Sage Journals: Discover world-class research

Abstract

Counseling is an age-old practice with roots dating back to the 20th century. Twenty-first-century boom in technology has offered new opportunities for counseling practice, making it possible for counselors and clients to interact virtually without recourse to physical meetings. This study sought to investigate students’ experiences of online counseling in some Ghanaian universities. A qualitative phenomenological approach was used to examine the experiences of undergraduate students using online counseling. Five of the student-clients used WhatsApp messaging, two used e-mailing, and one used WhatsApp video. A thematic approach was used to analyze student-clients’ experiences. Accessibility, convenience, privacy, and mobility were some significant benefits they indicated concerning online counseling. On the contrary, loss of non-verbal cues, mistrust, and poor internet connectivity were their major obstacles to online counseling. Nevertheless, their issues were resolved with the use of online counseling. It is recommended that Counselors are trained in the use of online resources for counseling, and Management of Universities should introduce counseling technology devices to students to make online counseling more accessible and convenient.

Keywords

online counseling technology face-to-face counseling non-verbal cues Africa

Introduction

Counseling is a fundamental profession which has made a lot of impacts, and distinctively has developed in a variety of ways in the 21st century. Counseling has become a very useful area in the sense that it has improved the lives of people (clients). It has made people understand themselves, maintain good interpersonal relationships, and develop good communication and relationship skills (Buku, 2016; Hays & Erford, 2018).

The development of counseling can be traced back to the formation of guidance associations in the 1950s, the strengthening of school guidance programs, and training of school counselors in the United States (Bedu-Addo, 2016; Buku, 2016; Hays & Erford, 2018; Taylor & Buku, 2003). The 1960s and 1970s brought about the diversification of counseling into settings like schools, communities, hospitals, and universities. In addition, the 1980s and 1990s saw the licensure movement in counseling, which assisted in improving professionalism by setting guidelines and standards of practice. In the 21st century, technology and globalization have affected the profession, with the birth of online counseling as well as multiculturalism in the profession (Geldard et al., 2015; Sue et al., 2019; Zamani et al., 2010). Due to this globalization, counseling has extended to multiple areas including, but not limited to, stress management, sports and leisure, academic counseling, career counseling, and geriatric and community mental health. All these are underpinned by globalization and technology. This is because the world has become a huge place with interdependent issues and often it is technology that is used to speed up operations so a lot of problems will be solved in a shorter period of time.

Information and Communications Technology (ICT) is increasingly helping to change people’s lives in unprecedented ways. ICT is transforming public service delivery and democratizing innovation, and counseling is no exception in this regard.

ICT with its various facets has become powerful to the extent that e-health interventions have proven to be effective in treating health problems; about four out of five internet users report to seeking counseling on health-related issues online (Hennemann et al., 2017; Uzoekwe et al., 2012).

Although, there is increasing participation in online counseling, professionals have nevertheless raised concerns about the ethical and legal standards of care delivery (American Counseling Association, 2014; Remley & Herlihy, 2020), while those who stand against most things technology have wondered how effective this approach is compared with the traditional face-to-face counseling (Kolog, 2014; Wang et al., 2010). Other experts are also reluctant to its use because of lack of knowledge in ICT as well as apprehension about change. Interestingly, both the research community and the counseling profession in developed nations like the United Kingdom, the United States, and Canada have consistently asserted that online counseling although exclusive (using electronic means), is as applicable as face-to-face counseling (Cohen & Kerr, 1999; Kraus, 2011c; Nagel & Anthony, 2011).

Review of Literature

According to Barak and Grohol (2011) and Kanani and Regehr (2003), the use of ICT has offered opportunities in communication. Online counseling has assisted counselors to provide support for clients through zoom sessions, text messaging, online chats, e-mailing, and phone calls (telephoning), thereby providing mental wellness support for clients. This is because, clients have the opportunity to discuss issues with counselors at their own private and convenient places without having to physically see the counselor. The use of computer and online counseling, therefore, has eased the work of some counselors who always have to make appointments with clients to meet them face-to-face and also eased the load of clients who have to travel to see the counselor. This has enriched the counseling profession and upgraded performance (Barak & Grohol, 2011; Kraus, 2011c). The orthodox form of counseling, that is, face-to-face mode of counseling is currently known to be extensively expedient, accessible, and vigorous.

Online counseling has been defined as the process of a professional counselor meeting a client one-on-one in a remote environment using electronic means (Li et al., 2013; Maples & Han, 2008). Counseling online is in two main forms. These are synchronous and asynchronous forms (Gamble et al., 2015; Suler, 2011). Synchronous forms of counseling are instantaneous, that is, messages sent are real time (WhatsApp, Viber, Telegram, video chats) and asynchronous forms are delayed by time (e-mail; Gamble et al., 2015; Li et al., 2013).

It has been found that the traditional face-to-face counseling is similar to video conferencing in that it engages the counselor who communicates with the client face-to-face (Barak & Grohol, 2011). In video conferencing, the images and voices of the parties engaged in communication are transmitted at a long distance, and all these are done through electronic means. Because of its indispensable nature, Suler (2011) advocated that video conferencing can be used in our educational set up for both student and teacher for online lectures and distance learning; not exempting its essential use in counseling.

Online counseling comes with numerous benefits. Regarding self-disclosure, Tate and Zabinski (2004) asserted that clients find it less difficult disclosing themselves to counselors via electronic means than face-to-face approach. This is because demographics such as gender, age, and name may be hidden. Other studies also proof that honesty may increase; clients may feel less defensive, fearless, and less vulnerable (Kotsopoulou et al., 2015; Mishna et al., 2015). This is because they cannot see the counselor during interactions. Also, they do not have to contend and make meaning of the therapist’s instantaneous emotional feedback signals which may affect emotions and delivery (Maples & Han, 2008).

The anonymity provided by online counseling when clients set up a new e-mail address that does not contain their name and it is not linked to anything else that could identify them may be beneficial. Given that clients being anonymous will ease their pain, reduce stigma, and improve their confidence when communicating with counselors on their issues (Kraus, 2011a; Mishna et al., 2015). Similarly, the obscurity of online counseling may also decrease nervousness and the pressure clients go through (Manhal-Baugus, 2001). From the discussions raised regarding anonymity, it would be ascertained that it (anonymity in counseling) may be beneficial for clients with issues of rape and abuse which is accompanied by shame or fear of being judged (Cipolletta & Mocellin, 2018). As a result, clients in online counseling have been reported to disclose important information earlier than those in face-to-face counseling (Haberstroh et al., 2007; Young, 2005).

Just as there is a scheduling of meeting in face-to-face counseling, so there is for online counseling. But an essential thing about online counseling is that, because it is data driven, the counselor and client become more focused on the issues to be discussed and so more time is being saved so a counselor can attend to other duties as well as the client (Kotsopoulou et al., 2015; Tate & Zabinski, 2004).

Convenience, accessibility, and cost are very beneficial to online counseling. For instance, both counselor and client can conveniently access counseling anywhere without being limited to the confines of the counselor’s counseling chamber (Rummell & Joyce, 2010). It is envisioned that online counseling will eliminate stigma, reduce pressure and frustration, increase accessibility, and enhance clients’ confidence. Given that, clients are able to access counseling anywhere; especially students during holidays are able to maintain contact with their counselors irrespective of the distance. Again, it enables counselors to follow-up on students even after completion without recourse to the kind of space they are confined in. The process involved in online counseling makes it flexible and easy to use. According to studies, clients prefer to use online counseling because they are able to communicate with their practitioners at their own convenience and do not have to leave their work or home to see a counselor (DuBois, 2004; Young, 2005). Hearing impairments and clients with eye problems may also benefit from online counseling (DuBois, 2004; Young, 2005).

Online counseling is also seen to be less costly. Although one needs to acquire the necessary tools to be able to communicate remotely, the issues of travel, time, and accommodation become less expensive as compared with face-to-face counseling. This enables both parties to save time for other engagements and reduce risk (Young, 2005).

One of the unique features in counseling is the use of non-verbal cues. It is known that the use of non-verbal cues takes about 80% of communication and it is essential in counseling to enable the counselor understand the clients’ issues and assist them promptly (Young, 2005). Nevertheless, this is absent in the online counseling process (Haberstroh et al., 2007). The exhibition of non-verbal cues improves communication especially on the part of the counselor and makes clients feel more accepted and understood in the therapeutic relationship (Hanley & Reynolds, 2009; Rummell & Joyce, 2010). This is consistent with Haberstroh et al.’s (2007) qualitative study where their report showed that participant (counselor) noted that the absence of non-verbal cues brought a loss of touch with the client and made communication more difficult and less comprehensible. It would be said that, clients too may feel some loss of control with the absence of a non-verbal cue from the counselor.

Paraphrasing is a vital skill in counseling psychology. Counselors use paraphrasing to enable them comprehend the issues clients present during counseling and this cannot be overemphasized. On the contrary, Haberstroh et al. (2007) noted that the immediacy of feedback in asynchronous counseling is an issue for clients. Given that, clients are not sure if they have been understood by the counselor and this creates misgivings on the part of the client. The authors, therefore, feel that, there is misreading of clients’ feelings during online counseling.

Another issue associated with online counseling is time delay. E-mailing counseling has the tendency of delaying a counseling session. Because it is an asynchronous form of online counseling, it may take some time before communication can be established. At times, client may also deny the receiving of e-mails if he or she does not want to fulfill assignments given in the therapeutic process. Again, instant messaging can also be slow when compared with face-to-face counseling. Poor network connectivity may result in delay of message to either party (counselor and client) making both parties uncertain as to whether each has disconnected (Haberstroh et al., 2007). At times, due to delay of a message, ambiguity may set in when both counselor and clients try to process what has been written.

The enormity and importance of online counseling is much to be desired. Nevertheless, Ralls (2011) was of the view that the use of chat rooms limits the use of confidentiality to clients. Information disclosed in the chat rooms may be leaked due to negligence on the part of both counselor and client, and also the information can be hacked.

Aside the synchronous and asynchronous mode of doing online counseling, a number of applications (gamification) have been developed to assist in this regard (Dennis & O’Toole, 2014; Franco, 2016; Granic et al., 2014). For instance, the use of computer games serves as a motivation for young people designed to challenge them to progress to their targets and beyond and completing challenging tasks. Progressing to their targets helps reduce stress, build confidence, and improve emotions (Dennis & O’Toole, 2014; Fleming et al., 2017; Merry et al., 2012). Adventures, puzzles, and also quests are the programs/games for teaching basic skills and to manage stress. They are designed to enable users to customize it for their particular task and embark on an expedition to bring some joy into their troubled lives.

Undoubtedly, online counseling is essential and has limitations as well. The unavailability of non-verbal cues, asynchronous time delay, technical difficulties, and loss of physical presence may make the modality unpleasant for some clients and counselors. But for others, the anonymity, limited cost, the convenience, and privacy make it more attractive to use.

Twenty-first century boom in technology has offered new opportunities for counseling practice, making it possible for counselors and clients to interact virtually without recourse to physical meetings. While online counseling is gaining a lot of adherents in the developed world, in the Ghanaian context, no formalized online counseling is being offered in our universities (especially government-owned), senior high schools and health institutions, due to lack of online counseling practitioners and the necessary technological tools. It has been argued that depending on the nature and severity of the issue at stake, a client would want to use online counseling mode so they feel less stigmatized without having to be seen by others (such as, clients in a waiting room, administrative staff, or people walking past a counseling center).

On the contrary, other experts opine that online counseling is ineffective because it lacks face-to-face encounter (Ersahin & Hanley, 2017; Reynolds et al., 2013). The rapidly developing field of online counseling has raised a lot of concerns among practitioners of counseling (Kolog, 2014; Wang et al., 2010). The introduction of ICT has taken a lot of professions from physical interactions to electronic means of dealing with issues. Counseling is no exception as some clients can conveniently use online means to communicate with online practitioners (Kolog et al., 2014). Face-to-face counseling approach is nevertheless essential and inevitable especially with deep-seated problems (Kraus, 2011b; Zamani, 2009). Consequently, the developing pace of ICT in counseling should not be a replacement of traditional face-to-face counseling.

There is a scarcity of formalized online counseling in Ghanaian universities. Few studies have shown an exploratory study on students’ perception and also attitude toward online counseling (Awabil & Clifford, 2018; Kolog, 2014). Past studies focused on secondary school students who are restricted with the use of phones and also are limited in the use of computers. The study was based on the hope-centered model (Hope game online) considered to provide inherent abilities in people which will motivate them to succeed in life and the ability to create avenues to achieve desired goals and motivate an individual to use those avenues (Kolog, 2014; Kolog et al., 2014). Again, studies with university students focused on their attitudes to online counseling. These are students who have not experienced online counseling but the research was to determine the extent or level to which they will use online counseling if the opportunity presents itself (Awabil & Clifford, 2018).

Due to the busy schedules of the researchers (counselors), they had the opportunity to engage some students in online counseling. During these encounters, the researchers believed that their interactions with the students yielded good results. But then, the merits of the interactions cannot be used as the only factor to the introduction and effective implementation of online counseling in the universities. It would be emphasized that although online counseling is being implemented, it largely goes unnoticed. In terms of policy, there has not been any laid down rules or procedures in our universities with regard to online counseling. It is in view of these that the researchers embarked on this study to discuss the issues raised by student-clients in their experiences of online counseling.

The following objectives guided the study:

Identify the convenience or benefits student-clients had with online counseling.

Identify the various obstacles associated with online counseling students-clients experienced.

Identify the various ways student-clients related in a non-verbal environment.

How can online counseling be effectively implemented in the university?

The following questions were raised for the study:

What are the benefits student-clients experience with online counseling?

What are the various obstacles associated with online counseling student-clients experienced?

What are the various ways student-clients related to the counselor in a non-verbal environment?

How can online counseling be effectively implemented in the university?

Online counseling has the propensity of reaching a larger population and saving time. The findings of this study will be a great resource especially in Ghana regarding the preparation of online counseling to ensure effectiveness of service provided to students and to provide a more in-depth perspective in addition to the lack of knowledge regarding counselor approach to online counseling and training in Ghana.

The information gathered after the study of this work will add to the numerous literatures on online counseling and precisely to that of Africa and Ghana.

Method

A qualitative phenomenological approach was used in the study because it looked at the experiences of the student-client in the use of online counseling. Student-clients who have undergone counseling in the selected university campuses served as participants for the study.

To get the sample from the populace, purposive sampling was employed. The purposive method of sampling was used because the study’s focus was on only students who have experienced online counseling with counselors of the university. As noted earlier, online counseling has not been formalized on these campuses and hardly is it being used. Therefore, these students were the ones who have undergone the online counseling process for a while and who were able to answer the questions needed for this study. Eight students were used for the study. These were student-teachers in teacher education universities in Ghana whose ages were between 20 and 30 years (three females and five males). Problems presented for their interactions online were study habits, problems with roommate, and relationship with the opposite sex. Five of the students used WhatsApp messaging, one used the WhatsApp video, and two of them used e-mailing. In Ghana, WhatsApp is the most frequently used online chat among the young and old. It was not surprising that six of the student-client resorted to the use of WhatsApp. Internet is the driving force of WhatsApp which enables users to send text messages, pictures, audio, and videos. It can also be used to make audio and video calls. The service is similar to the normal short messaging services (SMS), but the difference is that, WhatsApp uses the internet. Due to that, the cost of using WhatsApp is significantly less costly than the SMS. For the e-mailing, as it is asynchronous, the student-client had to send messages through the e-mail address of the counselor using the google e-mail application. One main hindrance to the use of the WhatsApp was poor access to internet connectivity because of the location of the university campuses.

An interview guide was used to gather the data. The instrument (interview guide) had five main items which elicited information concerning online counseling from the student-clients. The instrument also included information on demographic details of the students. With regard to validity, experts in counseling ascertained the content and face validity of the interview guide and also taking into consideration Lincoln and Guba’s (1985) trustworthiness of a qualitative data.

Participant students were briefed on the processes involved in responding to the items. Questions raised during the briefing process were thoroughly explained to the student-clients. All debriefing was done online through phone calls and WhatsApp messaging with the student-clients, so researchers maintain anonymity of the student-clients. Some of the questions asked were, “What online application did you use to interact with your counselor?” “What major experiences can you share during the use of the application for counseling?” “What are some of the obstacles you encountered during the counseling process online?” As already noted, poor internet connectivity hindered the smooth interaction with student-clients. Nevertheless, the interviews were successfully done. The interview session took 30 to 45 min with each student-client. Based on their schedule, they gave the time for the interview session online. In view of that, 5 days was used for the interview session for those student-clients who opted to use the WhatsApp medium. As one participant used the e-mail approach, the participant opted to use the same medium for the interview session. Because of that, 2 days was used to elicit responses from the participant as the process was asynchronous and the student-client responded to the e-mail at his convenience.

The interview responses were subjected to thematic analyses. This technique allowed for structuring, categorizing, and interpretation of the transcribed data. Again, rigor was ensured by giving the transcripts to three other colleagues not connected to the present study who ensured that there are no inaccuracies and discrepancies within the transcripts created by the researchers and the intended meaning of the participants’ responses for the study. Before the interviews, persons used for this study had to consent to the involvement of this study (Creswell & Creswell, 2018). Therefore, permission was sought from these persons before the interviews were conducted.

Results

Student-clients were made to respond to some interview questions to enable researchers understand the real experiences of students during online counseling.

From the data gathered, all student-clients underwent counseling online by the use of WhatsApp chat, e-mail, and WhatsApp video. As noted earlier, five of the student-clients used the WhatsApp chat, two used e-mail, and one used WhatsApp video. The following themes emerged from the interview: (a) benefits of online counseling, (b) obstacles of online counseling, (c) a client–counselor non-verbal relationship, (d) activities available online to help in the therapeutic process, and (e) ways to effectively implement and improve online counseling.

Benefits of Online Counseling

From the information gathered, student-clients gave numerous benefits of online counseling. Most of them ascertained that they have experienced face-to-face counseling before and so can ascertain that undergoing counseling online is not different. Some of the benefits of online counseling are mobility, thus they can access counseling in their personal space, improved privacy, problems are solved in virtual space, easy access to the counselor, and anonymity. For instance, with mobility, one of the student-clients noted,

online counselling is beneficial to me because, I could talk to the counsellor anywhere I found myself not necessarily travelling to his/her office. (WhatsApp messaging)

In terms of easiness, time, and access to both parties (client and counselor), a student-client posited,

it helped me as a client a lot because the counsellor always checked on me by sending messages which has helped shaped my life till now. (e-mail)

Issues are freely discussed, and it saves time. (WhatsApp video)

Other student-clients noted,

You feel at ease (comfortable zone to express your situation without shyness). (WhatsApp messaging)

It is pressure-free. (WhatsApp messaging)

High level of friendly interaction; you also gain much freedom in the process of the counselling. (WhatsApp video)

With regard to privacy and anonymity, a student-client stated,

privacy is great in online counselling. For example, going to the counselling centre where administrators will be asking questions and also pinpointing of fingers of others will be avoided. (e-mail)

With virtual solution, one of the student-clients noted,

it helped me solved my problem without having to necessarily see the counsellor. (WhatsApp messaging)

Another posited,

yes, the counsellor helped me to solve my problem; my issues were resolved by the counsellor due to rapport. I felt at ease to disclose my problems. (WhatsApp video)

From the information, it would be noted that student-clients were at ease and comfortable accessing online counseling but nonetheless, they asserted that there were issues with it.

Obstacles of Online Counseling

The following were some excerpts of student-clients’ perception on obstacles to online counseling:

On the issue of non-verbal cues and mistrust, some students retorted,

the facial expressions and the demeanour of the counsellor is missed. I may, therefore, not know if the counsellor is angry with me or not with respect to the issues we discuss. (WhatsApp messaging)

Similarly, one student-client noted,

lack of trust on the side of the counsellee in the counsellor since it is not a face-to-face encounter. (e-mail)

Lack of attention:

since it was not a face-to-face counselling but online counselling, it is difficult to respond or use and follow the nonverbal cues. (WhatsApp messaging)

Fear:

I was afraid, this is because I did not trust the counsellor that much since I cannot see him, but I had to use the online because I cannot travel from my residence to see the counsellor because the journey is far. But afterwards, I gained his trust and things went well. (WhatsApp messaging)

While some of the students mentioned relationship issues when it comes to obstacles to online counseling, some also mentioned lack of resources, poor network, and slow pace of communication and conducive environment. For instance, a student-client stated,

poor communication due to network problems which makes the chat very slow. (WhatsApp messaging)

The environment (my room) was noisy because I am a residential student and had my other mates making noise at the background (at the verandah) which prevented me from hearing properly.

How Clients Related to the Counselor in a Non-Verbal Environment

With respect to student-clients behavior or how they related in a non-verbal environment, information on all the clients were almost the same. One major issue raised was that they found it difficult expressing themselves and exhibiting their non-verbal cues as the counselor cannot see them. A student-client who used the video chat also mentioned same but he noted that although they can see each other (counselor and student-client), some gestures of his are not really seen by the counselor and often, the network was poor.

Some excerpts were as follows:

We can see each other alright, but sometimes I do certain things the counsellor I know, cannot see and we also experience bad network. (WhatsApp video)

since it was not a face-to-face counselling but online counselling, it is difficult to respond or use and follow the nonverbal cues. (e-mail)

For one student-client, he was apprehensive. This is what he had to say:

I was afraid, this is because I did not trust the counsellor that much since I cannot see him but I had to use the online because I cannot travel from my residence to see the counsellor because the journey is far. But afterwards, I gained her trust and things went well. (WhatsApp messaging)

Resolutions of Student-Client Problems

In all of clients’ misgivings, it would be noted that majority of them believed that their issues were solved through the online counseling. One of the student-clients posited,

Yes, even though we did not meet face-to-face, the counsellor took his time and took me through a lot of discussions and deliberations not once, not twice but anytime I call and at last, I understood myself and got a solution to my problem. (WhatsApp messaging)

Another student confirmed the previous findings:

Yes, because my counsellor had time to listen to me, she came out with her suggestions which I reflected on and came out with my decisions and based on my decision, she helped me address my problem. (WhatsApp messaging)

On the contrary, two student-clients exclaimed,

No! I was afraid to present my true problems. (e-mail)

no, due to irregular and unreliable network system counselling was not good at the beginning. I had to resort to the face-to-face counselling after some time. (WhatsApp video)

This implies that although there has been positive effect of online counseling, more will have to be done to help clients resolve their issues.

Activities Available Online to Help in the Therapeutic Process

Often, in some developed countries, counseling facilities have numerous activities and services online to assist clients with their problems without having a chat or video conversation with the counselor. Some of these activities are counseling session cartoons, short plays, listen to podcast, and counseling games. In view of that, student-clients were asked if they would prefer such activities/services to help in counseling. A few gave the affirmative and the rest also disagreed. The following were some of the responses:

Yes, because the counselling play can give me insight, hope and confidence in discussing my problems or issues with the counsellor. (WhatsApp video)

Similar comment by another student-client,

Yes, because I might even feel shy when I am with the counsellor face-to-face but with the video, I can feel relaxed and in the comfort of my home come out with solutions to my problems. (WhatsApp messaging)

Another student-client sees it as a solution machine as well as an entertainer:

Yes, because the counselling games can be entertaining for me. (e-mail)

On the contrary, others gave the negative:

No, I will not have time to watch a cartoon. (WhatsApp video)

This implies that cartoon is not his favorite.

Another student detests listening to audio. Here she goes:

no, I am not a fun of listening to a podcast. (WhatsApp messaging)

Ways to Implement and Improve Online Counseling

Finally, student-clients were asked if online counseling should be introduced and made available to students. All of the eight respondents stated in the affirmative. They mentioned that some issues should be resolved before online counseling can easily be accessible and bring about success.

Most of the respondents mentioned improvement of the school’s internet WIFI and proper education on online counseling for both counselors and clients.

For instance, one student-client noted,

internet connectivity should be improved, and the student population should be given more education on online counselling. (WhatsApp video)

It can be made as a portal on the school’s website. (WhatsApp messaging)

Education is key and easy to go. When the students have the application on their phone, it will be easy to use. An application must be used; you open it and download the app and you are good to go. (WhatsApp messaging)

Another student-client made an interesting comment. The student believes that as there is a group counseling being organized face-to-face, then online group counseling is possible. This is what the student-client had to say:

online counselling could be improved by setting groups based on their issues and having a counsellor to monitor the groups; with this, more problems will be solved with just a group counselling online. (WhatsApp messaging)

From the responses given by student-clients, one will affirm that counseling through online approach is there to support face-to-face counseling, therefore, a lot has to be put in place to establish a proper online counseling in universities in Ghana. Table 1 shows the key findings of the study related to the themes.

Table 1.

Tabulation of Key Findings of the Study.

Theme	Key findings
Benefits of online counseling	i. Mobility ii. Privacy iii. Problems are managed without recourse to physical contact iv. Convenience and accessibility v. Anonymity
Obstacles to online counseling	i. Loss of non-verbal cues ii. Mistrust for loss of physical contact iii. Lack of attention on both sides of client and counselor iv. Poor internet
Experience in virtual space	i. Lack of expression through writing ii. Loss of non-verbal cues to really follow through the conversation
Resolution of problems	iii. Problems were resolved iv. Sometimes client resort to face-to-face due to network issues
Support applications for online counseling	i. Positive affirmation to gamification ii. Podcast, video games, and role-play can be used
Ways to implement and improve online counseling	i. education of students on online counseling ii. enhanced internet connectivityiii. introduction of online group counsellingiv. use of online portals

Discussion

Technology has come to stay and it is expedient that we make use of the various benefits that come with it. The findings represent the experiences of a small number of students who access counseling and in particular, online counseling. In view of this, their responses cannot be generalized to the population of students. It is aimed that this study will help pave way for a formal introduction of online counseling in our universities.

This study revealed several benefits of online counseling. These were the assurance of privacy, mobility, easy access to counselor, and a relaxed process of following up on clients. These findings corroborate with scholars (Cipolletta & Mocellin, 2018; DuBois, 2004; Sheppard et al., 2007; Young, 2005) who asserted that clients prefer online counseling because of its convenience and accessibility. It is not surprising that there is consistency in convenience across countries and cultures. This is because the use of Apps (WhatsApp, e-mail, webcam, Skype, etc.) are the same in all regions because the same applications are being used and the settings may be similar. But concerning accessibility, network problems and locations may be different. It would be reiterated that although online counseling is accessible, in Ghana, for instance, there are problems of wide internet coverage in university campuses which hinder students in reaching out easily to counselors or professionals online when they encounter issues. Furthermore, students do prefer the WhatsApp messaging because they have realized it is significantly less costly than making normal phone calls.

With regard to anonymity and problem solving in virtual space, researchers are of the view that they eliminate stigma and will assist the client to disclose their personal information regardless of gender, age, and social background (Manhal-Baugus, 2001; Suler, 2004; Tate & Zabinski, 2004). Although it is believed that there is anonymity in online counseling, clients may either choose to disclose their identity or use pseudonyms to show the extent to which the client would want to be anonymous. But then, it may be problematic for counselors to engage with clients with unknown identity. It is imperative that the counselor and the client will come to a better conclusion to prevent any misunderstanding in the therapeutic relationship. It is advisable that counselors during the intake process discuss with clients, situations that will demand face-to-face interactions (Haberstroh et al., 2014; Kraus, 2011b; Li et al., 2013). For instance, it may be inappropriate to meet online with a suicidal client or clients who may be a threat to others. These situations should be discussed with the client, and explanations should be explicit regarding times that face-to-face interaction will be needed and also online emergencies.

Although clients experienced some advantages of online counseling, their belief is that, there are a lot of issues with accessibility of online counseling. As noted in the analysis, student-client issues centered on inconsistent network, not relating properly or not being able to express oneself online, and lack of trust due to the absence of physical contact. It would be deduced however that although student-clients had great experiences online, they encountered some trust issues. This is why Shandro (2007) reiterated that experts believe that online counseling is a contradiction of certain essential elements (verbal and non-verbal communication) during counseling sessions. Again, online counseling is ineffective because anybody can access client’s information and may be potentially harmful due to trust issues on both parties. Therefore, care must be taken when doing online counseling. Similarly, Bloom (1998) mentioned that non-verbal communication is inevitably an essential resource during the therapeutic process and cannot be discounted by the counselor. As a result, it is important the client is seen by the counselor in the counseling process.

The study’s results indicate that because clients lack a physical contact with the counselor, they are unable to read certain cues of the counselor to ascertain their acceptance by counselors and more importantly, counselors are not able to assist them on time due to the absence of physical contact.

On the aspect of clients’ and counselors’ behavior in a non-verbal environment and technological problems, it would be mentioned that these issues will serve as a barrier to counselors and may not be helpful in a therapeutic process. Research has shown that the lack of non-verbal cues may mar the counseling process as these non-verbal cues are very essential in the therapeutic relationship (Haberstroh et al., 2007; Hanley & Reynolds, 2009; Rummell & Joyce, 2010). The authors believe that the absence of a non-verbal cue will eliminate focus and alertness during the therapeutic process.

Finally, the results revealed that not all student-clients were in favor of the use of some technological devices and applications such as cartoons, plays or drama, and podcast to assist clients to solve their issues. A few mentioned the use of games and drama as a plausible application for use in counseling. This corroborates with Geldard et al. (2015) on the use of computer games which serves as a motivating factor for young people to develop skills and decrease depression. In the use of a game, for instance, some of the games have levels of play which when used, the client completing a task will be motivated to move to the next level. Some of the games are developed to decrease depression, stress, and anxiety, and others are adventurous and puzzle-like to teach skills and habits (Fleming et al., 2017; Granic et al., 2014). Therefore, clients should be well assessed by the counselor before introducing such devices in the therapeutic process.

Conclusion and Recommendations

It is known that counseling has been enhanced with the introduction of online counseling as a buttress to face-to-face counseling. The difference with the online counseling is with technology serving as a mediating tool to help solve problems. It is expected that the following recommendations will assist in introducing online counseling formally to the university system and improve on it.

The study revealed some benefits of online counseling. From research, it has been confirmed that these benefits experienced by the students are common to online counseling. These are accessing counseling services conveniently while enhancing privacy and mobility. This implies that counselors in universities can adopt this mode of counseling. From other studies, it has been realized that developed countries have established online counseling in their universities and so students have the opportunity to log on to the institution’s website and engage in a chat with a counselor or schedule an appointment with a counselor. From the survey done by the researchers, it was noted that most of the universities in Ghana do not have such facilities. It will, therefore, be appropriate for Heads or Directors of Counseling Centers in Ghanaian Universities to be trained and tasked to develop such avenues for counseling to be accessible and convenient.

In any system, there are tethering issues and online counseling is no exception. From the study, student-clients mentioned several obstacles to online counseling, some of which are poor network, which is a major obstacle; lack of trust on the part of the client; and lack of non-verbal cues. These obstacles if addressed properly will make online counseling more successful and enjoyable. If not, students will stick to only face-to-face counseling and those who cannot, will resort to other means of solving their issues of which some may be detrimental. It is therefore expedient that network problems on campuses are resolved as quickly as possible so that students have access to them, and counselors should endeavor to schedule some time with clients so at least they meet once or twice (face-to-face) during their interactions online. The counselor should discuss this with the client during the intake process and seek for the client’s consent before the counseling relationship will commence. This will also assist the counselor to read meaning to the client’s behavior and gestures. Also, it will develop trust on both parties as some of the clients mentioned their mistrust within a non-verbal environment.

It would be reiterated that counselors should endeavor to ensure that clients can really express themselves properly online and provide proper networks for student-clients to access counseling.

Again, counselors should ensure that clients prefer online counseling before using it as some may not be conversant with it but may not utter it which may mar the therapeutic process.

It is important that counseling directorates of universities in Ghana would prepare various materials that will assist in the therapeutic process. Although some of the students negated the use of podcasts and counseling cartoon, most of them agreed that drama, videos, podcasts, and cartoons will be useful. With that, they can easily have access to them on their institutional website and make use of it.

Formalized online counseling is possible in Ghana. It will be imperative for universities to embrace online counseling as it will save time and more clients will be catered for at shorter periods of time without having to see the counselor physically. Again, there is scarcity of online counseling practitioners in Ghana. It is imperative that the Ghana Psychology Council (Regulatory body) and the Ghana Psychological Association should pave the way by organizing training programs on online counseling. This will serve as motivation for counselors to pursue further training in online counseling. It would also be imperative that online group counseling would be initiated. This will assist the counselor to meet a group of students with common needs (Colón & Stern, 2011; Ponnusawmy & Santally, 2013). Group counseling online is especially useful for treating wide range of issues such as anxiety, anger management, and alcoholism. Online group counseling has been found to be curative in nature. It provides a sense of belonging, respect for other members, and an environment for learning, encouragement, and behavior change (Colón & Friedman, 2003; Colón & Stern, 2011).

In implementing online counseling effectively in the Ghanaian universities, it is expected that university management would liaise with the university counselors and the Information Technology (IT) Department in introducing online counseling platforms to assist students with issues. The university management can employ graduate students in counseling programs to manage these sites so counselors can freely meet their clients online without hitches.

Online counseling may provide a supportive, reflective experience for some student-clients, but may be limited in assisting clients who desire face-to-face relationships due to their peculiar issues. It is recommended that future research should center on client variables, their expectations, and values regarding insights and observations of online counseling relationships. Future research should take a look at the benefits and obstacles of the specific approaches (e-mail, WhatsApp, skype, zoom) used in online counseling in Ghana. Furthermore, as noted by Zamani (2009), online counseling has not come to abolish the traditional/orthodox face-to-face counseling but to reinforce the whole practice of counseling. It should be emphasized that face-to-face counseling is essential and relevant (Zamani, 2009). Therefore, as Obi et al. (2012) suggested, there should be a rethink of merging online and face-to-face counseling to bring diversity in the counseling process.

Limitations of the Study

The sample size of this study might be biased considering the huge numbers in the university. Large numbers undergoing online counseling would have exposed the researchers to a lot of data on merits, demerits, and experiences of online counseling. This smaller group in this study may not have revealed some sensitive findings a large group would have done. Given the sample size, it is obviously known that this study could not be generalized to the population.

Considering that the study was carried out online and the student-clients were contacted via WhatsApp and e-mail, it may be that they may have been limited in the use of these avenues/approaches in expressing their concerns about online counseling. A face-to-face interaction would have yielded more responses and student-client would have responded more to the issues raised compared with the online format.

Footnotes

Acknowledgements

We would like to acknowledge the immense help given to us by our student-clients who availed themselves for this research work.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Patricia Mawusi Amos

References

American Counseling Association. (2014). ACA code of ethics as approved by the ACA governing council American Counselling Association. https://www.counseling.org/docs/default-source/ethics/2014-code-of-ethics.pdf?sfvrsn=2d58522c_4

Awabil

Clifford

(2018). Attitude of Ghanaian University students towards online counselling. Journal of Education and Practice, 9, 10–16.

Barak

Grohol

J. M.

(2011). Current and future trends in internet-supported mental health interventions. Journal of Technology in Human Services, 29(3), 155–196. https://doi.org/10.1080/15228835.2011.616939

Bedu-Addo

P. K. A.

(2016). Guidance and counselling “unmasked” (4th ed.). Approachers Ghana Ltd.

Bloom

J. W.

(1998). The ethical practice of web counseling. British Journal of Guidance & Counselling, 26(1), 53–59.

Buku

D. K.

(2016). Foundations of guidance and counselling. Benjoy Enterprise.

Cipolletta

Mocellin

(2018). Online counseling: An exploratory survey of Italian psychologists’ attitudes towards new ways of interaction. Psychotherapy Research, 28, 909–924. https://doi.org/10.1080/10503307.2016.1259533

Cohen

G. E.

Kerr

B. A.

(1999). Computer-mediated counseling. Computers in Human Services, 15(4), 13–26. https://doi.org/10.1300/J407v15n04_02

Colón

Friedman

(2003). Conducting group therapy online. In Goss

Anthony

(Eds.), Technology in counselling and psychotherapy (pp. 59–74). https://doi.org/10.1007/978-0-230-50015-0_4

10.

Colón

Stern

(2011). Counseling groups online: Theory and framework. In Online counseling (2nd ed., 183–202). https://doi.org/10.1016/B978-0-12-378596-1.00010-1

11.

Creswell

J. W.

Creswell

D. J.

(2018). Research design: Qualitative, quantitative, and mixed methods approaches. Organizational research methods (5th ed., Vol. 6). http://www.amazon.com/Research-Design-Qualitative-Quantitative-Approaches/dp/0761924426

12.

Dennis

T. A.

O’Toole

L. J.

(2014). Mental health on the go: Effects of a gamified attention bias modification mobile application in trait anxious adults. Clinical Psychological Science, 2(5), 576–590. https://doi.org/10.1177/2167702614522228

13.

DuBois

(2004). Clinical and demographic features of the online counselling client population. Counselling and Psychotherapy Research, 4(1), 18–22. https://doi.org/10.1080/14733140412331384028

14.

Ersahin

Hanley

(2017). Using text-based synchronous chat to offer therapeutic support to students: A systematic review of the research literature. Health Education Journal, 76(5), 531–543. https://doi.org/10.1177/0017896917704675

15.

Fleming

T. M.

Bavin

Stasiak

Hermansson-Webb

Merry

S. N.

Cheek

. . . Hetrick

(2017). Serious games and gamification for mental health: Current status and promising directions. Frontiers in Psychiatry, 7, Article 215. https://doi.org/10.3389/fpsyt.2016.00215

16.

Franco

G. E.

(2016). Videogames and therapy: A narrative review of recent publication and application to treatment. Frontiers in Psychology, 7, Article 1085. https://doi.org/10.3389/fpsyg.2016.01085

17.

Gamble

Boyle

Morris

Z. A.

(2015). Ethical practice in telepsychology. Australian Psychologist, 50(4), 292–298. https://doi.org/10.1111/ap.12133

18.

Geldard

Foo

R. Y.

(2015). The use of technology when counselling young people. In Counselling adolescents: The proactive approach for young people. https://uk.sagepub.com/sites/default/files/the_use_of_technology_when_counselling_young_people.pdf

19.

Granic

Lobel

Engels

R. C. M. E

. (2014). The benefits of playing video games. American Psychologist, 69, 66–78. https://doi.org/10.1037/a0034857

20.

Haberstroh

Barney

Foster

Duffey

(2014). The ethical and legal practice of online counseling and psychotherapy: A review of mental health professions. Journal of Technology in Human Services, 32(3), 149–157. https://doi.org/10.1080/15228835.2013.872074

21.

Haberstroh

Duffey

Evans

Gee

Trepal

(2007). The experience of online counseling. Journal of Mental Health Counseling, 29(3), 269–282. https://doi.org/10.17744/mehc.29.3.j344651261w357v2

22.

Hanley

Reynolds

D. A. J.

(2009). Counselling psychology and the internet: A review of the quantitative research into text-based therapy. Psychology Review, 24, 4–13.

23.

Hays

D. G.

Erford

B. T.

(2018). Developing multicultural counseling competence: A systems approach (3rd ed.). Pearson Education.

24.

Hennemann

Beutel

M. E.

Zwerenz

(2017). Ready for eHealth? Health professionals’ acceptance and adoption of eHealth interventions in inpatient routine care. Journal of Health Communication, 22(3), 274–284. https://doi.org/10.1080/10810730.2017.1284286

25.

Kanani

Regehr

(2003). Clinical, ethical, and legal issues in E-therapy. Families in Society: The Journal of Contemporary Social Services, 84(2), 155–162. https://doi.org/10.1606/1044-3894.98

26.

Kolog

E. A.

(2014). E-counselling implementation: Contextualized approach [Master’s thesis, University of Eastern Finland].

27.

Kolog

E. A.

Sutinen

Vanhalakka-Ruoho

(2014). E-counselling implementation: Students’ life stories and counselling technologies in perspective. International Journal of Education and Development Using Information and Communication Technology, 10(3), 32–48.

28.

Kotsopoulou

Melis

Koutsompou

V. I.

Karasarlidou

(2015). E-therapy: The ethics behind the process. Procedia Computer Science, 65, 492–499. https://doi.org/10.1016/j.procs.2015.09.120

29.

Kraus

(2011a). The business of online counseling. In Online counseling (2nd ed., pp. 129–143). https://doi.org/10.1016/B978-0-12-378596-1.00007-1

30.

Kraus

(2011b). Ethical issues in online counseling. In Online counseling (2nd ed., pp. 85–106). https://doi.org/10.1016/B978-0-12-378596-1.00005-8

31.

Kraus

(2011c). Online counseling: Does it work? Research findings to date. In Online counseling (2nd ed.). https://doi.org/10.1016/B978-0-12-378596-1.00003-4

32.

Aga Mohd Jaladin

Sharil Abdullah

(2013). Understanding the two sides of online counseling and their ethical and legal ramifications. Procedia—Social and Behavioral Sciences, 103, 1243–1251. https://doi.org/10.1016/j.sbspro.2013.10.453

33.

Lincoln

S. Y.

Guba

E. G.

(1985). Establishing trustworthiness. In Naturalistic inquiry. Sage. https://ethnographyworkshop.files.wordpress.com/2014/11/lincoln-guba-1985-establishing-trustworthiness-naturalistic-inquiry.pdf

34.

Manhal-Baugus

(2001). E-therapy: Practical, ethical, and legal issues. CyberPsychology & Behavior, 4, 551–563. https://doi.org/10.1089/109493101753235142

35.

Maples

M. F.

Han

(2008). Cybercounseling in the United States and South Korea: Implications for counseling college students of the millennial generation and the networked generation. Journal of Counselling & Development, 86(2), 178–183. https://doi.org/10.1002/j.1556-6678.2008.tb00495.x

36.

Merry

S. N.

Stasiak

Shepherd

Frampton

Fleming

Lucassen

M. F. G.

(2012). The effectiveness of SPARX, a computerised self-help intervention for adolescents seeking help for depression: Randomised controlled non-inferiority trial. British Medical Journal, 344(7857), Article e2598. https://doi.org/10.1136/bmj.e2598

37.

Mishna

Bogo

Sawyer

J.-L.

(2015). Cyber counseling: Illuminating benefits and challenges. Clinical Social Work Journal, 43(2), 169–178. https://doi.org/10.1007/s10615-013-0470-1

38.

Nagel

D. A. M.

Anthony

(2011). Text-based online counseling: Chat. In Online counseling (2nd ed., pp. 169–182). https://doi.org/10.1016/B978-0-12-378596-1.00009-5

39.

Obi

M. C.

Oye

N. D.

Mohd

T. N.

Bernice

(2012). The impact of ICT on career counseling services: A case study of Nigerian Secondary Schools. International Journal of Evaluation and Research in Education (IJERE), 1(1), 1–16. http://iaesjournal.com/online/index.php/IJERE

40.

Ponnusawmy

Santally

M. I.

(2013). Exploring the potential of online group counseling: A case-study for Mauritian students presenting the internet addiction disorder syndrome. European Scientific Journal, 4, 1857–7881.

41.

Ralls

(2011). Online services resource guide for advisors and counsellors. VLC Quality & Assessment Center, North Carolina Community College System.

42.

Remley

J. T. P.

Herlihy

(2020). Ethical, legal, and professional issues in counseling (6th ed.). Pearson Education.

43.

Reynolds

D. J.

Stiles

W. B.

Bailer

A. J.

Hughes

M. R.

Hughes

M. R.

(2013). Impact of exchanges and client-therapist alliance in online-text psychotherapy. Cyberpsychology, Behavior, and Social Networking, 16(5), 370–377. https://doi.org/10.1089/cyber.2012.0195

44.

Rummell

C. M.

Joyce

N. R.

(2010). “So wat do u want to wrk on 2day?” The ethical implications of online counseling. Ethics & Behavior, 20(6), 482–496.

45.

Shandro

(2007). The effectiveness and ethicality of online counseling [Master’s thesis]. http://dtpr.lib.athabascau.ca/action/download.php?filename=caap/matthewshandroProject.pdf

46.

Sheppard

G. W.

Schulz

W. E.

McMahon

S.-A.

Mcmahon

S.-A.

Sheppard

G. W.

Schulz

W. E.

(2007). Code of ethics. www.ccpa-accp.ca

47.

Sue

D. W.

Sue

Neville

H. A.

Smith

(2019). Counseling the culturally diverse: Theory and practice (8th ed.). John Wiley.

48.

Suler

(2004). The online disinhibition effect. CyberPsychology & Behavior, 7(3), 321–326. https://doi.org/10.1089/1094931041291295

49.

Suler

(2011). The psychology of text relationships. In Online counseling (2nd ed.). https://doi.org/10.1016/B978-0-12-378596-1.00002-2

50.

Tate

D. F.

Zabinski

(2004). Computer and internet applications for psychological treatment: Update for clinicians. Journal of Clinical Psychology, 60(2), 209–220.

51.

Taylor

A. I.

Buku

D. K.

(2003). Basics in guidance and counselling (2nd ed.). Department of Psychology, University of Education, Winneba.

52.

Uzoekwe

H. E.

Obika

J. A.

Obineli

(2012). In-cooperating E-counselling in the professional development of counselling practice: Merits and demerits. AFRREV IJAH: An International Journal of Arts and Humanities, 1(1), 227–238. https://www.ajol.info/index.php/ijah/article/view/106377

53.

Wang

Yi Chi

Chen

Xin

. (2010). Web peer counseling system. In Proceedings of the ICEIT 2010: 2010 international conference on educational and information technology. IEEE. https://doi.org/10.1109/ICEIT.2010.5607633

54.

Young

K. S.

(2005). An empirical examination of client attitudes towards online counseling. CyberPsychology & Behavior, 8(2), 172–177. https://doi.org/10.1089/cpb.2005.8.172

55.

Zamani

Z. A.

(2009). Computer technology and counseling. In 2009 2nd IEEE International Conference on Computer Science and Information Technology (pp. 488–490). IEEE. https://doi.org/10.1109/ICCSIT.2009.5234649

56.

Zamani

Z. A.

Nasir

Yusooff

(2010). Perceptions towards online counseling among counselors in Malaysia. Procedia—Social and Behavioral Sciences, 5, 585–589. https://doi.org/10.1016/j.sbspro.2010.07.146

Experiences of Online Counseling Among Undergraduates in Some Ghanaian Universities

Abstract

Keywords

Introduction

Review of Literature

Method

Results

Benefits of Online Counseling

Obstacles of Online Counseling

How Clients Related to the Counselor in a Non-Verbal Environment

Resolutions of Student-Client Problems

Activities Available Online to Help in the Therapeutic Process

Ways to Implement and Improve Online Counseling

Discussion

Conclusion and Recommendations

Limitations of the Study

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

ORCID iD

References