Making connections: investigation of an online counselling service for gay and same-sex attracted men in South Australia
Making connections: investigation of an online counselling service for gay and same-sex attracted men in South Australia
HIV Australia | Vol. 10 No. 2 | October 2012
BEN YI and ROB WILLOUGHBY evaluate the benefits of delivering counselling services online as a way to overcome barriers to access in rural areas.
Background
The internet is increasingly used by people as a means to seek out healthrelated information.1 Research findings in the United States suggest that more than a hundred million people (75% of all adults and 28% of all teens) per month use the internet to look for health-related information.2, 3
Technological advances have also largely expanded the ways in which many health services are delivered.4 Web-based health information and referral services are readily accessible and are continually gaining more popularity among users; some mental health professionals have already started online group work around mental and behavioural health issues.
The internet certainly presents a way to reach a range of individuals who are currently marginalised and isolated, either due to social stigma or geographic location.5
A wide range of webbased online services and e-programs targeting the LGBTI community are also emerging, and computer mediated communication could be increasingly used for counselling purposes to meet the complex needs of these diverse communities.
With all of this in mind, we want to consider the ways online health services could eventually develop into a more interactive mode and allow therapeutic intervention, advocacy and support in an online counselling context.
How can computer mediated technology build a pathway to deliver professional online counselling services to people who are both socially and geographically isolated in our community?
Rationale
Use of the internet in Australia is commonplace; in 2010–11, 79% of South Australian households had internet access, and 77% of these household members were using the internet every day.6
Gay and same-sex attracted men live in communities across South Australia, including in the country and geographically isolated areas. There are currently no identified counselling services in rural and remote areas of South Australia that specifically cater for gay and same-sex attracted men.
There are many barriers that can prevent gay and other same sex attracted men in rural areas from using local health services. In the counselling experiences of the AIDS Council of Australia (ACSA), these barriers may include: feeling embarrassed, uncomfortable or afraid when visiting health service providers; lack of trust in maintaining their confidentiality in a small community; differing health beliefs; distance and cost; lack of private vehicle ownership; and culturally inappropriate services.
Online counselling could provide a potential platform that is peer-based and userfriendly and would be readily accessible to this client group.
Gay and same-sex attracted men living with HIV who are isolated both socially and geographically experience significant overlapping layers of stigma and discrimination.7
These men can experience discrimination restricting access to supportive health care because of their HIV status as well as their sexual identity, and this is further compounded by their physical and social isolation.8 This lack of accessibility to health services can impact on their overall physical and mental health and wellbeing.
In a 2008 qualitative study involving 16 general practitioners who treated gay and HIV-positive men, social isolation was found to be a significant factor contributing to their patients’ overall health status.9
Other evidence reveals a high prevalence of major depression and suicidality among these isolated groups.10 Establishing an online counselling service that people can access in a space where they feel more comfortable to talk through their issues would be beneficial.
In practice, text-based messaging tools (such as Skype™, Microsoft Messenger (MSN)™ and so forth), as well as email, have been widely used for counselling purposes; instant messaging tools provide synchronous conversations in real time, while the use of emails may allow asynchronous communication and provide a client with sufficient time to respond.11
Online counselling services can transcend of the limitations of time and distance and can be accessed when and where the client chooses.
Feasibility: potential challenges?
As always, there are two sides to the coin: online counselling presents some challenges that we need to acknowledge and confront, such as issues around non-verbal communication and confidentiality.
Counselling online using email and other text-based messaging tools represents a challenge in terms of a lack of visual and auditory cues. These non-verbal cues often offer a counsellor implied messages around the client’s ongoing feelings and emotions.12
The absence of non-verbal feedback during text-based online counselling sessions potentially creates challenges for counsellors in making accurate assessments.
Confidentiality is also a major concern in the provision of counselling services.13 It is often the case that a client who wishes to express deep inner feelings around ongoing sensitive issues or traumatic experiences may fear the consequences of accidental or deliberate disclosure of the shared information.14
Traditional face-to-face counselling provides more security in controlling information disclosure in a private and safe environment for a conversation, with password locked computers for e-records and confidentiality forms for signature. The counsellor can also potentially show the client information security measures such as locked cabinets for client’s records.15
All of these measures in practice are likely to boost a client’s confidence to share their issues. Counselling in an online environment may lack some of these secure components, since confidentiality relies largely on the computer security system which could be perceived to be vulnerable to a hacker’s attack or other conditions that may lead to the loss of client’s data.16
To ensure a client’s information is well protected, encryption and authentication in online messaging and emailing systems need to be maintained and further developed.
Fee-based online counselling has been the tradition for most online professionals, both domestically and overseas.17 However, there are still concerns around the practicalities: how much should online counsellors charge?
How safe is the payment process? What is the general affordability for the client group? Would such a service charge be an obstacle for clients’ motivation for seeking help? A solution to this may be to conduct a survey of potential clients in order to clarify their opinions on these questions.
Conclusion
‘The right dose differentiates a poison’.18 We believe there’s no ‘black or white’ answer for online counselling yet; it has to be operationally appropriate to ensure each client’s online therapeutic experience is a positive one.
The feasibility of online practice is an exciting prospect to explore based on more scientific research as well as an active engagement with the targeted community.
References
1 Chiasson, M., Hirshfield, S., Rietmeijer. C. (2010). HIV prevention and care in the digital age. J Acquir Immune Defic Syndr., 55(Suppl 2).
2 ibid.
3 Harris Interactive. (2002). Cyberchondriacs continue to grow in America. Health Care News, 2(9), 1–2.
4 Mallen, M.,Vogel, D. (2005). Online counselling: A need for discovery. The Counselling Psychologist, 33(6), 910–921.
5 Chiasson, et al., op. cit.
6 Household Use of Information Technology, Australia (2010–11). Australian Bureau of Statistics. Retrieved from: www.abs.gov.au
7 McDonald, K. (2012). ‘You don’t grow another head’: The experience of stigma among HIV-positive women in Australia. HIV Australia, Vol 9, No. 4.
8 ibid.
9 Corderoy, A. (2008). Not so gay, isolation and depression’, Australian Doctor. Retrieved from: www.australiandoctor.com.au
10 Newman, C., Kippax, S., Mao, L., Saltman, D., Kidd, M. (2008). GPs understanding of how depression affects gay and HIV positive men. Australian Family Physician, 37(8), 678–80.
11 Mallen, M., Vogel, D. (2005). Introduction to major contribution: Counselling psychology and online counselling. The Counselling Psychologist, 33, 761.
12 Lewandowski, J., Rosenberg, B., Parks, M. Siegel, J. (2011). The effect of informal social support: Face-to-face versus computer-mediated communication. Computers in human behavior, 27(5), 1806–1814.
13 Gedge, R. (2002). Online counselling services in Australia –the challenges of a new vehicle for an old Art. Retrieved from: http://ausweb.scu.edu.au
14 ibid.
15 ibid.
16 ibid.
17 ibid.
17 Caspar, F., Berger, T. (2005). The future is bright: How can we optimize online counselling, and how can we know whether we have done so? The Counselling Psychologist, 33(6), 900–909.
Ben Yi is a Masters in Social Work Student on placement at ACSA. Rob Willoughby is Senior Counsellor at ACSA.