Email counselling with young people in Australia: a research report.

Rawson, Sarah ; Maidment, Jane

Introduction

During 2009, Kids Help Line (KHL) responded to 14,076 email and web counselling requests from young people aged between 5 and 18, with the online media attracting a far higher proportion of young people wanting counselling and support than telephone (93% compared with 47%) (Kids Helpline, 2009:9). Even so, internet counselling is still in its infancy in terms of usage in Australia. While there is a great deal of theoretical speculation about the efficacy of online counselling, the lack of research and evaluation into this area of service delivery has been noted (Urbis Keys Young, 2003).

According to the Australian Bureau of statistics 72% of Australian households now have home internet access and 78% of households have access to a computer. Between 1998 and 2008-09, household access to the internet at home has more than quadrupled from 16% to 72%, while access to computers has increased from 44% to 78%. Broadband is accessed by close to two-thirds (62%) of all households in Australia and 86% of all households with internet access (ABSa, 2009). Of particular relevance to this research is the level of internet access for Australian youth. Almost 84% of Year 4 students and almost 90% in Year 8 reported having an internet connection at home during 2007 (ABSb, 2009). These figures clearly show the prevalence of the internet as a mode of communication for young people in Australia and highlight the need to examine the effectiveness of the growing online counselling services designed specifically for this age group.

Despite burgeoning internet usage, examination of issues such as the development of the therapeutic alliance, exploration of how empathy is experienced and the use of online counselling as the primary means of intervention (rather than an adjunct to traditional therapy) have yet to be researched in any depth (Mallen, Vogel & Rochlen, 2005). To begin the inquiry we examined two sets of literature. These included material on the development of rapport in helping relationships, along with examination of research and literature on internet counselling, support and usage.

Brief Overview of Literature

Therapeutic Alliance

The therapeutic alliance has been defined as "the extent to which a client and therapist work collaboratively and purposefully and connect emotionally, and is conceptualised as a common, or generic factor in that it is believed to cut across various treatment approaches" (Gellhaus Thomas, Werner-Wilson & Murphy, 2005: 19).

The conceptualisation of this type of alliance has psychodynamic origins, dating back to Freud's theories of transference and counter transference, in which he maintained the need for a 'serious interest' in and 'sympathetic understanding' of the client to permit the healthy part of the client's self to form a positive attachment to the analyst (Freud, 1913). These ideas were later built upon by Carl Rogers who advocated for worker non judgement, respect, empathy and unconditional positive regard towards clients (Rogers, 1967), and were further examined by Bordin (1979, 1994) to distinguish specific ways in which the 'alliance' could be conceptualised. For the purposes of research a number of psychometric scales have subsequently been developed to aid the measurement of the client/worker alliance. Principle components of these include dimensions that focus upon mutuality and empathy, a sense of collaboration and support and the degree to which agreed tasks are achieved (Doucette & Bickman, 2001; Horvath, 1994). Quantitative research has consistently identified the quality of the therapeutic alliance as being a central influencing factor on the outcome of interventions across a range of helping modalities (Gellhaus Thomas, Werner-Wilson & Murphy, 2005). Research pertaining to the notion of alliance building in email counselling has been difficult to locate using either qualitative or quantitative methodologies. In this context it is important to note the difference between the asynchronistic method of communication occurring during KHL email counselling, and real time synchronistic counselling accessible from some agencies using 'chat' modality online. Emailing counselling at KHL consists of 'virtual' discussions that do not take place in real time, but are developed between the young person and their counsellor over a period of time. There have been mixed anecdotal responses to the idea of rapport building online using asynchronistic communication.

Robson and Robson (1998) maintain that counselling involves an intimate, albeit professional, relationship. As the client-counsellor relationship develops, clients learn more about themselves, and this can lead to a more intimate relationship with the counsellor. They argue, with the lack of verbal communication the capacity to develop such a relationship online will be severely limited (Robson & Robson 1998).

This point, however, has been debated. After examination of a variety of case studies, the International Society for Mental Health Online maintains that:

As the text relationship develops, the partners also become more sensitive to the nuances of each other's typed expressions, and together may develop their own private language and style of communication. While the therapeutic relationship may in some ways be made more complex by the absence of some sensory cues, in many ways we are in fact learning to work with the presence of new additional (text based) data and the power of the word. (Fenichel, Suler, Barak, Zelvin, Jones, Munro, Meunier, Wlaker Schucker, 2002 p. 6)

The question, largely unanswered in the existing research then becomes, how is the therapeutic alliance developed in an online environment? This research project was designed to address this particular question.

Lack of verbal and visual cues

Much of the debate about the effectiveness of online counselling cites the lack of verbal and visual cues. The client's tone, speech quality, personal hygiene, body language and appearance are all cues absent from online counselling, while a large part of traditional therapy depends upon assessment of these characteristics (Barak 1999, Robson & Robson 2000, Gwinnell 2003). Nevertheless, the online environment has adapted somewhat to accommodate this deficiency (Colon 1996), with workers at KHL observing extensive use of emoticons to convey affect and mood, eg: :-), :-(; use of imagery in dialogue, eg: I am looking really flat and low; and use of shorthand text for ease of flow in dialogue and to convey emotion, eg: lol (laugh out loud). Others however warn that emoticons may be too simplistic to interpret authentic emotional responses with accuracy (Mallen, Vogel & Rochlen, 2005). An additional feature of cyber communication that appears to encourage young people's use of online counselling is the degree of anonymity this medium affords.

Anonymity and Identity

Online services appeal to people who wish to remain anonymous. There is also evidence to suggest that people are more likely to admit vulnerabilities within the context of a computer text exchange (Christensen, Griffiths, & Korten, 2002).

This finding has been supported through case studies examined by the International Society for Mental Health Online:

Unlike the telephone, they [online interactions] provide enhanced anonymity, opportunity for self-expression through writing, increased ambiguity of counsellors, ease of escape, and enhanced aloneness, thus facilitating depth of self-disclosure and exposure of personal materials, as well as accelerating the speed of opening up. (Fenichel et al 2002, p. 8)

However, anonymity also brings with it ethical dilemmas in relation to verification of identity. The anonymity and unreality associated with chat rooms and email may encourage a form of role play. Gwinnell (2003) calls this the 'masquerade aspect' of online counselling. Choosing a false name, persona or presentation, is similar to wearing a mask. Self-protection, or a desire to remain anonymous while exploring role playing, encourages people to choose other screen identities.

Additionally, the potential also exists for deliberate deception and manipulation of the counsellor or online support group, or both. Again, Gwinnell (2003) points out that the internet offers a powerful and even potentially dangerous forum for acting out and victimising more vulnerable individuals. In addition, opportunity exists for professionals to misrepresent themselves. The client has little chance to be able to examine true and full information about a service provider and consequently they can be left unprotected (Barak 1999). This situation is further compounded by the limited formal guidelines that exist for conducting asynchronous online counselling.

However KHL does have a rigorous training program for counsellors to complete before they begin email counselling which includes: discussion of research findings about email counselling and ethical dilemmas; simulation of email responses to a variety of topics; use of specific tools for rapport building such as emoticons, language, speed of reply, length of reply and risk assessment. This training is offered to counsellors in a variety of learning environments through online learning modules, group and individual supervision, formal regular feedback from overseeing supervisors, and also a probationary period through which each and every email to a client is checked by a supervisor before being sent to a client. Staff are unable to work for KHL as independent email counsellors without passing probation.

Asynchronous thoughtfulness

The asynchronous quality of email communication provides both client and counsellor with the opportunity to devote greater thoughtfulness to their responses. This in turn may lead to more effective communication (Childress 1998). Evidence from KHL suggests that online counselling 'provides an opportunity for thoughtfulness and reflection and may encourage clarity of communication' (KHL 2000). These types of communication may impact on the depth of disclosure that occurs during an online counselling session.

Depth of Disclosure

KHL have discovered through earlier research that web clients were more likely to be direct about serious personal concerns than telephone clients, particularly around issues of suicide ideation and child abuse (KHL 2000). The safety and anonymity of online interactions appear to lend themselves to self-disclosure, particularly for children who fear prejudice on the basis of gender, race, ethnicity, disability and those who fear public displays of emotion (Barak 1999, Griffiths 2001, Sussman 2002, Wilson & Lester 1998).

Even so, recent American research with 64 participants focusing on self-disclosure in the online environment yielded contradictory data, suggesting online communication does not in fact foster self-disclosure to the same extent as face to face encounters in counselling (Mallen, Day, Green, 2003). Clearly there are mixed findings about the efficacy of facilitating self-disclosure in an online environment. The influence of writing text as opposed to verbalising problems or issues has also been subject to some examination.

Externalising and the text modality

It has been argued that the very process of writing an email externalises the client's problems (Murphy & Mitchell 1998). As they type, the client's written representations of their issues appear before them. It is believed that this process can enhance the externalising of problems and therefore promote therapeutic change (Murphy & Mitchell 1998). Writing about events is a form of journaling that enables the client to externalise their pain and issues, creating some distance between the events and their personal identity. The process of journaling has been used creatively as a tool in counselling to encourage self-reflection and self-assessment (Burnett & Meacham, 2002) where people make connections between their existing knowledge and their new knowledge (Gilmore 1998). Journaling, or the process of writing and recording one's life experience and perspective, has many similarities to the process of email counselling with the added benefit that the client gets to keep a complete record of his/her entire set of transactions with the counsellor, as the 'file' is created online.

The KHL system for managing the email counselling system works in the following way:

* Emails are received into a general email address and appear in an 'unallocated queue' in order of the date received.

* Shift supervisors and senior counsellors read every email to assess urgency. Emails of high risk content are marked urgent / 24 hours.

* Counsellors respond to emails from the 'unallocated queue' according to a) urgency and b) date order.

* After an email has been responded to by a counsellor, the client's subsequent emails automatically go into that counsellor's inbox. Supervisors still have access to the counsellor's in-box. Thus the client has continuity of care with one ongoing counsellor.

Research Method

In a qualitative inquiry, knowledge is personally constructed and contextually bound. The medium of email counselling lends itself to qualitative examination as KHL clients use email counselling to convey their reality. The text medium gives clients the opportunity to carefully construct, edit and verify their reality, in a way that is not necessarily available in face to face or telephone counselling. Clients have the benefit of distance and time to reflect on their reality as they are writing, and also have the opportunity to rethink and reflect upon their stories as they keep copies of their emails. The absence of verbal and visual cues ensures that counsellors ask for clarification and context from a client in an effort to understand their story, rather than perhaps shortcutting that process in the presence of other cues, such as voice, tone and background noise. Given these unique dimensions associated with email counselling we decided that a qualitative approach provided opportunities for narrative and content analysis of the text-based data.

Design & Pre-testing

The research design comprised of an electronic survey with a series of four closed questions relating to participant demography and internet usage, and seven open-ended questions.

The questions were designed as a result of examining aspects of the therapeutic alliance gathered from a number of sources. These included Carl Rogers' person-centred counselling and aspects of the relationship development between counsellor and client (Rogers, 1957), the working alliance inventory designed by Horvath and Greenberg (1986), and anecdotal evidence of aspects of therapeutic alliance gathered from counsellors at KHL.

Pre-testing of the questionnaire structure, comprehension and general wording occurred prior to the questionnaire appearing live online. Pre-testing involved contacting via email, a random selection of ten existing email clients and providing them with a draft of the survey questions. These clients were asked for feedback about the wording, structure and comprehension of the survey. Before use three KHL counsellors, two youth workers and two teachers also studied the survey and these people's specific knowledge of 'child friendly' language helped to shape the style used. Supervisors and managers at KHL perused the survey to check it fulfilled the necessary requirements for KHL, including confidentiality and anonymity. The survey was then posted on the homepage of KHL for six weeks during the months of March and April 2005. All responses remained anonymous and were forwarded to the researcher via email from the webpage posting box.

Data Analysis

Narrative analysis was used in this research to examine the email responses about online counselling. These responses were subjected to categorical-content analysis using a narrative interpretation. Breaking this down further, in working from a categorical perspective, the original story was dissected and sections or sometimes single words belonging to defined categories were collected from the entire story (rather than individual questions) and from several texts belonging to a number of narrators (Cortazzi 1993).

This process resulted in a series of categories being created, which were used to code the data, providing descriptive accounts (case studies) and present an analysis of notable patterns. Table 1 provides examples of how individual case data was categorised.

Firstly all the qualitative data and identified key words and phrases in each response from the interviews were read using an initial memo process noting recurring words and phrases. These were next clustered into a series of categories with an analysis of the context in which each of these categories were integrated. For example, referring to Table 1, in the section 'choice of email counselling', one response was: "it gives you more time to think". This fitted into the category (created through identification with key word/s) of 'Reflection and asynchronous thoughtfulness'. This category was then expanded to include the context (ie: the development of the therapeutic alliance in email counselling): 'Email promotes reflection on one's story'. This was a gentle, detailed form of analysis taking into account the importance of every individual response, and then identifying common words / phrases, and resulting in themes relevant to email counselling.

Participants

Participants in this research included new and existing email clients at KHL. The age range for clients at KHL is between 5 and 18. However, given the overwhelming majority of clients who access web and email counselling are between 12 and 18, clients of that age range were invited to participate in this study. Participants were recruited for the study via an invitation that was posted on the KHL website near information about web counselling. The invitation provided a hyperlink to the electronic survey. Counsellors also voluntarily informed their clients and directed them to the hyperlink. Table 2 provides a breakdown of the ages of the 63 young people who participated in the research.

This breakdown in age range of participants reflects the age statistics typically seen in email counselling at KHL. That is young people between the ages of 14 and 18 are the most frequent users of the email service (KHL, 2004).

Table 3 provides a gender breakdown of the participants in the research. Statistically, young females are more frequent service users at KHL (KHL, 2004, 2009), so it was not surprising that young women made up the majority of participants in the research. The participants who completed the online surveys were therefore representative of the gender and age range of client groups who are known to use KHL services the most.

Ethical Considerations

One of the most challenging ethical dilemmas in this study involved the issue of informed consent. Clients at KHL are overwhelmingly under 18 years of age and as such technically require adult or parental consent for counselling and / or participation in research studies. KHL maintains that, as they are a confidential, anonymous service (no identifying information other than a first name is required, and even then young people often use 'code names'), it was not necessary to collect signed consent forms from the parents of the young clients participating in the research.

Involvement in this research and all service delivery provided by KHL to young people is of a voluntary nature at all times. However, given the seriousness of the work done by the agency and the accompanying issues related to duty of care, the area of not having parental consent for young people's involvement in the service continues to be a challenging and contentious issue.

Ethics approval for conducting this research was sought and provided from both Kids Helpline and Central Queensland University. Participants were encouraged to 'talk' online with their Kids Helpline counsellor should any issues arise as a result of participating in the research process.

A number of strategies are in place to deal with duty of care considerations in email counselling at KHL. These responses are provided due to increased occurrences of serious, life threatening presentations in the online environment. These strategies include:

* Additional training and experience required for email and web counsellors (in comparison to phone counsellors).

* Monitoring by shift supervisors of real time calls to support counsellor and client during at risk presentations.

* 24/7 availability of the manager of counselling services for consultation in relation to breaching confidentiality in cases of extreme risk.

* Access to police communications who trace IP addresses if immediate intervention is required.

* Capacity to encourage online clients to cross over to the phone counselling service (which operates 24/7) if required. From a technological perspective it is faster and easier for police to trace a phone call if extreme risk is present.

Limitations of the Research

The study had a number of limitations. Firstly, it was challenging to recruit participants using the internet. Existing email clients rarely go back to the website after their first visit to acquire the email address and also rarely read the automatic response received after each email. Secondly, the traditional method of ensuring reliability and validity, that is inviting participants to validate their own data through a discussion of responses, was not available given the anonymous nature of both KHL clientele and the research data collection method. Thirdly, the actual computer page housing the survey did not provide a large amount of room for young people to provide their answers. This may have discouraged young people from providing more in-depth reflections. Finally, since young service users were encouraged to respond to the survey by their own counsellors, these personal connections with KHL staff may have influenced survey responses.

Even though these factors have been identified as limitations, the replies received from the 63 young people who contributed survey responses did provide a wealth of qualitative data and highlighted several interesting and previously unexamined aspects of the development of the therapeutic alliance in email counselling. The most significant of these findings are discussed below.

Results and Discussion

For the purposes of reporting the data, after each quote the gender and age of the participant is shown. In addition, quotes from participants have been taken directly from the data, with no editing or correction of spelling and grammar.

Themes and patterns in relation to therapeutic alliance

It is worth noting that a number of participants found it difficult to define aspects of the therapeutic alliance or noted that they could not tell when the counsellor was listening, if they cared and what they were like. This perhaps shows the complexity of the concept (therapeutic alliance) and the difficulty in definition, when referring to the text form. In total, 23 participants (36.5%) fell into the category of either answering that they didn't know how the alliance is formed, or noting that it wasn't possible to tell if a counsellor was listening, if they cared about what they are saying, or what the counsellor was like. However, many of these participants went on to clarify these answers and showed that they could identify elements of the alliance, without possibly fully understanding the concept. For example:

"You can't really. But they sort of sound kind in the email" ( F15).

"I don't know really. The way they talk to you about your issues. It's not good if they ignore what you're saying and don't talk about it in your reply" (F14).

"I don't know. Generally the smiley faces do a lot for me in terms of feeling like they are friendly" (F18).

While the therapeutic relationship, and its definition, may in some ways be made more complex by the absence of some sensory cues, in many ways we are in fact learning to work with the presence of new additional (text-based) data and the power of the word (Fenichel et al 2002). Table 4 shows a summary of the responses to the questions relating to therapeutic alliance. The most frequently cited themes and patterns have been identified next to the quotations provided by participants. This method of presenting the data, as discussed by Lieblich, TuvalMashiach, & Zilber (1998), is part of content analysis and allowed for the conceptualisation of key categories. Key words were extracted from the data and presented in the column on the right as themes and patterns relating to therapeutic alliance in email counselling.

Table 4 shows a number of patterns emerging from the data. The notion of reflection was identified by several participants. Reflection being a key tool in narrative therapy enables clients to 'see' their stories, which in turn can lead to a closer examination of patterns and beliefs. In this regard the medium of email counselling has the added benefit of being in a modality which provides a clear externalisation (that is, the written word) of problems and issues the client might be experiencing. It would appear from this data that facilitating reflection was a key process in the text medium towards building the therapeutic alliance.

The length and depth of reply also figured prominently in participant responses, which may be related to the differing conceptualisations of time, discussed below. Complex issues take more time to deal with in all counselling mediums. The length and depth of an email may be an indicator for the client of a counsellor's interest, their willingness to engage in a meaningful way, and their understanding of the gravity of a young person's problem or story. It became apparent that at times and for some young people, a short email response indicated a lack of interest and understanding, for example as one participant notes,

"if they just give you a couple sentences, then it's like they haven't taken any time and don't care. If its longer it shows they are really trying to get to the heart of stuff. And they care more" (F16).

Emoticons and informal language are phenomena particular to text-based communication and in the data collected feature as tools for building a therapeutic alliance. As has been identified in the brief review of the literature, the 'short cut' of smileys and other emoticons can give the client and counsellor a window into the feelings and emotions shared by both, and act as a substitute for verbal and visual cues (Colon 1996).

Humour and personalised language also featured in the data. Humour can convey a sense of fun and can ease anxiety very quickly. It would seem from the data that personalised language, such as using the client's name, or signing off in an informal way like "see you later", conveyed to the client that the counsellor is willing to 'meet' on more personal terms which appeared to encourage more personal disclosure and sense of trust.

The traditional counselling skills such as showing empathy, validating, summarising, paraphrasing, using respectful language (Geldard & Geldard 1999), were all mentioned by participants in the research as factors that contributed to building the therapeutic alliance. This shows that many of the elements of the alliance developed in more traditional counselling media were in turn transferred to this online counselling situation. The data clearly suggested it was possible to show empathy, for example, without tone of voice and facial expressions.

Time

The issue of time presented itself in the research data in two key areas. Firstly almost half (46%), of the participants believe the service would better meet their needs if the email responses from counsellors were quicker. These results also reflect anecdotal evidence at KHL, where clients often comment to counsellors that they wish the service was faster. Secondly, a number of participants made comments about time in questions relating to therapeutic alliance, that is, how you could tell the counsellor is listening to you, how you could tell what the counsellor is like and how you could tell that the counsellor cares about what you are saying. Diagram 1 shows a number of responses to the above questions. The diagram is circular in nature, each section relating back to, and feeding into, the core interpretation of time in this context.

It became clear from responses that the length of time it took for a client to feel comfortable with a counsellor varied dramatically between participants and was often subject to a number of contextual factors. It was not clear, however, whether or not it took longer to build the therapeutic alliance in email counselling, which was an assumption of this research, given the passage of time spent in receiving, reading and writing responses to client emails. It may be that the added dimensions of time passing within the emailing process, along with factors of faith in the service which were evident in client comments, and the process of validation through writing and having emails read, enabled the therapeutic alliance to develop quickly. The elongated process of writing back and forth may therefore in and of itself compensate somewhat for the lack of verbal and visual cues.

The process of the counsellor simply replying appeared to have a powerful effect for young people in terms of contributing to a strong therapeutic alliance. A number of participants stated that the counsellor replying automatically showed them they care and wanted to help. For clients, the process of expressing their feelings and problems, and being heard (which is implied in a response), is a powerful dimension of the helping relationship. This dimension of alliance-building simply through the process of text exchange appears to be absent from the literature about online counselling, but came through strongly in the data analysis.

In conclusion

In relation to KHL current online service delivery, this research suggests that email counselling meets a clear and present need for young people who, for a range of reasons are unable or unwilling to access other more traditional modes of therapy.

[ILLUSTRATION OMITTED]

Many of the issues identified within existing literature in relation to email counselling have been present in the data collected for this research. Points relating to privacy, access, level of disclosure, safety in distance, anonymity, opportunities for reflection and asynchronous thoughtfulness all featured prominently in the perspectives of young people who participated in the research. The skills of summarising, paraphrasing, using respectful language, showing empathy, using humour and being consistent were also identified by the young people as being used by counsellors in the online environment, and appreciated by the clients. The added tools of emoticons and 'short hand' sentences in the email exchanges helped to convey meaning and contributed to the therapeutic alliance.

In relation to this alliance, the concept of time featured prominently in a number of ways and brings a new and unique dimension to consider in this area of research. Examining the notion of 'time' must include the contradictory aspects of young people wanting faster replies, but appreciating the extra time the counsellor takes to reply in depth. In addition, the concept of time passing was identified as being part of the appeal of email counselling and a contributing factor in the development of the therapeutic alliance, with the passage of time needed also for rapport building and personal change to occur.

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Table 1: Two Examples of Categorical Data Analysis

                         Categories               Comments /Memos

Female 18: elements of therapeutic alliance

"as they don't judge     Non judgmental           Participant is
you you start to open                             guarded at first
up"

"if they answer with     Respect                  Need for respect
respect and insight"                              common to all
                                                  interactions

"if they write back      Reply                    The alliance is
that's a start"                                   already being built
                                                  based on one reply

"I just figure they      Trust (faith, hope)      Trust in counsellor
must be a good person"                            as expert' and
                                                  good'

"the detail they have    Depth of reply           Time = level of care
written in emails
tells you they care
and are listening"

Female 18: choice of email counselling

"don't feel              Stigma                   Mental health stigma
comfortable talking to
a stranger on the
phone. They might
think I'm crazy"

"I feel more distance    Safety in distance       Email less
when emailing"                                    confronting

"it gives you more       Reflection and           Email promotes
time to think"           asynchronous             reflection on one's
                         thoughtfulness           story

"I can use it as a       Journaling, Reflection   Email promotes
diary"                   and asynchronous         reflection on one's
                         thoughtfulness           story

Table 2: Age of Participants

Age                   Number of participants

Under 12                     4 (6.4%)
12                           3 (4.7%)
13                          9 (14.3%)
14                           5 (7.9%)
15                          14 (22.3%)
16                          11 (17.5%)
17                          10 (15.9%)
18                           6 (9.5%)
Over 18                      1 (1.5%)

Total Participants              63

Table 3: Gender of Participants

Gender                  Number of participants

Male                           4 (6.4%)
Female                        59 (93.7%)
Total Participants                63

Table 4: Aspects of Therapeutic Alliance in Email Counselling

                                                        Key words,
                                                        themes,
Survey         Participant responses                    phrases
Questions                                               relating to
                                                        therapeutic
                                                        alliance

How can you    "If they mention all the issues you      Encouragement,
tell the       raised in your email, and encouraged     validation,
counsellor     you to say more about them or ask        reflection
is listening   some questions. And if they
to you?        acknowledge your emotions, and can
               tell how you are feeling" F18 (Female
               18 years of age)

               "by the tone of what they say and how    Tone,
               they say it. by referring back to        summarising
               thinghs i have said in previous
               emails" F13

               "I can tell they are listening           Interest,
               because of the depth of their emails     depth of
               and how it goes into what i wrote,       understanding
               and how they seem "interested" by
               asking questions related to what i
               wrote." F15

               "So like if u say something and then     Paraphrasing,
               in their response they kinda rephrase
               it and ask questions about it" F17

               "When the counsellor talks about what    Reflection
               you have said you know they've read
               your email and thought about it" F17

               "They repeat everything I say and        Reflection,
               then add to it to make me reflect on     paraphrasing
               what I have said to them." F15

How can you    "By the way they write, how long the     Length and
tell what      letter is, if they crack jokes, and      depth of reply
the            how they word what they write" F15
counsellor
is like?       "can tell the counsellor is              Respectful
               understanding because she speaks         language,
               politely, clearly and mentions my        familiarity
               name in reply emails which adds a
               more personal feel to the email" F16

               "You can't fully, but generally the      Emoticons,
               smiley faces do a lot for me in terms    reflection,
               of feeling like they are being           informal
               friendly. If they throw in a nice        language
               comment or remember something you
               said in an earlier email it makes you
               feel they are nice. Informal language
               and maybe some little phrases helps
               as well." F18

               "if they are funny sometimes, or use     Humour,
               nice words that make you feel good.      respectful
               like that they understand or it's ok     language
               to feel stuff. if they are gentle and
               use gentle language like 'what would
               it be like' instead of 'do this'
               thats cool" M16

               "humour, smileys, gender, someone who    Humour,
               uses respectful language and takes       gender,
               time to pick out the main stuff we       emoticons,
               write. if they make an effort to use     respectful
               language we understand, that tells us    language,
               they are trying and if they don't        paraphrasing,
               push too hard, that tells us they are    patience,
               patient. when i read back their          consistency
               emails i can get a sense of who they
               are by the language they use. if they
               are consistent i know they are being
               themselves and being honest." F18

               "you cant for awhiel so you gueard       Non-judgmental
               yourself incase it turns out they are
               judgemental, then as they dont judge
               you you start to open up." F18

               "It sounds silly but like by putting     Emoticons
               smiley faces and stuff its kinda like
               thats them smiling and being nice"
               F17

               "lol, how they type, like in short       Informal
               engligh, how they put words etc" M15     language

               "you can tell what the counsellor is     Empathy
               like from the way they sympathise
               with you and talk to you, and greet
               you." F17

               "My counsellor is gentle and patient     Gentleness,
               and sometimes tells jokes or tells me    patience
               sayings." F17

How can        "they keep in touch with you" F15        Commitment
you tell the
counsellor     "sometimes you know they care if they    Listening
cares about    listen alot and make you smile and
what you are   understand you" F12
saying?
               "If they say they care, and think of     Honesty
               ways to help you that fit the
               description of what you are going
               through" F15

               "because they put themselves in your     Empathy
               shoes" F13

               "If the email is brief and seems         Depth of reply
               abrupt it makes you feel they don't
               care very much. You can tell they
               care if they say they care, or if
               they take the time to write a fairly
               good reply, and encourage you to keep
               contacting." F18

               "they write back and you can tell        Consistency
               they have read your stuff. they tell
               us they care about what we are saying
               and if they keep doing that we might
               believe them" M16

               it's good when the counsellor tells      Validation,
               us that we have a right to feel the      honesty
               way we do and that they would like to
               help. that tells us they care. If
               they get back to us soon it shows
               they don;y want us to be alone and
               that also shows us they care." F18

               "Because they will respond with          Respect
               respect and the best answer they
               have." F17

               "use of langiage again ... just          Reflection
               mentioning things i've said, asking
               questions." F16

               "I think that sympathy is a great way    Empathy,
               for kids to know that the counsellor     validation
               cares about them. When the counsellor
               acknowledges the problem the kid has
               and says e.g. how bad that must be,
               you know that they really care about
               your situation" F17