set up and we all kind of know how it works.

Participant 9: I think that clients who have trauma [experiences] struggle more. They have a hard time to be present. Some people have more [expression] through their body language, so they need a more solid atmosphere.

Participant 6: [Therapy] feels less of a ritual… How to replace it? … I can’t control how the client comes into the session, how they’re sitting, their environment, distractions. For me there’s something sacred around the container and the preparation, and so I can both prepare and have my surroundings. I obviously have less control over the client [now]. I notice it a little bit more now and so I think it’s important to do what I can do from my end to hold that.

Some interesting observations were revealed by the participants about challenges caused by the blending of the home environment and the digital therapeutic space, which include disruptions from family members during therapy sessions, other technological interruptions (phones, laptops, tablets), lack of private space, and client behaviours that would not ordinarily occur during physical (face-to-face) sessions (T2-3: Disruptive environment).

Participant 8: With my teenage clients, I think that they don’t have as much respect for the therapy… [It’s] not the kids, but the parents will come into the room and say, “are you talking to [participant name]?”, and they’re like “yeah”, and then the [parents] will say something like, “ok, well, when you’re done, I’ll need you to do the laundry”, you know. … there’s more interruptions not only from their environment, their phones and whatever, or their cat or their baby, but also from other people living in the household who are reminding them of chores or whatever, so it’s harder to maintain focus.

Participant 3: I have noticed that clients from lower socioeconomic backgrounds tend to experience more distraction. I can give you some examples of what I mean: people who often do therapy in their cars are usually from poorer socioeconomics, which means less time, and they often quite literally don’t have the private space.

Participant 7: I had a client who… She will drink alcohol, she will have a cocktail or whatever, during the session… And that would just very rarely happen in your office. But if they’re home, and their fridge is right there, and it’s a time where they would kick back anyway, then this seems more natural to have a drink when you’re talking with a therapist. That was definitely surprising to me, to see that there’s a blending between someone’s home life and their therapy appointment. […] In that sense, the container-ontained relationship is out of control.

Several participants noted that online therapy is not suitable for clients who suffer from severe psychopathology or mental health distress (e.g., trauma or personality disorders) (T2-4: Severe psychopathology), because they require greater contact and containment that cannot be facilitated via online mediums:

Participant 8 : I feel like right now I have a client who wants to transition to [face-to-face] psychotherapy because they are too severe, but because there’s this force to be online, I feel like one of the issues is that not everyone is well-suited for this mode of therapy.

In sum, the participants reported that technological issues (T2-1) could negatively impact the containment of the therapy (T2-2). Moreover, they noted that some clients were not in an ideal environment to engage in therapy (T2-3). Because of these challenges, they perceived online therapy not suitable to treat severe psychopathology (T2-4).

3.3. Theme 3: Preparation and Training for Online Therapy

All participants reported having only had minimal or no training for online therapy prior to the pandemic (T3-1: Lack of training).

Participant 2: I received zero training, even though I would have liked to receive education on online therapy. For example, what about privacy? Containment in the room?

Some of the issues identified in training for online therapy include a) lack of documents, surveys and scales for online sessions; b) lack of technological guidance (for both clients and therapists); and c) lack of guidance on how therapeutic relationships and outcomes can be addressed in online therapy (T3-2: Lack of guidance).

Participant 8: I’ve had to make certain documents online because they previously [didn’t exist] […] for example, certain anxiety, depression, relationship, satisfaction, mood surveys that I would typically do as a check-in just before the session with the clients to get the baseline of their functioning. The first two weeks of being online I couldn’t get them because there was no way to administer them. So, tools had to be developed specifically for online therapy.

Participant 5: I think that it would be really helpful just to understand what is exactly being expected from you and what are the differences between [online and face-to-face] therapy.

Participant 3: I still feel like there is a lack of more nuanced aspects that I was trained about in-person, for example, observing the space, the container of where you are with the client, the quality of the presence. We didn’t get too much into that when we did the training, and I think that’s generally very important. […] Similarly, I wish I have been taught the ground rules more from the beginning to asking about the address, you know, those tips like: make sure you check with the clients that they’re in a private space, that they do not have any distractions, even other screens, phones, things like that. It’s just not natural for people to do and I think they make a big difference, if you know this from the beginning and set it up. You avoid disruptions and the general loss of the quality.

In order to mitigate the lack of training and experience in online therapy, some participants joined an online community of therapists; however, more support is needed (T3-3: Need for a helpful online community).

Participant 8: When working online, I found it more difficult to do consults with other therapists because in real life you’re in an office and you can say, “hey, can I ask you a question about something?” or “do you have this resource?”. Fortunately, there are online consult groups that I am a part of, but there is that missing component of peer support. It’s more difficult online.

Lastly, some participants highlighted a need for a careful evaluation of online therapy while recognising the potential of this form of therapy (T3-4: Need for evaluation).

Participant 3: Online therapy is shaking up the field. Because a lot of people that could not access therapy can now access it. The rules of the language of therapy are changing, and it opens up the field for new interpretations. I do not think we know yet how digital technologies will change our consciousness, and how we manipulate it for therapeutic benefits. Much like we do not see how complexity of narrative is changed over digital technologies.

Taken together, the participants did not feel that they had had enough training (T3-1), nor that helpful guidance was available (T3-2). Though some of them accessed an online community of therapists, more support was needed (T3-3). Additionally, a need for empirical evaluation of online therapy was suggested (T3-4).

4. Discussion

Since the beginning of the COVID-19 pandemic, the use of online therapy has increased rapidly, and working populations have utilised this form of therapy and received its benefits. However, the existing research primarily focused on clients’ perspectives, missing an understanding of how therapists perceive and experience online therapy. Accordingly, we aimed to (i) examine the perception towards online therapy, (ii) offer suggestions for future practice, and (iii) discuss how employees can benefit from online therapy. Our analysis identified positive experiences (T1), challenges (T2), and preparation and training (T3) relating to online therapy (Aims 1 and 2). The participating therapists perceived online therapy positively, reporting more utility than expected (T1-1) relating to factors such as quality assurance (T1-2), accessibility (T1-3), and control over therapy (T1-4), while noting some challenges, including the technological disruption (T2-1), a lack of containment (T2-2), disruptive environment (T2-3), and unsuitability for severe mental illnesses (T2-4). A lack of training and guidance (T3-1, -2) was noted by the participants, indicating a need for a more helpful online community and the evaluation of online therapy (T3-3, -4) in the future. These findings are discussed below, regarding clients in employment (Aim 3).

One notable finding of our study is that, although the participating therapists felt that they had not been trained enough in online therapy (see T3), overall, they found it helpful and were willing to continue using it (see T1). In addition to their positive experience, they also reported the advantages of online therapy from the client’s perspective relating to time, location, and costs. These components contribute to the accessibility of online therapy, which may be particularly helpful to busy clients. During the pandemic, many employees were forced to work from home, yet online therapy offered access to treatment for these clients. Considering the increased rates of mental health problems in the workforce during the COVID-19 pandemic [ 36 , 37 ], the value of online therapy is high, suggesting a need for more robust education and preparation for this form of therapy. Specifically, guidance on the digital skills, intake assessments, and how therapeutic relationships and outcomes can be addressed was raised as an example for educational items. Indeed, many therapy regulatory bodies have produced information sources to educate their registered members about online therapy [ 38 ]; however, more research-informed guidelines need to be established.

Moreover, many therapists showed an intention to continue using online therapy, which can have implications for clients, including employed clients. For example, shame regarding mental health problems tends to be high in many occupational groups, reducing help-seeking in this population [ 5 , 8 , 39 , 40 ]. Online therapy can offer access to treatment for these shame-sensitive employees, as they can access therapy from home without any time and costs associated with physically accessing a therapy room. As mental health shame is strongly associated with poor mental health in many different occupational groups [ 21 , 39 ], access to therapy without causing shame can be a safer approach to protect employee mental health. Moreover, as many employees receive therapy, the normalisation effects may be present, reducing shame in order to facilitate help-seeking in the workplace [ 40 ]. This in turn can result in increased compassion in the organisation [ 41 ], which is linked to numerous advantages, such as collaboration, trust, and loyalty [ 42 ]. Longitudinal data are needed to evaluate the impact of online therapy in organisations.

While highlighting the positives of online therapy, challenges were also reported (see T2). Technological problems, including a lack of digital skills in therapists and/or clients, are among them. An unstable internet connection can disrupt the flow in a therapy session, negatively impacting the therapeutic relationship and outcomes. Moreover, while many clients can benefit from the flexibility of online therapy, some clients are not equipped with a good environment at home to focus on therapy (e.g., presence of other family members, including children). Alternative approaches for this population need to be considered. Therapeutically, the participating therapists noted the limited view of the client as a challenge; much information can be received from the physiology (e.g., posture, how they move their hands and feet, etc.), which is often excluded in online therapy. This type of information is particularly important when treating a client with severe mental health problems [ 43 , 44 ], and this is another area of challenge noted by the therapists. How appropriate online therapy is for severe mental health problems remains to be appraised, indicating a need for future research.

5. Study Limitations

There are several limitations arising from this research project, which are important to note. First, as with all small-scale qualitative projects, the data and findings contained within this project cannot be assumed to be representative of larger therapist groups. Indeed, this study was conducted in California, US, with a particular social and cultural representation of what online therapy is (or is not). More diverse and larger samples are needed in the future studies. Nevertheless, the themes arising from this study will be of interest to therapists and clients from a broad range of backgrounds and will give insight into ways of working therapeutically online. Second, as the therapists have been drawn from a wide and eclectic mix of therapeutic orientations, each with sometimes diverging conceptualisations of therapy, there is limited sample homogeneity, which has prevented the in-depth exploration of therapies in depth. Third, due to the nature of study recruitment, the sample was self-selecting: participants who took part likely had stronger views of online therapy. This has likely impacted the study results. To counter this, further studies which use a quantitative and larger-scale study design will be useful in exploring in further depth some of the initial themes generated from this study.

6. Conclusions

The demand for online therapy due to the COVID-19 pandemic is expected to continue to increase in the coming years. This study reported the first-hand experience of online therapy from the professional therapist’s perspective, regarding the advantages, challenges and workplace implications. While noting the small sample size, the findings will help (i) therapists refine their future practice, and (ii) working clients and workplace leaders to consider helpful applications of online therapy to improve individual and organisational mental health outcomes.

Acknowledgments

We are grateful to all the therapists who took part in this study, and Cary Ann Rosko MFT for her support in this project.

Appendix A. Interview Schedule

Author Contributions

Conceptualization, Y.K.; methodology, G.K.; software, Y.K.; validation, Y.K.; formal analysis, G.K.; investigation, Y.K., G.K. and C.L.; resources, Y.K., G.K. and C.L.; data curation, Y.K., G.K. and C.L.; writing—original draft preparation, Y.K., G.K. and C.L.; writing—review and editing, Y.K., G.K., A.-M.E. and A.O.; visualization, Y.K. and G.K.; supervision, Y.K.; project administration, Y.K. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the University of Derby Research Ethics Committee 06-15-YK on 11 January 2017.

Informed Consent Statement

All subjects gave their informed consent for inclusion before they participated in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The processes and effectiveness of online counselling and therapy for young people

• Mitchell Dowling

Student thesis : Doctoral Thesis

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Online counseling: A narrative and critical review of the literature

2013, Journal of Clinical Psychology

Objective: The paper aimed to critically review the literature on online counseling. Method: Database and hand-searches were made using search terms and eligibility criteria, yielding a total of 123 studies. Results: The review begins with what characterizes online counseling. Outcome and process research in online counseling is reviewed. Features and cyberbehaviors of online counseling, such as anonymity and disinhibition, convenience, time-delay, the loss of social signaling, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client suitability and clients’ and therapists’ attitudes and experiences of online counseling are reviewed. Conclusion: A growing body of knowledge to date is positive in showing that online counseling can have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters. A need remains for stronger empirical evidence to establish efficacy, effectiveness and to understand better the unique mediating and facilitative variables.

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• Published: 22 February 2022

Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period

• Elena Ierardi   ORCID: orcid.org/0000-0002-9293-9239 1 ,
• Marta Bottini 1 &
• Cristina Riva Crugnola   ORCID: orcid.org/0000-0002-9258-6664 1  

BMC Psychology volume  10 , Article number:  35 ( 2022 ) Cite this article

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The COVID-19 pandemic has increased online counselling interventions, including those aimed at university students. The principal aim of the study is to evaluate the effectiveness of the online counselling intervention during the COVID-19 pandemic, also with regards to the effectiveness of the face-to-face intervention.

34 students (Mean age = 23.74; Female = 27) who requested online university counselling during COVID-19 have been compared with 81 (Mean age = 22.8; Female = 60) students who requested university face-to-face counselling before the pandemic. The psychopathological problems were assessed with the Symptom Checklist 90 Revised, attachment styles with the Attachment Style Questionnaire, adverse childhood experiences with Adverse Childhood Experiences Questionnaire, and life satisfaction with the Life Satisfaction Scale.

At the pre-intervention phase, psychological distress was similar in both groups with no differences in the General Severity Index of the SCL-90 R, and there were no significant differences for secure/insecure attachment, adverse childhood experiences, and life satisfaction. The online counselling intervention during the pandemic was effective in reducing psychological distress scales as depression ( p  = .008), obsessive–compulsive ( p  = .008), interpersonal sensitivity ( p  = .005), and anxiety ( p  = .011), and in the total scale of the SCL-90 R ( p  = .017). The face-to-face counselling intervention was effective in reducing psychological distress in all subscales and in the total scale of the SCL-90 R ( p  = .000) and in increasing the level of life satisfaction ( p  = .023). Attachment style did not moderate the effectiveness of the online and face-to-face interventions.

Conclusions

Students seeking counselling, both before and during the pandemic, show similar levels of psychological distress. The online counselling intervention was almost as effective as face-to-face counselling intervention with respect to psychological distress; it was not effective in increasing life satisfaction.

Peer Review reports

The consequences of the spread of COVID-19 and of self-isolation and quarantine measures have led to radical changes in people’s daily lives, such as loneliness, high levels of depression, anxiety, alcohol abuse, drug use, self-harm, domestic violence, sleep problems, and suicidal behaviors [ 1 , 2 ]. In fact, many studies have shown a high increase in psychological problems shortly after the declaration of the state of emergency [ 3 , 4 , 5 ] with an increase of 20–30% of depression and anxiety compared to the pre-pandemic period [ 6 ].

Also, studies have identified the impact of COVID-19 on university students’ mental health.

During this period, the students suffered from anxiety and depression as well as social dysfunctions [ 6 , 7 ], stress, concentration disorders, and psychosomatization [ 8 ]. At the same time, students reported concerns about the lack of social activities and their future career opportunities, especially those who were closer to graduation [ 9 ].

To face the state of emergency and the growing psychological problems in the pandemic period, the services that provide psychological help have had to change place and space, transforming their intervention from face-to-face, to online intervention [ 10 ]. Online psychological interventions were present even before the pandemic emergency; with the rapid development of technologies, in fact, starting from the twenty-first century, there has been an increasing possibility of carrying out psychological counselling online [ 11 , 12 ].

Considering the importance of mental health interventions aimed to young adult [ 13 ], it is extremely useful to examine whether such online counselling interventions for university students are effective in improving subjective well-being as well as face-to-face counselling interventions do. In fact, counselling has an important role in supporting students with psychological problems, promoting a reduction of psychological distress and an increase in psychological resilience and academic performance [ 14 , 15 ].

Studies done before the pandemic period showed that online counselling can be as effective as face-to-face counselling for general population [ 16 , 17 ]. In this regard, Mullin et al. [ 18 ] showed that an online wellbeing program reduced the anxious and depressive symptoms compared with the control group at post-treatment and at a three-month follow-up. Other studies have shown that online counselling is also effective for people using substances [ 19 ] or showing psychological distress [ 20 ]. Furthermore, studies show that patients have high levels of satisfaction after having completed an online counselling process [ 21 ] and are able to express their discomfort as well as face-to-face counselling interventions [ 22 ]. A study carried out during the pandemic [ 23 ] showed the effectiveness of single online psychological counselling session in reducing anxiety and negative affect.

With regards to university students, some systematic reviews, carried out before the pandemic, showed that mental health interventions based on online with computer and phone interviews appear effective, particularly in improving anxiety symptoms [ 24 , 25 ]. However, studies comparing online counselling interventions with face-to-face interventions for university students found mixed results. Among these, Chan [ 26 ] compared in a group of teens and young adults the effectiveness of the counselling intervention provided online, offline and mixed (online plus face-to-face), showing that the most effective in terms of youth’s quality of life and sense of well-being was from mixed counselling and that the online counselling was more effective than face-to-face. Zeren et al. [ 27 ], comparing the effectiveness of online individual counselling, face-to-face counselling and a control group in undergraduate students, have not found significant differences among the types of intervention, highlighting that online counselling can be as effective as face-to-face counselling in improving satisfaction. However, only in the group with face-to-face intervention there was a significant increase in positive affect and a decrease in negative affect.

No study has evaluated the effectiveness of online interventions, comparing it with the face-to-face counselling interventions during the pandemic period; furthermore, no one has compared different approaches to counselling intervention aimed at university students, such as psychodynamic or cognitive-behavioral one. Only the study by Savarese et al. [ 8 ] qualitatively assessed online counselling for university students during pandemic period of COVID-19, suggesting that online counselling services for university students in times of emergency helped students to increase their resilience skills and is useful to identify psychological problems.

It is clear from above that the analysis of the effectiveness of online counselling interventions is an important field of research in which studies and empirical evidence are needed.

Quality of attachment styles might affect the effectiveness of counselling interventions in improving mental health. Several researchers have pointed out that insecure attachment can be considered a general factor of vulnerability with respect to psychopathology. For example, in the adult population both anxious and avoidant attachment styles are associated with depression, anxiety, obsessive–compulsive disorder, and externalizing pathologies [ 28 , 29 , 30 ]. A study by Riva Crugnola et al. [ 31 ] also showed correlations between psychopathological problems and insecure attachment in a group of university students. Other studies [ 32 , 33 ] found that anxious attachment predicted negative mental health outcomes during COVID-19 period, leading higher levels of depression and anxiety.

Approach of the study

The main aim of the study is to evaluate the effectiveness of a psychodynamic counselling intervention carried out online through video sessions with university students during the COVID-19 pandemic and to compare its effectiveness with the face-to-face psychodynamic counselling intervention, carried out before the pandemic.

The first aim is to assess psychological distress before the pandemic and during the pandemic in university students requiring university counselling. It is hypothesized that students during the pandemic had an increase in psychopathological distress compared to students who had requested counselling prior to the pandemic, based on recent literature [ 7 ]. The second exploratory aim—as aren’t enough studies on the subject—is to evaluate the effectiveness of the online intervention and compare its effectiveness with the face-to-face one. The third aim, also at an exploratory level, is to assess whether the attachment style can be a moderator of the effectiveness of the online counselling intervention and of the face-to-face counselling intervention.

Participants and procedure

The participants in our study were students of the University of Milano-Bicocca who referred themselves to the Counselling Service. The first group of 34 university students requested and carried out online counselling during the emergency situation caused by the COVID-19 from January 2020 to July 2021 and completed the battery of questionnaires both before the intervention (T0-baseline) and after the intervention (T1-after 4 counselling sessions). The second comparison group of 81 university students required counselling between January 2016 and December 2019 and carried out the intervention face-to-face. The socio-demographic characteristics of the participants are reported in Table 1 .

The data collection procedure takes place entirely online, after the acquisition of written informed consent, and students who voluntarily decide to participate fill in batteries of questionnaires administered at T0 and readministered at T1. All procedure involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The ethics committee of the University of Milano-Bicocca approved this research project.

Intervention approach

The intervention has been conducted at the University of Milano-Bicocca Counselling Service and is open to all students of the campus. It’s a psychodynamic intervention which offers students a brief consultation intervention composed of four meetings, conducted vis-à-vis [ 15 , 34 , 35 ]. The intervention starts with the student referring him/herself for counselling and is free for all students enrolled at the university. The intervention approach is focused on identifying the main problems that hinder the student's developmental process of identity and relational consolidation [ 36 ].

The sessions function as a transitional space, protected from family and academic pressures. The primary objective of the intervention is, therefore, to make an alliance with the student, in order to create a “safe” relational context [ 37 ]. This should improve his/her capacity to address difficulties and distress encountered in the academic life or connected to developmental crises that are typical of emerging adulthood [ 38 , 39 ].

From this perspective, the intervention aims to make the student aware of the conflictual nodes, underlying the request for consultation, as to increase his/her capacity to reflect on his/her mental and emotional states and on those of other people (relatives, classmates, partners, lecturers). Intervention in this way can be useful both to promote processes of elaboration and mentalization in students, allowing for initial processing of these problems [ 40 ] and to mobilize their resources which may be used to set in motion decision-making and responsibility assumption processes.

The team is composed of psychologists trained in psychodynamic psychotherapy and in psychodynamic counselling. The psychologists are supervised in group regularly every fifteen days by the service coordinator who is a psychoanalyst. During the COVID-19 period, the intervention was carried out online through video sessions using the same approach adopted in face-to-face interviews.

• Psychopathological problems

Symptom Checklist 90 Revised (SCL-90 R) [ 41 , 42 ] is a 90-item self-report questionnaire (rated on a 5-point Likert scale ranging from 0 “not at all”, to 4 “extremely”) that measures the perceived severity of psychopathological symptoms over the previous seven days. SLC-90 R includes 9 subscales: Somatization (SOM), Obsessiveness-Compulsivity (O–C), Interpersonal Sensitivity (I-S), Depression (DEP), Anxiety (ANX), Hostility (HOS), Phobic Anxiety (PHOB), Paranoid Ideation (PAR) and Psychoticism (PSY). The instrument also has three global indexes—Global Severity Index (GSI), Positive Symptoms Total (PST) and Positive Symptoms Distress Index (PSDI). In this study, we used the Global Severity Index as a global index. All the subscales and the global index showed good reliability in this study (.76 < α < .96).

Life Satisfaction

Life Satisfaction scale is a 9-point Likert scale (from 1 “very dissatisfied” to 9 “very satisfied”). Students are asked to indicate their general life satisfaction and satisfaction in relation to Study, Work, Friends, Family, Romantic Relationships, and Free time. The items of this scale were taken from the Italian version of the Response Evaluation Measure-71 [ 36 ]. In our study we used the general life satisfaction level scale, adding one item on study satisfaction that was not present in the original measure. Even though no data is available on the validity of this measure, we relied on the high face validity of these items.

Attachment Style

Attachment Style Questionnaire (ASQ) [ 43 , 44 ] is a 40-item self-report scale (evaluated on a 6-point Likert scale ranging from 1 "Totally disagree" to 6 "Totally agree") which yields five factor scores. One factor (Confidence in self and others) is related to secure attachment, whereas each of the other four scales (Discomfort with Closeness, Relationships as Secondary, Need for Approval, and Preoccupation with Relationships) represents a particular aspect of insecure attachment. We administered the ASQ only at T0.

The ASQ scales were grouped together in order to highlight differences with respect to the two types of insecure attachment. As indicated by Fossati et al. [ 45 ] through the four scales which measure insecure attachment it is possible to identify the dimensions of insecurity: Avoidance and Anxiety. Following Monteleone et al. [ 46 ], two new scales were created relating to insecure attachment: Avoidant Attachment which is the average of the scores of the Discomfort with Closeness and Relationships as Secondary scales and Anxious Attachment which is the average of the scores of the Preoccupation with Relationships and Need for Approval scales. The scales showed good reliability in this study (.74 < α < .77).

Adverse Childhood Experiences

Adverse Childhood Experiences Questionnaire (ACE-q) [ 47 ] is a self-report questionnaire consisting of 10 items, aimed at investigating the adverse experiences that the subject lived before the age of 18, such as physical, sexual, psychological abuse, losses, separation and neglect. For each question, the subject can assign a score of 0 (no—if he/she has not experienced the adverse experience in question) or 1 (yes—if he/she has experienced the adverse experience mentioned). The final score is calculated by adding up the answers. Based on the literature, there is a consistent presence of adverse experiences in the history of the subject with a cut-off greater than or equal to 4 [ 48 ]. We administered the ACE-q only at T0.

Data analysis

We used SPSS Statistic 27.0 package for all analyses. First, in order to understand if the two groups are similar, we analyzed the demographic variables through Chi-square test for categorial variables and t-tests for continuous variables. We then analyzed any differences between the two groups in psychopathological distress, attachment style, life satisfaction, and adverse experiences at T0 through the t-test. We conducted dependent t test for each group to evaluate the effectiveness of the online and face-to-face interventions on the SCL-90 R and level of life satisfaction. Moreover, we conducted a more detailed analysis with repeated measures univariate analysis to evaluate whether there were differences in effectiveness between online and face-to-face intervention in reducing the level of distress and in increasing the level of life satisfaction. To analyse the changes groupXtime interactions, a two-way mixed design repeated measures analysis of variance was performed.

We also evaluated attachment style as a possible moderator using the MEMORE (Mediation and Moderation for Repeated Measures) procedure, a plug in for SPSS to conduct moderation analysis with repeated measures designs [ 49 ]. Cohen’s d and partial eta squared was considered as the effect size. The effect size values considered were 0.10 = small, 0.25 = medium, and 0.40 = large.

Preliminary analysis

Preliminary analyses with chi-square and t-test did not show significant differences between online counselling group and face-to-face counselling group on socio-demographics characteristics (see Table 1 ).

Differences between the two groups

We used t-test to analyse the differences between the online counselling group and face-to-face counselling group on psychopathological distress, life satisfaction, attachment style, and adverse childhood experiences (see Table 2 ).

Regarding SCL-90 R, no significant differences emerge with regards to the total scale and subscales except for the Paranoid Ideation subscale which results in having a higher score in the face-to-face counselling group. The two groups were compared through the Chi-square also in respect to the distribution of global psychopathological distress calculated through cut-off values of SCL-90 R GSI scores reported in the manual [ 50 ]. The Chi-square test showed no significant differences (X 2  = 2.86; p  = .23). In the online counselling group, 58% were in the non-clinical range, 23% in the subclinical and 19% in the clinical range. In the face-to-face intervention group, 41% were in the non-clinical group, 29% in the subclinical and 28% in the clinical group.

To analyze the attachment style in a dichotomous way security versus insecurity, we used the ASQ Confidence scale as indicator [ 45 ]: scores below the 25 th percentile were considered as an indicator of insecure attachment, whereas scores above the 25 th percentile were considered as secure attachment. The Chi-Square test indicated no significant differences in the distribution of secure/insecure attachment between the two groups (X 2  = .80; p  = .37). Instead, statistically significant differences emerge in the scales. Face-to-face intervention group students had higher score on Avoidant and Anxious Attachment scales, Discomfort with Closeness, and Need for Approval.

Finally, there are no significant differences between the two groups in terms of life satisfaction and in the amount of adverse experiences lived.

Effectiveness of online counselling intervention

We examined the effectiveness of the online counselling intervention in online counselling group students on psychopathological problems and general life satisfaction level at T0 and T1 (see Table 3 ).

Dependent t-test indicated that there was a significant decrease in psychopathological symptoms from T0 to T1 in relation both to the GSI scale of SCL-90 R and to the Obsessive–Compulsive, Interpersonal Sensitivity, Depression, and Anxiety subscales. There is no significant increase in the overall level of satisfaction from T0 to T1.

Effectiveness of face-to-face intervention

Then, we evaluated the effectiveness of face-to-face counselling intervention carried out with the university students before the pandemic, estimating any differences in psychopathological distress and general life satisfaction level at T0 and T1 (see Table 4 ).

Dependent t-test indicated that there was a significant decrease in psychopathological symptoms from T0 to T1 in relation both to the GSI scale of SCL-90 R and to the Somatization, Obsessive–Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Anger Hostility, and Psychoticism subscales. There was a significant increase in the overall level of life satisfaction from T0 to T1.

Effectiveness comparison of the two intervention modalities

To identify any differences in the effectiveness of the two interventions, repeated measures ANOVAs were conducted to test the timeXgroup interaction effects (see Table 5 ).

Results did not reveal any significant interaction effects between the group and the temporal dimension T0 and T1 for psychopathological distress and the level of life satisfaction.

Moderation effect

We used MEMORE procedure to test the moderation effect of attachment style on the change of the psychopathological problems and on the level of life satisfaction in both groups. We used the secure/insecure attachment variable as a possible moderator (see above). The results showed that in the online counselling group students attachment style was not a significant moderator of the effectiveness of the intervention, both considering GSI Total scale, t(32) = .35, p  = .72, and the level of life satisfaction, t(32) = − .93, p  = .35.

Also, in the face-to-face intervention group students, attachment style was not a significant moderator of the effectiveness of the intervention, both considering GSI Total scale, t(81) = − .51, p  = .60, and the level of life satisfaction, t(81) = − 1.24, p  = .21.

The COVID-19 pandemic has led significant consequences on the mental health of university students. To face the emergency, online counselling interventions have increased, but however no study has evaluated the effectiveness of university online counselling during the pandemic period and no study has compared it with face-to-face counselling. Our study, therefore, filled a gap in a new research field, demonstrating the effectiveness of an online psychodynamic university counselling intervention during the COVID-19 pandemic. The online counselling intervention has proven to be able to reduce psychopathological distress in terms of depression, anxiety, obsessiveness-compulsiveness, and interpersonal sensitivity with a medium–high effect size as face-to-face counselling intervention. Even at the level of total psychopathological distress, both interventions were effective, showing the face-to-face intervention a large effect size and the online intervention a small effect size. A possible explanation for these results might be that a significant part of university students uses technologies in their daily life. Therefore, online counseling can be similar to face-to-face counseling in creating a good therapeutic alliance between psychologist and students based on empathy and listening [ 27 , 51 ].

However, the face-to-face intervention has shown to have a greater impact than the online intervention on the discomfort and psychological well-being of students, also reducing the scores in anger, somatization and psychoticism subscales of SCL-90 R and promoting an increase in the level of general life satisfaction of students with a medium effect size. These results are in line with the study by Zeren et al. [ 27 ] which assessed pre-pandemic the effectiveness of online counselling for university students. They found that in general the online counselling intervention can be as effective as face-to-face counselling, but that only in the group with face-to-face intervention there was an improvement in positive affect.

A further relevant data emerged is that the quality of the attachment style is not a moderator of the effectiveness of the intervention neither for the face-to-face intervention nor for the online intervention in line with a previous study [ 15 ]. The intervention therefore has an effect in improving mental health both for university students with secure attachment styles and for university students with styles of attachment more at risk such as those insecure. This therefore shows the general effectiveness of the psychodynamic counselling model. It might be interesting, in a future study, to consider other moderators, including mentalization skills, personality structure, social support perception, and history of adverse childhood experiences.

Contrary to our initial hypothesis and the literature, university students who requested counselling during the pandemic did not show more pathological distress than students who required it before the pandemic. It should be noted, however, that usually students who request counselling intervention, have shown greater psychopathological symptoms than university students who did not request it [ 31 , 52 ].

Moreover, students in the face-to-face intervention group had more avoidant and anxious insecure attachment styles than students of the online intervention. In this regard, it can be hypothesized that the pandemic may have also led students with secure attachment styles to undertake a counselling intervention for support in a moment of vulnerability. On the other hand, no significant differences emerged between the two groups regarding the presence of adverse experiences in their history.

The study has several limitations. Firstly, the small number of the group that carried out the online intervention limits the generalizability of the results. Secondly, the non-randomization of the two groups and the different periods in which the interventions—the online one during the pandemic period and the face-to-face one before the pandemic—were carried out could be another limit. Thirdly, we have not used a specific questionnaire to assess the psychological impact of the pandemic on university students. Finally, the effectiveness was assessed only at the end of the intervention, while in future studies it might be useful to evaluate whether the effectiveness is maintained over time with subsequent follow-up, e.g., after 6 months.

The online counselling intervention for university students was overall effective in the reduction of general psychopathological distress and in many psychopathological dimensions. On the other hand, face-to-face interventions have proven to be more effective in reducing a wider spectrum of psychopathological problems and in increasing life satisfaction. The lower effectiveness of online interventions, especially regarding life satisfaction, could be linked to the pandemic situation itself and the resulting lockdown, which put a strain on the psychological well-being of the student population, inducing feelings of isolation and uncertainty. This—it can be hypothesized—has made it particularly difficult to increase satisfaction through short interventions. To take these aspects into account, it would be important to evaluate the effectiveness of online counselling in a non-emergency situation.

Given the overall effectiveness of online counselling in supporting students by reducing their psychological distress during the period of the COVID-19 pandemic, these data pave the way for the possibility of using it, together with face-to-face counselling, even in post pandemic times, e.g., to reach a larger number of students, such as off-site students or students who are afraid of social stigmatization in making use of mental health services.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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The study was funded by the Department of Psychology, University of Milano-Bicocca (2020-ATE-0130).

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Elena Ierardi, Marta Bottini & Cristina Riva Crugnola

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EI and CRV constructed the design of the study, contributed to the data interpretation and wrote the manuscript. CRV was a major contributor in the conception, design and implementation of the psychodynamic counselling intervention. EI conducted the statistical analysis. MB contributed to the data collection. All authors read and approved the final manuscript.

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Ierardi, E., Bottini, M. & Riva Crugnola, C. Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period. BMC Psychol 10 , 35 (2022). https://doi.org/10.1186/s40359-022-00742-7

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Counseling & Human Services Theses & Dissertations

Theses and dissertations published by graduate students in the Department of Counseling and Human Services, College of Education, Old Dominion University, since Fall 2016 are available in this collection. Backfiles of all dissertations (and some theses) have also been added.

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Dissertation: The Lived Experiences of Counselors-in-Training Completing Practicum and Internship During COVID-19 , Shelby Lauren Dillingham

Dissertation: Climbing the Academic Ladder While Black: Exploring the Experiences of Institutional Belongingness for Black Counselor Education and Supervision Doctoral Students at Predominantly White Institutions , Jasmine Alicia Hawa Griffith

Dissertation: Understanding the Role of Adverse Childhood Experiences on Resilience in Police Officers , Wayne F. Handley

Thesis: The Experiences of Multilingual Learning-Focused School Counselors: A Phenomenological Investigation , Chelsea Jo Hilliard

Dissertation: Partners in Crisis: A Phenomenological Exploration of Collaboration Between Crisis Intervention Team Officers and Mental Health Professionals , Jessica L. Huffman

Dissertation: Exploring the Experiences of School Counselors Advocating for Social Justice Within Urban PK-12 Charter Schools , Betsy Marina Perez

Dissertation: Supervision Needs of Novice Behavioral Health Providers in Integrated Primary Care Settings: A Delphi Study , Nicholas D. Schmoyer

Dissertation: Wellness as a Predictor of Turnover Intention in the Active Duty Military , Thomas Clifford Seguin

Dissertation: Consensus on Best Practices in Neuroscience-Informed Treatment of Combat-Related Posttraumatic Stress in Military Veterans: A Delphi Study of Experts in the Field of Mental Health , Danielle Lauren Winters

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Dissertation: Providing Family Centered Care Within Pediatric Integrated Care Settings , Emily D. Bebber

Dissertation: The Lived Experiences of 911 Dispatchers With Compassion Fatigue: An Interpretive Phenomenology , Angela Johnson

Dissertation: Exploring the Lived Experiences of Self-Identified Politically Conservative Students in Graduate Counseling Programs in Public Universities , Elizabeth A. Orrison

Theses/Dissertations from 2022 2022

Dissertation: Mental Health Counselors’ Perceptions of Professional Identity as Correctional Counselors in an Integrated Behavioral Health Care Setting , Jeanel L. Franklin

Dissertation: Complex Thought for Complex Work: Preparing Cognitively Complex Counselors for Work in Diverse Settings , Alexandra C. Gantt

Dissertation: Trauma and Crisis Counselor Preparation: The Relationship of an Online Trauma and Crisis Course and Counseling Self-Efficacy , Julia Leigh Lancaster

Dissertation: An Investigation of Healthcare Professionals’ Perspectives on the Tasks of Mental Health Counselors in Hospital Settings , Suelle Micallef Marmara

Dissertation: Broaching Race and Race-Related Issues: Phenomenological Inquiry of Doctoral Student Supervisors of Counselor Trainees , Judith Wambui Preston

Dissertation: A Phenomenological Investigation of School Counselor Antiracist Social Justice Practices , Stephanie Deonca Smith-Durkin

Dissertation: Counselor Perceived Competence Diagnosing Disorders from DSM-5 Diagnostic Categories Survey Results and the Development and Validation of Scores on the Diagnostic Self-Efficacy Scale , Erin Elizabeth Woods

Dissertation: The Experiences of School Counselors Providing Virtual Services During Covid-19: A Phenomenological Investigation , Allison Kathryn Worth

Dissertation: A Comparison of Sorority Women and Non-Sorority Women’s Alcohol Use: Perception, Rate of Use, and Consequences , Betsy Zimmerman

Theses/Dissertations from 2021 2021

Dissertation: Effectiveness of College Counseling Interventions in International Student Adjustment to United States Higher Education Systems: A Meta-Analysis , Joshua Ebby Abraham

Dissertation: What Are We Missing?: A Comparison of Experiences of Race-Based Trauma by Black Americans and Black Jamaicans , Bianca R. Augustine

Dissertation: Site Supervisors' Perspectives on Supervision of Counselor Trainees in Integrated Behavioral Health (IBH) Settings: A Q Methodology Approach , Yeşim Giresunlu

Dissertation: The Impact of a Crisis Intervention Team Program on Psychiatric Boarding , Kurtis Hooks

Dissertation: A Case Study on the Application and Implementation of Positive Behavioral Interventions and Supports for Students with Emotional Disabilities in Alternative Education , Kira Candelieri Marcari

Dissertation: Initial Development of the Escala de Fortaleza en Jóvenes para Padres , David Moran

Dissertation: Incivility of Coworker Behaviors and Minority Firefighters’ Belongingness in the Workplace , Alyssa Reiter

Dissertation: A Meta-Analysis of Three Years of Data on Outcomes of Therapy Groups for Inmates in the Virginia Department of Corrections , Abie Carroll Tremblay

Theses/Dissertations from 2020 2020

Dissertation: Improving Veterans’ Psychological Well-Being with a Positive Psychology Gratitude Exercise , Clara Im Adkins

Dissertation: An Examination of the Relationship Among Social Services Support, Race, Ethnicity and Recidivism in Justice Involved Mothers , Ne’Shaun Janay Borden

Dissertation: Development and Validation of the Students With Learning Disabilities School Counselor Self- Efficacy Scale: A Psychometric Study , Rawn Alfredo Boulden, Jr.

Dissertation: Minority Counselor Multicultural Competence in the Current Sociopolitical Climate , Kathleen Brown

Dissertation: A Meta-Analysis of Group Treatment Outcomes for Veterans with Substance Use Disorders , Robert “Tony” Dice

Dissertation: Investigating the Impact of the FAVA Well-Being Protocol on Perceived Stress and Psychological Well-Being With At-Promise High School Students , Renee L. Fensom

Dissertation: Mental Health Counselors' Perceptions on Preparedness in Integrated Behavioral Healthcare in Underserved Areas , Kyulee Park

Dissertation: Group Treatment Effectiveness for Substance Use Disorders: Abstinence vs. Harm Reduction , Jill D. Parramore

Dissertation: Best Practices in Clinical Supervision: What Must Supervisees Do? , Johana Rocha

Dissertation: A Phenomenological Investigation of Counselors’ Experiences With Clients Affected by Problematic Internet Pornography Use , Kendall R. Sparks

Dissertation: Counselor Education Doctoral Students’ Research Self-Efficacy: A Concept Mapping Approach , Zahide Sunal

Dissertation: A Systemic Review and Meta-Analysis of Psychoeducational Groups for the Treatment of Psychopathology Resulting from Child Sexual Abuse , Alexis Lynnette Wilkerson

Dissertation: School Counseling Professionals’ Experiences Using ASCA’s Mindsets & Behaviors for Student Success to Achieve College and Career Readiness , George Wilson

Theses/Dissertations from 2019 2019

Dissertation: Exploring the Lived Experiences of Career Oriented Military Spouses Pursuing Education for Career Advancement , Melody D. Agbisit

Dissertation: Reshaping Counselor Education: The Identification of Influential Factors on Multisystemic Therapy , T'Airra C. Belcher

Dissertation: An Investigation of Posttraumatic Growth Experienced By Parents After a Miscarriage , Barbara Elizabeth Powell Boyd

Dissertation: The Psychometric Properties of the School Counseling Internship Competency Scale , Melanie Ann Burgess

Dissertation: Intersectional Identities and Microaggressions: The Experience of Transgender Females , Cory Daniel Gerwe

Dissertation: Comparing Higher Order Value Differences By Religious and Spiritual Association and Implications for Counseling: An Exploratory Study , Gregory C. Lemich

Dissertation: The Effects of Supervisory Style and Supervisory Working Alliance on Supervisee Disclosure in Supervision: A Moderated Mediation Analysis , Chi Li

Dissertation: A Comparison of College Student-Athletes With Attention-Deficit Hyperactivity Disorder (ADHD) and Nonathletes With ADHD: Academic Adjustment, Severity of Mental Health Concerns, and Complexity of Life Concerns , Sonja Lund

Dissertation: An Experimental Study of Research Self-Efficacy In Master’s Students , Nicola Aelish Meade

Theses/Dissertations from 2018 2018

Dissertation: Multilevel Confirmatory Factor Analysis of the Family Adjustment Measure with Lower-Income, Ethnic Minority Parents of Children with Disabilities , Vanessa Nicole Dominguez-O'Hare

Dissertation: Risk and Resiliency Factors Affecting the College Adjustment of Students with Intersectional Ethnocultural Minority and LGBTQ Identities , Stacey Christina Fernandes

Dissertation: The Relationship Between Childhood Adversity and Adult Relationship Health for Economically Marginalized, Racially and Ethnically Diverse Individuals , Sandy-Ann M. Griffith

Dissertation: An Exploration of Practicum Students' Experiences of Meaning-Making Through Altruism , Debra Paige Lewis

Dissertation: Addiction Counselors' Perceptions of Clinical Supervision Practices , Marla Harrison Newby

Dissertation: Exploring the Variant Experiences Through Which Racial/Ethnic Minorities Select Art Therapy as a Career , Mary Ritchie Roberts

Dissertation: Psychosocial Determinants of Medication Adherence among HIV-Positive Individuals in Mexico City , Anthony Vajda

Theses/Dissertations from 2017 2017

Dissertation: Cross-Racial Trust Factors: Exploring the Experiences of Blacks Who Have Had White Mentors in the Counseling Profession , Eric Montrece Brown

Dissertation: Personality, Motivation, and Internet Gaming Disorder: Understanding the Addiction , Kristy L. Carlisle

Dissertation: The Relationship Between Trauma Exposure and College Student Adjustment: Factors of Resilience as a Mediator , Amber Leih Jolley

Dissertation: Establishing the Psychometric Properties of the Understanding Mental Health Scale: A Dissertation Study , Michael Thomas Kalkbrenner

Dissertation: Attitudes and Actions that Adoptive Parents Perceive as Helpful in the Process of Raising Their Internationally Adopted Adolescent , Marina V. Kuzmina

Dissertation: Towards a New Profession: Counselor Professional Identity in Italy. A Delphi Study , Davide Mariotti

Dissertation: Exploring the Relationship Between Depression and Resilience in Survivors of Childhood Trauma , Marquis A. Norton

Dissertation: Understanding the Experiences of Women with Anorexia Nervosa Who Complete an Exposure Therapy Protocol in a Naturalistic Setting , Gina B. Polychronopoulos

Dissertation: An Exploratory Factor Analysis Examining Experiences and Perceptions of Campus Safety for International Students , Sonia H. Ramrakhiani

Dissertation: The Role of Self-Care and Hardiness in Moderating Burnout in Mental Health Counselors , Traci Danielle Richards

Theses/Dissertations from 2016 2016

Dissertation: Examining Changes in College Counseling Clients’ Symptomology and Severity over an Eight Year Span , Caroline Lee Bertolet

Dissertation: Initial Development and Validation of the Transgender Ally Identity Scale for Counselors , Jamie D. Bower

Dissertation: A Counselor’s First Encounter with Non-Death Loss: A Phenomenological Case Study on New Counselor Preparation and Experience in Working with Non-Death Loss , Charles P. Carrington

Dissertation: The Relationship Between Counselors' Multicultural Counseling Competence and Poverty Beliefs , Madeline Elizabeth Clark

Dissertation: Counselors’ Perceived Preparedness for Technology-Mediated Distance Counseling: A Phenomenological Examination , Daniel C. Holland

Theses/Dissertations from 2015 2015

Dissertation: Factors Associated with Family Counseling Practices: The Effects of Training, Experience, and Multicultural Counseling Competence , Amanda A. Brookshear

Dissertation: An Examination of Supervisory Working Alliance, Supervisee Demographics, and Delivery Methods in Synchronous Distance Supervision , Robert Milton Carlisle III

Dissertation: A Phenomenological Investigation of Counselors' Perceived Degree of Preparedness When Working with Suicidal Clients , Heather Danielle Dahl

Dissertation: African American Pastors and Their Perceptions of Professional School Counseling , Krystal L. Freeman

Dissertation: A Phenomenological Investigation of Wellness and Wellness Promotion in Counselor Education Programs , Brett Kyle Gleason

Dissertation: Examining Disordered Eating Amongst Sorority Women , Andrea Joy Kirk

Dissertation: Bhutanese Counselors' Experiences with Western Counseling: A Qualitative Study , Susan V. Lester

Dissertation: An Exploration of Health Providers' Responses to Intimate Partner Violence (IPV) in Malaysia , Kee Pau

Dissertation: A Mixed Methods Study of the Intersection of Sexual Orientation and Spiritual Development in the College Experience , Kevin C. Snow

Theses/Dissertations from 2014 2014

Dissertation: Ethical and Legal Knowledge, Cognitive Complexity, and Moral Reasoning in Counseling Students , Matthew W. Bonner

Dissertation: A Grounded Theory of the College Experiences of African American Males in Black Greek-Letter Organizations , David Julius Ford Jr.

Dissertation: The Experiences of School Counselors with Court Involvement Related to Child Custody , Crystal E. Hatton

Dissertation: A Grounded Theory of Suicidality in Children Ten and Younger , Katherine Angela Heimsch

Dissertation: School Counseling Program Models Utilized By School Districts , Tracy L. Jackson

Dissertation: The Relationship Among Counseling Supervision Satisfaction, Counselor Self-Efficacy, Working Alliance and Multicultural factors , Jennifer Dawn Logan

Dissertation: Development of the Profession of Counseling in Kenya, Uganda, and Tanzania: A Grounded Theory Study , Mueni Joy Maweu Mwendwa

Dissertation: Resident Assistants' Self- Efficacy for Participation in Counseling Activities , Miranda Johnson Parries

Dissertation: Role Ambiguity of Counseling Supervisors , Aaron Gabriel Shames

Dissertation: Degree of Implementation of the American School Counselor Association National Model and School Counselor Burnout , Katrina Marie Steele

Dissertation: College Health and Mental Health Outcomes on Student Success , Daniel Joseph St. John

Dissertation: Supervisor Perceptions of Their Multicultural Training Needs for Working with English Language Learning Supervisees , Hsin-Ya Tang

Theses/Dissertations from 2013 2013

Dissertation: Experiences of Resident Assistants with Potentially Suicidal Students: Identification, Referral, and Expectations , Katherine M. Bender

Dissertation: Counselor Demographics, Client Aggression, Counselor Job Satisfaction, and Confidence in Coping in Residential Treatment Programs , Erik Braun

Dissertation: School Personnel Perceptions of Professional School Counselor Role and Function , Caron N. Coles

Dissertation: Factors That Influence Minority Student Enrollment at Various Levels of Postsecondary Education , LaShauna Mychal's Dean

Dissertation: Experiences and Perceptions of Mental Health Professionals Considered Effective in the Diagnosis and Treatment of Adults with Attention Deficit Hyperactivity Disorder , Bonita H. Erb

Dissertation: A Qualitative Study of the Experiences of Gatekeeping Among PhD Counselor Educators , Carol A. Erbes

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Home > Education > Counseling Psychology and Special Education > Theses and Dissertations

Counseling Psychology and Special Education Theses and Dissertations

Theses/dissertations from 2024 2024.

School Psychologist's Tiered Social-Emotional Recommendations in Response to Data Gathered From Social-Emotional Screening , Audrey Anita Andersen

Differences in Presenting Concerns of Anxiety Amongst Students in College Counseling Centers Across The United States , Julia Brim

Effects of Professional Development on Secondary School Teachers’ Self-Efficacy, Knowledge, and Attitudes About ADHD , Rebecca Jeanne Brown

Understanding Student Perceptions of a High School Wellness Center: An Interpretive Phenomenological Analysis Qualitative Study , Devan Audrey Clayton

Factors Surrounding Mental Health Well-Being for Male Adolescent Pacific Islanders , Melia Fonoimoana Garrett

Transition-Based Services and Community Support: Improving Knowledge of Community Resources for Youth with Disabilities in Role Transitions , Ian Christopher Gee

Attitudes, Opinions, and Beliefs of Teachers Toward Dual Immersion Programs in Utah Schools , Amy Lynn Hawks

Using Video Modeling to Improve Hygiene Practices for Students with Significant Cognitive Disabilities , Allison Hovey

Teaching Resilience in Pacific Islander Children through Culturally Adapted Stories , Isabel Medina Hull

Communication Between Young Adults and Their Siblings with Autism , Shane Morgan Petersen

Identifying Barriers to Sustainability of Dual Language Immersion Programs in Utah Schools , Jennifer Leigh Rowley

Collaboration of Board Certified Behavior Analysts and Special Education Teachers in Transition , Amelia Ruth Spencer

Trauma-Informed Mindfulness-Based Stress Reduction to Increase Family Quality of Life for Mothers of Children with Autism: A Pilot Study , Carol May Vaughn

Theses/Dissertations from 2023 2023

Religious Commitment, Religious Harm, and Psychological Distress: Course of Treatment Outcomes , Dane Abegg

School Psychologists' Recommendations for Tiered Interventions That Target Social-Emotional Competencies , Brandi Alise Bezzant

Mahu and Native Hawaiian Culture: Experiences of Non-Heteronormativity , Rachel Beth Chapman

Understanding Gender Identification Within Individuals With Autism Using the Bem Sex-Role Inventory , Zackery Alan Cusworth

Mental Health Effects of Applied Mental Health Courses vs. Non-Course Controls on Depressive Symptoms and Psychological Flexibility , Madeline Jane Cope Diopulos

Who is Talking About the Children? A Systematic Literature Review of the Missing and Murdered Indigenous Women Crisis Effects on Children , Angela Marcel Fields

Pivotal Response Treatment to Decrease Challenging Behavior and Increase Functional Communication in Preschool Children With Developmental Delays , Kalie Alexandra Gilmour

Grief in Children With Disabilities and how it is Portrayed in Children's Picture Books , Erjola Gjini

How Female BIPOC Students at a Predominantly White Institution Think About Belonging: A Multiperspective Study , Delirio Juarez

The Effects of a Peer-Mediated Social Skills Intervention on Children With Autism Spectrum Disorder , Shannon Elizabeth McConaghie

The Effectiveness of a Signature Strengths Intervention on Maternal Well-Being Among Mothers of Children with Autism , Tawni Nicole Poole

A Longitudinal Look: How Sleep Impacts Suicidal Thoughts and Behaviors in Autism and Social Anxiety , Lindsay Jacalyn Regehr

Invisibility, Confusion, and Adjustment:Exploring the Grief Experience of Grandmothers Supporting their Bereaved Grandchildren , Jordan Robertson

Collaboration Between Special Education Teachers and Board Certified Behavior Analysts , Megan Elizabeth Squires

Barriers and Facilitating Factors of Sleep Assessment/Screening Among School Psychology Practitioners , Tyler Jjay Landon Storey

What Brings BIPOC Preservice Special Educators to the Field of Education? , Charly McAllister Taylor

Theses/Dissertations from 2022 2022

Is Teaching Experience a Predictor for School Psychologists' Confidence and Competence in Behavior Intervention Plans? , Misty Dawn Lainé Coplan

Voices From the Field: A Critical Incident Study of Teachers' Perspectives on What Helps and Hinders the Implementation of Behavior Intervention Plans in the Classroom , Emily Anne Cragun

Teaching Social-Emotional Learning to Children With Autism Using Animated Avatar Video Modeling , Emelie Davis

Ethnic-Racial Socialization Experiences of Mexican American Youth , Katherine Donahey

District Leaders' Perception of Multi-Tiered System of Supports Implementation: A Qualitative Study , Julia E. Facer

Females With Autism Traits: A Retrospective Look at Developmental Trajectories , Greer Caroline Willman Finster

Delivering Explicit Math Instruction Through Point-of-View Video Modeling to Elementary Students With Autism Spectrum Disorder , Patsy McCray Gibbs

To What Degree Does Martial Quality Predict Longevity? A Meta-Analysis of Prospective Studies , Rachel E. Jensen

Critical Incidents in Sustaining a Behavior Management Level System With Special Education Students in a Self-Contained School , Stephanie Johnson

A Mixed Method Approach to Understanding Team Members' Perspectives After Receiving Problem-Solving Training and Performance Feedback , Alexander Mark Julian

Needs Assessment of Services Provided in a Rural School District for Students With Autism , Danielle Anne Katterman

Anxiety of Struggling Readers and Excelling Readers During the COVID-19 Pandemic , Chelsey Taylor Lemmon

Exploring the Perceptions of School Teams Implementing Multi-Tiered Systems of Support , Saanya Rajesh Lulla

Comparing the Effects of Online and In-Person Social Skills Training for Adolescents With Autism Using PEERS® , Benjamin Tze Ming Ooi

Autonomic Responses During Animated Avatar Video Modeling Instruction of Social Emotional Learning to Students With ADHD: A Mixed Methods Study , Jesse D. Rhodes

Mental Health and Religious Beliefs About Salvation: Associations and Structural Equation Modeling , Anthony Edward Rose

The Association of Psychotherapist Cultural Humility and Client Experiences and Outcomes in Psychotherapy: A Meta-Analysis , Lisa Michelle Scott

The Effects of Parents' Socialization Goals, Responsiveness, and Psychological Control on Chinese Adolescents' Anxiety , Chunyue Tu

Effects of a High School Yoga Program on Student-Reported Stress, Resilience, and Academic Outcomes , Stephanie Martha Vance

The Role of Social Response to Disclosure in Relgious and Spiritual Coping and Recovery From Sexual Assault , Megan Wolfe

Theses/Dissertations from 2021 2021

An Evaluation of Behavior Intervention Plans: Consideration of the Interventionist and Contextual Fit , Carly Parkinson Atchley

Effects of Parent-Implemented Interventions on Outcomes for Children With Autism: A Meta-Analysis , Wai Man Cheng

Mentor Modeling Mismatch: Power Dynamics in Cooperating Teacher's Modeling for Preservice Teachers , Morgan Christensen

Humor Production and Coping on Distress and Help-Seeking Attitudes Among Polynesian Americans , Augusto D. Gancinia II

PTSD Symptoms Among Parents and Service Providers of Individuals With Significant Disabilities , Bruna Fusco Gonçalves

Discussion Guide for using Data from the Student Risk Screening Scale - Internalizing and Externalizing: A Qualitative Study , Justina Grubb

A Qualitative Analysis of Incidents That Lead to High Quality Implementation of Behavior Intervention Plans From the Perspective of School Psychologists , Leah Hardy

Secularism: A Measure of Explicit Agreement With Assumptions of Secularism (MEAAS) , Conner Douglas Jones

Reframing Past Bullying Experiences Through the Lens of Harry Potter , Haeeun Lee

Fathers as Stay-at-Home Dads: Fathers' and Mothers' Perspectives on Children's School Experiences , Taylor Hubbert Michelsen

Creating Community for Parents: Faith, Trauma, and Online Talk , Erica Ellsworth Miller

Racial Discrimination and the Indirect Effects of Forgiveness on Well-Being Among Emerging Polynesian Americans , Emily E. Tanner

Grace, Legalism, and Life Outlook in LDS Students , Justin Brent Top

Rural Special Educators Teaching Reading: A Case Study , Sheryl Vernon

Stakeholders' Perceptions of Available Services in a Rural Community to Effectively Educate Individuals With Autism Spectrum Disorder , Candice Walker

Very Young Child Survivors of Parent Suicide: Perspectives on Children's Literature for Bibliotherapy , Cortland L. Watson

Perceptions of Special Education Services Delivered Through Online Learning Environments During COVID-19 , Alex W. Wheatley

Parent Perceptions of Literacy Development for Females Later Diagnosed With Autism Spectrum Disorder , Christine Marie Yaccarino

Psychometric Investigation of the Attachment to God Inventory and its Implications for the Psychology of Religion and Spirituality , Justin Paul Zamora

Theses/Dissertations from 2020 2020

Sexual Abuse Prevention for Adolescents with Intellectual and Developmental Disabilities: Parent Perceptions and Program Effectiveness , Katie Lyn Barton

Youth and Staff Perceptions of Modifications Made When Implementing Strong Teens in a Residential Treatment Center , Melissa Rae Bennion

Identifying, Increasing Awareness, and Supporting Military-Connected Adolescents in Public Schools , Amanda Bushman

Retaining School Psychologists: The Role of District Level Administrative Supervisors , Rachel Ruth Butler

Individual Experience, Individualized Help: A Case Study of Three Siblings Whose Father Died by Suicide , Caitlin Cotten

Effects of Performance Feedback on the Technical Adequacy of Behavior Intervention Plans , Rebecca M. Cramer

Success Off The Field: Academic Strategies of High-GPA College Athletes , Ashlynn Erbe

Perceived Benefit of a Special Education Multicultural Class , Hyesuhn Jeanna Evans

Do Patterns of Distress Vary in First-Generation College Students Seeking Psychotherapy? , Candice Gonsalves

An Evidence-based Evaluation of Behavior Management Practices Among Paraprofessionals , Jordan Mark Goodman

The Effects of Telehealth Training on Parents of Children with Autism in Albania , Freskida Griffiths

Interventions and Supports to Ameliorate Math Anxiety in K-12 Schools: A Meta-Analysis of Experimental Group Design Research , Madeline Rose Hardy

An In-Depth Exploration of Clinical Patterns Within Spiritually Integrated Therapy , Russell Neilend Jackson

Forgiveness and Gratitude as Mediators of Religious Commitment and Well-Being Among Polynesian Americans , Davis Kealanohea Kane

Moderation and Mediation Analysis of Religious Commitment, Positive Personality Traits, Ethnic Identity, and Well-Being Among Polynesian Americans , Davis Kealanohea Kane

Coming Out of the Shadows: Understanding Autism in Korean Culture , Yoojin Kim

Stack the Deck: A Self-Monitoring Intervention for Adolescents with Autism for Balancing Participation Levels in Groups , Lauren Elizabeth Lees

Precision Request for Noncompliance in Students with Emotional/Behavioral Disorders: Examination of the Interventionist , Collette Merrill

Columbine and the Myth of the Juvenile Superpredator , Christopher M. Mosqueda

Social-Emotional Learning in High School: A Mixed-Methods Evaluation of the Strong Teens Program , Oscar Olaya

A Test of the WhyTry Program on Youth Resilience , Travis Guy Price

What are Stakeholders' Perceptions of Rural School District Needs to Effectively Educate Students with Autism Spectrum Disorder , Kari Lyn Pugh

General Education Teachers' Self-Reported Response to Overt Student Problem Behavior in the Classroom , Ingrid Lewis Shurtleff

Understanding the Administrative Role fo School Psychology District Leaders , Alivia Nicole Smith

iMath - Using Video Modeling Via iPads to Teach Mathematics Skills to Struggling Students , Melissa Steinberg

Assessing the Validity of the Trauma Inventory for Partners of Sex Addicts (TIPSA) , Heidi A Vogeler

Bullying in the Wizarding World: Victim, Peer, and Adult Responses in Harry Potter and the Sorcerer's Stone , Casey John Winters

Inclusive Teaching in Faith Communities: Examining the Effects of Brief Video Trainings on Planning Inclusive Teaching for Individuals with Disabilities , Mary Margaret Woodruff

Theses/Dissertations from 2019 2019

Emotional and Behavioral Disorders Screening in Utah Schools , Oakley Dean Banks

Jumping Ahead of the Wait List: Pyramidal Parent Training , Rebecca Marie Barton

A Systematic Review of Interventions for Implementation Fidelity for Academic Interventions , Emily Morgan Beecher

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USC launches Master of Science in Marriage and Family Therapy online program

Culturally competent and versatile therapists are more critical than ever in the ever-evolving mental health landscape.

USC Rossier School of Education announces the launch of its new Master of Science in Marriage and Family Therapy online (MFT online) program. The innovative program is designed to prepare therapists for both in-person and telehealth settings, equipping them with the skills and knowledge needed to positively impact their communities.

In today's rapidly evolving mental health landscape, the need for versatile and culturally competent therapists is more critical than ever. The MFT online program addresses the growing demand for mental health services in a digital age, ensuring that individuals and families receive the care and support they need, regardless of their circumstances or location. The online format offers students the flexibility of online learning, expert-led courses and a supportive community.

“We believe in a holistic approach to addressing mental health issues, blending scientific research with practical application,” said USC Rossier Part-Time Master Lecturer Linda Hoffman , who is taking the lead in building the MFT online. “I am honored to oversee the development of the online version of our esteemed Marriage and Family Therapy program. Our dedicated team is committed to faithfully translating our comprehensive on-ground curriculum to an accessible and engaging online format. Together, we are expanding our reach and preparing future therapists to make a meaningful impact in the lives of individuals and families.”

The MFT online’s faculty are experienced practitioners who are adept at navigating the complexities of delivering psychotherapy to clients from diverse sociocultural backgrounds in an online therapy setting. Faculty understand the importance of factors such as body language, facial expressions and community contexts in providing effective therapy, and the curriculum is meticulously designed to help students develop these skills.

Graduates of the MFT online program will have a wide range of career opportunities available to them, including public mental health agencies, school-based mental health, community mental health, residential treatment centers and private practice. The comprehensive curriculum ensures that students are prepared for success in a variety of mental health professional pathways. Some graduates even go on to pursue doctoral degrees.

In addition to providing a solid foundation in marriage and family therapy, the program also meets the requirements for licensure as a Marriage and Family Therapist set by the California Board of Behavioral Sciences. Program coursework satisfies the academic requirements for licensure in California including pre-degree hours of supervised professional experience. Upon completing the program, graduates must complete additional supervised professional experience to obtain licensure in the state of California. While the MFT online program provides a pathway to licensure in California, students may need to fulfill additional requirements depending on the state in which they plan to practice. Licensure requirements vary by state, so students interested in pursuing licensure in a state other than California should research the specific requirements for that state .

“The launch of the MFT online program marks a significant milestone in USC Rossier’s commitment to providing innovative and comprehensive education in the field of mental health care,” said  Pedro Noguera , dean of USC Rossier. “The new program reflects our dedication to excellence and our mission to empower students to make a positive impact in their communities. I know they will contribute to and make an impact in the field of marriage and family therapy."

Learn more at Master of Science in Marriage and Family Therapy online (MFT online) .

Pedro Noguera

• Distinguished Professor of Education
• Emery Stoops and Joyce King Stoops Dean

Marriage and Family Therapy

Master of Science (MS)

Article Type

Article topics.

• Educational psychology

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Methodist University Blazes Path with Unique Online Clinical Mental Health Counseling Program

• Feature Story

Kourtney Johnson thought she had her career all figured out. As an up-and-coming chef, she was determined to utilize her skills to make people happy and improve the community. But life had its own plans for Johnson.

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When she was 26, Johnson suffered two separate accidents at work and in a car, leading to various diagnoses by doctors: rheumatoid arthritis, spina bifida, and scoliosis. Her life was turned completely upside down a new career path was needed.

Johnson realized she could help people in a different way – through their mental health. She turned to another passion in psychology. After earning a bachelor’s degree, it has led her to one of Methodist University’s newest programs: an online master’s degree in Clinical Mental Health Counseling .

“I want to be that advocate and that voice to help the military and African American community,” said Johnson, who considers herself a Korean native before finding a home in Fayetteville. “The online program is allowing me to work on becoming a sound board for future generations.”

Johnson is part of the first class of students taking part in Methodist University’s Clinical Mental Health Counseling program – an online master’s program that is capturing attention from around the region.

“You’ll find a few similar programs in the region, but they’re all completely in-person or hybrid,” said Dr. Keleigh Blount, director of the Clinical Mental Health Counseling program. “But Methodist University’s program is different because it’s asynchronous and can be completed online.”

Clinical mental health counseling primarily focuses on overall mental well-being and mental health of people – training students to diagnose, plan treatments, and use different therapeutic strategies such as animal assistance therapy, trauma-focused therapy, and more to help people feel at their best.

The two-year program consists of one year of didactic learning that teaches the basics of the profession, how to get licensed, and the concept of developmental approach. After that, students have the opportunity for hands-on learning through a year of clinical work. Since the program is online, students are able to earn 700 hours of clinical work through any clinical mental health counseling site of their choice as long as certain criteria are met.

“Some of our students are in the military and some of our students are parents,” Blount said. “Students are already telling us that they enjoy the asynchronous model and the flexible deadlines. We want them to be healthy and well in this program.”

So far, the program has welcomed students from all the way in Texas to its home state of North Carolina. Johnson, a military spouse, is one of the local students who is able to complete all of her classwork from the comfort of her Fayetteville home.

“Even though I’m an online student, I love the fact that the University still pays attention to me,” Johnson said. “My advisor is my biggest cheerleader. She’ll reach out and tell me how amazing I’m doing and that she’s proud of me. Then, you have the professors who are amazing.”

Methodist University’s Clinical Mental Health Counseling program currently has the expertise of Blount and Dr. Elisabeth Simpson, clinical placement coordinator for the program. Both continue to work as counselors while teaching and offer expertise in disability, mental health, research, families, the criminal justice system, cancer treatment, and others.

Along with the program’s top-notch faculty and unique learning model is the ability to work with Methodist University’s renowned health sciences programs – such as Physician Assistant Studies , Doctor of Occupational Therapy , Doctor of Physical Therapy , and Nursing .

“One of the beautiful things about our program is that we are building it to be more interdisciplinary than other similar programs,” Blount added. “With the pending medical school coming to Methodist University, we wanted to work with the other health sciences programs to have cross work. We can work with their students on how to handle certain subjects like substance abuse.”

The program can begin pursuing accreditation from the Council for Accreditation of Counseling and Related Educational Program (CACREP) once the first class of students graduates in May 2025 – a time that Johnson looks forward to.

“Next, I want to start working on my doctorate so I can begin working in forensic psychology,” Johnson said. “I love forensic cases and I want to help victims of domestic violence, trauma, addiction, and clinical mental health issues. I just want to be able to help people.”

Johnson has come a long way since first learning about her diagnoses in her mid-20s, a road that wouldn’t be possible without her education at Methodist University.

“I love Methodist University,” she added. “It’s taught me how to center my emotions and how to give myself credit through all of the difficult times. With the help of Methodist University, I know I can become the clinical psychologist I want to be without a shadow of doubt.”

To learn more or apply to Methodist University’s Clinical Mental Health Counseling program, visit the program webpage.