Textish Counselling – Part 2

Posted by: Dawn Schell on July 30, 2012 2:30 pm

As I mentioned in my last posting I am sharing a number of studies or projects where text messaging is being used in counselling.

One interesting application was Project O, based in Singapore.  This project was designed for students doing their “O” level exams and was launched to 40,000 O-level students through 163 secondary schools. The aim of the project was to assist students in coping with exam anxiety.   Social Workers and educational psychologists provided email counselling and an SMS buddy support service.   As students were preparing for their exams they could send text message to Project O and receive immediate support.  

Youthline, a New Zealand helpline for young people, starting using text-based counselling in December 2004.  As mobile phones and text-messaging became more widely accepted they found youth increasingly requesting text-messaging as an option for discussing their concerns. Early on Youthline’s suggestion to counsellors was to encourage youth to phone in after 5-6 text message exchanges.   These are a few of the responses from youth.

Cn I jus txt, coz I don wan 2b heard
Can u plz jst txt me s0 i d0nt feel al0ne
Il neva b abl 2 talk bwt it. S0ri 4 bthrn u
Im sori i dnt thnk i cn cal. i jst feel 2 stupid[1]

Youthline reports their service has grown and has been reshaped based on what youth said they wanted.  

In Australia a youth mental health outreach team undertook an observational study to address concerns that providing clients with direct mobile phone access to their therapists would open therapists to “excessive and inappropriate levels of client contact”.  The observed 7 months worth of text messages between therapists and youth.   Contrary to expectations only 2% were considered inappropriate. The study showed “therapists have reported that it has helped improve initial engagement and retention, provided a less confrontational way to monitor clients between contacts, and is particularly useful for scheduling contacts such as telephone calls, home visits, and appointments.”[2]

In Ireland[3] the use of text-messaging was proposed as a means of lowering barriers to help-seeking in students with depression.  A parenting intervention program ran a pilot study that incorporated text-messaging in between sessions.  The messages focussed on tips and support for completing the ‘homework’.  A Danish harm-reduction program sent pre-programmed messages to client’s phones twice a day.  Again, the client’s received tips, information and support as they worked on reducing their drug usage.

Finally, a CBT depression program ran a pilot program on using text-messaging as an adjunct to therapy.  One of their conclusions was, “The use of text messaging as part of mental health care may help maximize the resources needed to provide services in a cost-effective manner.”[4]

Text messaging has potential.  As the observational study in Australia concluded that using text messaging “could play a role in connecting with youth in a more accessible and responsive way”.   

What work needs to be done?
Drafting policies for use of SMS in clinical practice
Determining how to deal with issues of privacy and confidentiality
Further study into how SMS could potentially enhance the process of engagement and communication with clients

What do you think?

 Dawn Schell, MA, CCC, CCDP is an affiliate counsellor with Worldwide Therapy Online Inc.  http://www.therapyonline.ca


[1] Haxell, A. (2008). Cn I jus txt, coz I don wan 2b heard: Mobile technologies and youth counseling. In Hello! Where are you in the landscape of educational technology? Proceedings ascilite Melbourne 2008  http://www.ascilite.org.au/conferences/melbourne08/procs/haxell.pdf

[2]  Furber, G.V., Crago, A., Meehan, K., Sheppard, T. D., Hooper, K., Abbot, D. T., Allison, S. & Skene, C (2011). How Adolescents use SMS to micro-coordinate contact with Youth Mental Health Outreach Services.  Journal of Adolescent Health, 48, 113–115.

[3] Joyce, D. & Weibelzahl, S. (2006). Text-messaging as a means to lowering barriers to help seeking in students with depression. National College of Ireland. Retrieved from http://www.iadis.net/dl/final_uploads/200604S110.pdf

[4] Aguilera, A. & Munoz, R. F. (2011) Text-Messaging as an adjunct to CBT in Low-Income Populations: A Usability and Feasibility Pilot Study. Professional Psychology: Research and Practice  Vol. 42, No. 6, 472–478

*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

3 comments on “Textish Counselling – Part 2”

  1. Jessica says:

    I work as a therapist that primarily works with youth. I really use text messaging, but, I have found it to be very useful in helping students start to feel comfortable enough to engage in conversation. I do have a question regarding privacy and confidentiality. Is there a specific way that these text messages should be recorded? I haven’t found anything online yet in regards to how to maintain privacy. If anyone has any insight or research in this area I could greatly appreciate it.

  2. Linda Thompson says:

    Hi Dawn – I have been doing Etherapy, for the past year or so, within the context of survivors of trauma towards healing programs, and I can hardly wait to have chat service available which is what my clients really need. Etherapy in my practice is a posting and a gap of time for processing, then I use a different color font go into the body of their message with paraphrasing, clarification or insert an emitiocon. Texting and Skype options are not options I can even entertain at this point – too much strain on the old eyes and fingers with arthritis. This senior consultant will leave that to the young ones. i enjoyed your article. Thanks Linda

  3. Lenore Berscheid says:

    I work as a crisis therapist in 2 rural communities in Manitoba, visiting each one day a week. I have found texting valuable as a therapeutic tool with 3 female clients. One, a teenager living at home during pregnancy, birth, and arrival of her son and coping with conflict in the family. The other 2, women in their 30s. In all 3 cases texting followed multi personal sessions. In all cases texting allowed for confirmation of empathy and reinforcement of cognitive restructuring. All three clients reported high degrees of relief from anxiety. They felt connected, heard, encouraged. Their returning texts reflected renewed confidence. Text exchanges during periods of high anxiety involved about 3 to about 20 texts to me that I responded to as soon as possible.

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