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Online Youth Counselling and Therapy A
Systematic Review of Individual Synchronous
Interventions Zehra Ersahin, MBPsS,
MSc Counselling Psychologist in Doctoral
Training, University of Manchester-
Zehra.ersahin_at_postgrad.manchester.ac.uk
Research Rationale
Findings
3. In-Session Processes
Four key themes emerged through the thematic
synthesis. A pie chart illustrating the key
themes in proportion is illustrated below.
Research Aim To systematically review the
empirical studies in the field of online youth
counselling. Although there is an e-spectrum of
interventions, current study has been interested
in the evidence for the therapeutic support that
is provided via individual synchronous chat
channels. To date, no one has systematically
looked at what research says about online youth
counselling that is provided in real time.
Therefore, it is hoped that this current review
contributes to the growing evidence, with a
particular interest in the online youth service
users. Research Question What are the key
themes present within the research literature
regarding online youth counselling/therapy that
is utilised via individual synchronous chat
channels?
The properties under this theme encapsulate (a).
therapeutic alliance, (b). benefits and
constraints young people experience online, (c).
compensatory techniques both young people and
counsellors use, and (d). the type of
interventions counsellors utilise online. A
self-explanatory mapping diagram of the subthemes
are illustrated below.
Introduction Young people show particular
interest in the available online support services
in the context of their hybrid lives. Research
reveals young people to be the happiest when they
are online (YouthNet, 2013). In such a context,
there have been substantial moves to online media
from traditional face-to-face counselling
services in the last decade, causing much debate
on the efficacy of online interventions. Given
that online mental health support keeps
attracting increasing numbers of young people
(Kooth, 2013 Childline, 2014), understanding the
ways todays adolescents communicate and seek
online help requires insight to provide
appropriate support that they can relate to.
Key Themes 1.Developing safe and youth-friendly
online services

• The findings suggested that counsellors working
  online with young people should have an
  appropriate level of training, particular
  experience in working with young people,
  developing online therapeutic alliance, and
  competency in technology (Hanley, 2006, 2011).
• In the Netherlands, Fukkink (2011) reported on
  developing a multidimensional support model that
  is delivered by young peer counsellors.
• In Sweden, Wentz, Nyden and Krevers (2012)
  developed an e-support and coaching model for
  young people with ASD and/or ADHD.

Methodology
Discussion
4. Session Outcome Impact

• Williams et al. (2009) reported the rapport
  building and task accomplishment behaviours had
  moderately strong effects on young peoples
  responses to online therapy (N85). However,
  online sample scored weaker alliance and session
  impact compared to telephone sample.
• Hanley (2009) suggested the online working
  alliance to be of good quality, with over half of
  the sample (58.7) scoring the quality as medium.
  
• King et al.s (2006b) analysis on pre-post GHQ-12
  scores revealed significant reduction in both
  online and telephone counselling clients
  distress levels (partial eta squared .503,
  plt0.01).
• IBSC was found to improve users self-esteem,
  sense of coherence and subjective quality of life
  Wentz, Nyden, Krevers, 2012).

The emerging themes in the current synthesis
cover different territories, showing promising
results especially on the efficacy rates of
counsellor in-session behaviours. Young people
seem to value the time they spend with a
professional online, without much difference in
the type of support offered. This seems to be
the case regardless of who offers the support.
Although the overall quality of therapeutic
alliance was found to be medium across the
studies, the time and environmental constraints
that were reported across studies gives insight
to this limitation. Young peoples motivations
accessing online support might explain the
positive outcomes reported across all age groups
(Dowling Rickwood, 2013). However, the youth
research is in its infancy, and while preliminary
progress has been made, there is much ground yet
to be covered.
A review of the literature has been conducted on
all identified peer-reviewed empirical references
related to online youth therapy, using the
following databases PsychInfo, Pubmed, Cochrane
Library, and EBSCO. The following terms formed
the basis of the search young people or
adolescents or youth or teen AND online
counsel(l)ing or online therapy or internet
therapy or cybertherapy or e-therapy or
chat support. The results (N112 in total) were
hand-searched using inclusion and exclusion
criteria, and irrelevant studies were removed.
The data extraction identified 12 relevant
empirical studies using the current inclusion
criteria as well as the quality appraisal (NICE,
2007) utilised. The data, in the findings/results
sections of the studies was analysed using
Thematic Analysis methodology as outlined in
Thomas Harden (2008). The initial synthesis led
to the creation of 150 initial codes, reflecting
mostly the original codes in the data. Next, all
the codes were cross-examined grouping under 20
descriptive themes first, and 4 key themes at
final stage.
2. Client Characteristics

• 2.1.Access groups
• Across six of the studies that reported sample
  characteristics (N1221), girls were found to
  access online counselling more than boys do.
  Callahan and Inckles (2012) Irish sample
  suggested girls utilise online chat a great deal,
  while boys prefer chat-lines.
• Age-wise, those utilising online chat were the
  oldest in comparison to other means.
• 2.2. Presenting Issues
• Young people were found to present with complex
  mental health needs online.
• Common issues were abuse, family/peer
  relationships, self-harm, depression, sexual
  abuse/rape, anxiety/stress, alcohol/drug misuse,
  anger, self-esteem, and sex/sexuality issues, and
  eating disorders (i.e. Fukkink, 2011)

References
? Callahan, A Inckle K (2012) Cybertherapy or
Psychobabble? A Mixed Methods Study into Online
Emotional Support. British Journal of Counselling
and Psychotherapy, 40(3), 261-278 ? Dowling, M.,
Rickwood, D. (2013). Online counselling and
therapy for mental health problems a systematic
review of individual synchronous interventions
using chat. Journal of Technology in Human
Services. 31(1), 1-21. ? Fukkink, R. (2011). Peer
counseling in an online chat service A content
analysis of social support. Cyberpsychology,
Behaviour and Social Networking, 14(4)247-51. ?
Hanley, T. (2011). Understanding the Online
Therapeutic Alliance through the eyes of
adolescent service users. Counselling and
Psychotherapy Research, 12(1), 35-43. ? King R,
Bambling M, Reid W, Thomas I. (2006). Telephone
and online counselling for young people A
naturalistic comparison of session outcome,
session impact and therapeutic alliance.
Counselling Psychotherapy Research, 6,
175-181. ? Thomas J, Harden A (2008) Methods for
the thematic synthesis of qualitative research in
systematic reviews. BMC Medical Research
Methodology 8-45 ? Wentz, E., Nyden, A.,
Krevers, B. (2012). Development of an
internet-based support and coaching model for
adolescents and young adults with ADHD and autism
spectrum disorders a pilot study. European Child
Adolescent Psychiatry, 21, 611-622 ? Williams,
R., Bambling, M., King, R., Abbott, Q. (2009).
In-session processes in online counselling with
young people an exploratory approach.
Counselling and Psychotherapy Research, 9(2),
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