Email counselling and the therapeutic relationship: A grounded theory analysis of therapists' experiences

Francis-Smith, Carole

Abstract

Provision of online counselling in its many forms has increased dramatically over the last 10 years, however research findings suggest that many therapists have concerns about whether a therapeutic relationship can be successfully engendered online, particularly given the absence of non-verbal communication cues. To date there is very little research available about the online therapeutic relationship; email counselling was chosen for the current study as through its dearth of non-verbal cues it may deemed most different to face-to-face counselling, and is considered to be the most popularly used mode.
The central aim of this study was to explore the accounts of therapists who have worked both face to face and by email about how they construct their experiences of the therapeutic relationship in email counselling. The secondary aim was to co-construct an explanatory grounded theory of the process.

The study adopted a constructivist grounded theory methodology (Charmaz, 2010); using an initial purposeful sampling strategy, nineteen participants were recruited to the study and completed an anonymous online qualitative survey; four also took part in semi-structured interviews. A theoretical sampling was then adopted to refine the developing theory; two novice email therapists and four non-email therapists were recruited. Overall there were twenty-five participants, some of whom engaged using more than one media.
The basic psychological processes that were co-constructed from the data indicated that many participants found working in the cueless online environment highly challenging and that the resultant anxiety led to several sets of behaviours. Participants described how Experiencing cuelessness i.e. the absence of sensory cues led to an experience of Losing touch in four ways; Loss of interactive factors with the client, Responding with no sensory steer, Losing control of the process and Losing control of the context to the client. This led to a sense of Peering through the looking glass when counselling online; counsellors felt as though they were Fantasising into a void, and Fearing [client] disappearing. Participants also described Worrying about risk and expressed Worrying about Client safety and Fearing exposure due to having a written record and any possible legal or professional ramifications. Further uncertainties were also revealed as participants were led to Questioning computer reliability and Questioning own competence.
Consequently participants were left Experiencing anxiety. This anxiety appeared to be managed in a number of ways; participants described Becoming more task orientated (Relying on skills and theory and Taking control of the context), Avoiding difficulties (Minimising the role of the computer and Minimising differences between modalities/ Holding on tight to the known), Overcompensating (Reflecting and perfecting), and Defending the professional self-concept (Protecting by defending expertise and Becoming an expert).
The key struggle and therefore core category would seem to lie in participants attempting to apply relational face-to-face skills to the cueless atmosphere of email therapy, the anxiety of which materialised in several avoidant behaviours.

The findings from this study provide important insights into therapists’ experience of email counselling and identify a process that could help inform future online therapists, as well as being useful to the online counselling profession as a whole. It is suggested that the email counselling process identified could provide a framework for therapists to reflect on their experiences. Full implications for practice, supervision, training and the psychological profession will be further discussed, in addition to directions for further research.

• Thesis Type: Thesis
• Publicly Available Date: Jun 6, 2019
• Keywords: email, e-mail, counselling, therapeutic relationship, grounded theory, therapists' experiences, online, therapy, therapist
• Public URL: https://uwe-repository.worktribe.com/output/806306
• Award Date: Dec 17, 2014