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Article Excerpt
This article reports on the development of measures of attitudes toward online and face-to-face counseling. Overall, participants expressed more favorable evaluations of face-to-face counseling than of online counseling. Significant correlations were found between online and face-to-face counseling with traditional help-seeking attitudes, comfort with e-mail, and interest in various counseling services. Counseling and research considerations are reviewed.
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In recent years, there has been an increasing amount of literature that addresses the debate regarding the use of the Internet for providing online counseling services to address mental health concerns. Advocates of online counseling have noted the potential utility in reaching populations that cannot or will not access traditional mental health services, the convenience of the service, the ease of record keeping, and the possible reduced costs associated with providing these services (Barak, 1999; King & Moreggi, 1998; Murphy & Mitchell, 1998; Tait, 1999). Opponents of online counseling cite many potential problems, including concerns regarding the delivery of online counseling services by unqualified practitioners as well as significant concerns regarding confidentiality, the lack of visual cues, the inability to directly intervene in a crisis, and the lack of therapeutic control (Barak, 1999; Ingram, 1997; King & Moreggi, 1998; Murphy & Mitchell, 1998; Sampson, Kolodinsky, & Greeno, 1997).
Although this debate is likely to continue in the academic and professional literature, one point of agreement is that online mental health service delivery is underway and is likely to expand in the future (Norcross, Hedges, & Prochaska, 2002). Yet surprisingly little is known about how potential help seekers perceive using online counseling services. To our knowledge, there seems to be no current systematic line of research that addresses precisely how people perceive online counseling services in comparison with more traditional psychological support services. In addition, although the literature has provided suggestions for the types of clients who might be good candidates for online counseling (Alleman, 2002; Stofle, 2001), currently there are no empirical data to support these claims. One of the most glaring reasons for the omission of this information is a lack of research instruments designed to measure the public's perceptions of online counseling services. To address this issue, our purpose in the present study was to develop an instrument that provides valid and reliable scores that describe attitudes toward online counseling and a comparable measure of attitudes toward face-to-face counseling services.
In considering the potential utility of such an instrument, several potential benefits should be outlined. First, the fact that online counseling services are increasingly being provided via a range of different service modalities (Bloom, 1998; Murphy & Mitchell, 1998) inherently demands a systematic investigation of how people perceive using these services and the types of clients who may be well suited for online counseling services. Many individual practitioners are opening their own "online practices," either by joining large networks of "e-therapists" available through dot-com companies or by building their own "virtual clinic" group or private-practice Web sites (Barak, 1999; Maheu & Gordon, 2000). In fact, on the nonprofit Web site Metanoia (http://www.metanoia.org), online therapy consumer advocate Martha Ainsworth reported that there has been a steady increase from 12 to more than 250 private-practice Web sites, representing more than 700 therapists, since 1995. Before investing the time, effort, and money to develop an online practice, counselors must know whether clients will make use of such a service and the types of clients who might be best suited or qualified for these services.
Another important reason to study consumers' attitudes is that counselors need to make informed evaluations of positive and negative statements currently being issued by professional organizations and individuals about the topic of online counseling. Several organizations (e.g., American Counseling Association, American Psychological Association, National Board for Certified Counselors) have already issued ethical statements pertaining to mental health services online. The wide range of professional opinions concerning online counseling makes it difficult for counselors to know what stance to take. Research that yields a greater understanding of the public's perceptions of online counseling may help to inform or clarify clinicians' perspectives on the need and demand for such services. If clients or prospective clients believe online counseling is a worthwhile option and mental health professionals can accommodate their needs in an ethical manner, then there may be a more convincing argument for online counseling.
Finally, the pursuit of a line of research that seeks to assess attitudes toward online counseling services seems particularly important in consideration of the extensive body of research on general attitudes toward help seeking. For more than 20 years, researchers have studied clients' attitudes toward seeking help in relation to various demographic, psychological, and cultural variables (see Fischer & Farina, 1995; Fischer, Winer, & Abramowitz, 1983; Rule & Gandy, 1994). Although some controversy remains over the relationship between attitudes and behavioral indices of help seeking (Fischer et al., 1983; Good & Wood, 1995), this line of research has yielded useful information pertaining to what types of people seem inclined to hold positive or negative attitudes toward general help-seeking services. Yet despite the value of this research, authors have noted that it is unreasonable to generalize the results of studies that assess general help-seeking attitudes to more specific types or modalities of counseling (Rochlen, Mohr, & Hargrove, 1999). Hence, there is a need for an instrument that can adequately assess attitudes toward online counseling services and a comparable instrument that can adequately assess attitudes toward face-to-face counseling services in order to generate valid comparisons.
One of the inherent challenges with this project involved the debate, which has been well noted in the literature, regarding the precise definition of online counseling (Alleman, 2002; Barak, 1999). Using mental-health-related e-mail and text-chat communications, some professionals are already providing online career counseling (Boer, 2001), online assessment (Barak & English, 2002), and online "coaching." These services sometimes incorporate "online counseling," but empirical research regarding consumers' and professionals' attitudes toward this type of online counseling is scarce. For our purposes, we are considering online counseling to be distinct from other types of computer-related services in that (a) it involves direct communication between a counselor and at least one client and (b) the communication is specifically intended to address mental health concerns, analogous to a "talk therapy" process that might be conducted face-to-face in a mental health professional's office.
In summary, debates among professionals regarding the utility and relevant limitations of online counseling, in conjunction with the considerable amount of online counseling currently being conducted, call for a systematic investigation of attitudes toward online counseling. Therefore, our study seeks to contribute to this research field by testing the development of a psychometrically sound measure of both online counseling attitudes and face-to-face counseling attitudes. Although the focus of this article is on attitudes toward online counseling, we hoped to develop an equivalent measure of attitudes toward face-to-face counseling services so that accurate comparisons could be generated between the two types of counseling services.
In this article, three studies, each addressing a different component of the instrument development process, are presented. The creation of the Online Counseling Attitudes Scale (OCAS) and the Face-to-Face Counseling Attitudes Scale (FCAS), including a description of our item-generation process, was the focus of Study 1. We hypothesized that attitudes toward online counseling services and attitudes toward face-to-face counseling services would be related and multidimensional and would yield a similar factor structure. Factor analysis was used to explore and test the dimensional structure of responses to the instruments. In Study 2, we provided preliminary score reliability evidence by testing the stability of the scores on each scale over a 3-week period. In Study 3, we sought to provide evidence of the construct validity of responses to the subscales by testing the relatedness of attitudes toward online and face-to-face counseling services with general psychological help-seeking attitudes, fear of intimacy, comfort with e-mail, and likelihood and interest in using online and face-to-face counseling. Finally, we sought to further evaluate the construct validity of scores on the scales by testing the hypothesis that data from the two measures of attitudes would not be influenced by social desirability response bias or by age. We describe the specific hypotheses in greater detail in each of the respective studies.
STUDY 1: SCALE DEVELOPMENT
The primary purpose of the first study was to investigate the underlying factor structure of the responses to the OCAS and the corresponding FCAS. To test differences between attitudes toward online and face-to-face counseling, our goal was to create two scales for each of the constructs. After meeting this objective, our intention was to report and compare the descriptive statistics between scores on the OCAS and FCAS. We assumed that the participants would be more familiar with face-to-face counseling services than with online counseling. Hence, we expected more positive attitudes toward face-to-face counseling than toward online counseling overall. In addition, based on...
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