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Online counseling using email: a qualitative study

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DOI: 10.1007/s12564-015-9393-6

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Online counseling using email: a
qualitative study

Amla Salleh, Ramlan Hamzah, Norazah

Nordin, Simin Ghavifekr & Toktam
Namyandeh Joorabchi

Asia Pacific Education Review

ISSN 1598-1037

Asia Pacific Educ. Rev.

DOI 10.1007/s12564-015-9393-6

1 23
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1 23
 Author's personal copy
Asia Pacific Educ. Rev.
DOI 10.1007/s12564-015-9393-6

Online counseling using email: a qualitative study

Amla Salleh1 • Ramlan Hamzah2 • Norazah Nordin1 • Simin Ghavifekr3 •

Toktam Namyandeh Joorabchi1

Received: 9 July 2014 / Revised: 18 February 2015 / Accepted: 4 September 2015

 Education Research Institute, Seoul National University, Seoul, Korea 2015

Abstract Despite numerous studies in increasingly pop- Introduction

ular online mental health service, the nature of the rela-
tionship between online counselors and their clients, ‘‘Psychotherapy sessions by phone, by computer and
particularly in the email modality, deserves more attention. video are all practical when face-to-face sessions are
To enhance the knowledge in this area, this study was not feasible’’ (Ellis 2006).
conducted to explore whether the online counseling rela-
As online counseling or therapy has become increas-
tionship could be developed using email communication.
ingly accepted by mental health providers (Richards and
Six qualified counselors and 59 clients volunteered to
Viganó 2013; Beattie et al. 2009; Wade 2010), numerous
participate in the study. Using a qualitative approach, we
studies have been carried out to examine its many varieties,
collected data from two focus groups, individual interviews
traits, and newly observed characteristics (Ekberg et al.
with participating counselors, 206 email interactions, and
2013; Leibert et al. 2006). Studies on chat and email
counselors’ journals. To identify themes, we employed a
counseling have provided some understanding of these new
grounded theory method. The emergent themes suggest
modalities of psychotherapy (Beattie et al. 2009 on
that counselors describe the e-counseling relationship as
depression; Harris et al. 2012 on email counseling in
having the following five features: initial establishment of a
general). Recent studies which attempt to establish evi-
virtual relationship, structuring, text reinforcement, the
dence of the existence of therapeutic elements and the
development of a text relationship, and termination of the
development of online counseling relationships have also
process. Each feature reflects a different level of relation-
indicated a promising trend (Barrazzone et al. 2012; Dunn
ship and different characteristics. Implications for future
2012; Ekberg et al. 2013). Although the research on the
studies are also discussed.
online therapeutic relationship is mostly positive, more
research is required to better understand the characteristics
Keywords Counselors
Counseling relationship
Email
and dynamics of this relationship (Richards and Viganó
counseling
Distance communication
Therapeutic
2013, p. 1002) as studies on asynchronous email counsel-
element
ing are currently limited. To enhance our current under-
standing of the online counseling relationship, this study
intends to explore whether this relationship can be devel-
oped using asynchronous email communication.
& Amla Salleh
s_amla@yahoo.com
1
Faculty of Education, The National University of Malaysia Online counseling
(UKM), 43600 Bangi, Selangor, Malaysia
2
IPG Kampus Pendidikan, Teknik, Kuala Lumpur, Malaysia Among online counseling modalities, email and chat
3
Faculty of Education, University of Malaya (UM), modes are found to be superior to the use of forums, audio,
50603 Kuala Lumpur, Malaysia and webcam and are nearly as efficacious as face-to-face

123
 Author's personal copy
counseling (Richards and Viganó 2013). They have been
employed to deliver online counseling as a stand-alone
service and as an adjunct to other services (Castelnuovo
et al. 2003).
Email exchanges and text chat rooms are solely based
on written text. Email exchanges are asynchronous which
means that the client’s and counselor’s communication do
not occur simultaneously (Barak and Grohol 2011) and that
responses are delayed (Richards and Viganó 2013). By
contrast, chat room conversations and instant messaging
are quasi-synchronous with the counselor’s and client’s
communication occurring at the same time (Ekberg et al.
2013; Beattie et al. 2009). Videoconferencing and Skype
counseling allow for the use of voice and vision, and such
interactions are immediate and spontaneous.
The nature of email counseling holds certain challenges
compared to the immediacy of face-to-face counseling and
therapy as (due to its time-delayed characteristics) it is
neither held in real time nor truly interactive (Fenichel
et al. 2002; Rochlen et al. 2004; Griffiths and Cooper
2003). There are also concerns that it is difficult to convey
empathy, warmth, and humor in text-based communication
(Danby et al. 2009; Ellerman-Bull 2003; Oravec 2000).
Studies have increasingly provided evidence that these
limitations are also associated with certain benefits and
advantages.
It has been theorized that anonymity or relative anon-
ymity (Suler 2010) can facilitate psychological safety,
disinhibition, and increased self-disclosure (Suler 2010,
2004). This is supported by other studies (Dunn 2012;
Efstathiou 2009; Hanley 2009) that show that participants
in computer-mediated communication (CMC) have a sig-
nificantly higher level of self-disclosure compared to those
in face-to-face interaction, supporting the notion of positive
disinhibition (Dunn 2012). Leibert et al. (2006) found that
college students who used online asynchronous counseling
also noted advantages, including ease of use, speed,
anonymity, and reduced stigma compared to traditional
counseling (Efstathiou 2009).
It has been hypothesized that the time delay which is
built into the asynchronous email counseling process can
cause a blank screen or the black hole phenomena where
one can easily project one’s own expectations and anxieties
due to unexplained delays in response (Suler 2004).
However, this time delay has also been found to have
several important benefits: facilitating the time required to
process experiences and emotions; promoting self-obser-
vation; increasing awareness; reducing impulsivity; and
enabling clients to engage in deeper reflection and to focus
on self-expression (Hanely 2009).
The absence of nonverbal cues or social signals
(Richards and Viganó 2013) in online counseling has also
become a subject of debate (Rochlen et al. 2004; Zamani
123
A. Salleh et al.
et al. 2010) due to the importance of such cues as a ther-
apeutic element and as the foundation of counseling rela-
tionships and intimacy (Alleman 2002; Wampold 2000).
However, it has been argued that the absence of these
nonverbal cues has the benefit of promoting disinhibition
(Suler 2004). The importance of disinhibition is supported
by studies which have found that it is relevant for clients
who are particularly sensitive to the physical presence of
another person and to cues indicating judgment (Dunn
2012; Fenichel et al. 2002). It also encourages clients’
sense of control over what they disclose, especially the
disclosure of sensitive information (Cohen and Kerr 1998;
King et al. 2006; Simpson et al. 2003; Hanley 2009).
Nonverbal cues can also be replaced to some extent by
using symbolic or graphic expressions such as emoticons
(Castelnuovo et al. 2003).
With regard to text-based communication in online
counseling, studies have demonstrated a host of positive
benefits that writing can have on psychological and phys-
ical health (Pennebaker et al. 1988). For example, it can be
cathartic (Sheese et al. 2004). The writer also has a control
of the content, pace, and depth of the written material,
which can potentially foster a sense of psychological safety
(Wright and Chung 2001). Writing can be referred to again
and again which allows clients more time to process the
content (Cook and Doyle 2002). Finally, it can facilitate
further reflection (Beattie et al. 2009). Although writing
only benefits a certain segment of the population (Beattie
et al. 2009; Suler 2010), its potential to be either an
alternative or complementary modality is promising.
Online counseling is also considered convenient by
both therapist and clients (Chester and Glass 2006; Mal-
len et al. 2005a, b; Young 2005). The accessibility of
online counseling can overcome many barriers to
accessing treatment including limited mobility due to
geographical isolation or physical disability, language
barriers, personal stigma in seeking help, and time
availability (Rochlen et al. 2004; Wright and Chung
2001). Moreover, it can extend access to specialized
services that might otherwise be beyond the reach of
clients (Simpson et al. 2005; Young 2005).
These unique features of online counseling, along with
its reduced costs, are the primary reasons why someone
would seek online counseling (Young 2005). With
accrediting bodies led by the American Psychological
Association (APA) Ethics Board and the National Board
for Certified Counselors (NBCC) that provide guidelines
for online clinical practice (Richards and Viganó 2013),
online counseling shows a great potential to be a com-
plementary mental health service for a certain segment of
the population. As a result, more evidence is required to
strengthen our knowledge of this new modality of
therapy.
 Author's personal copy
Online counseling using email: a qualitative study
Outcomes of online counseling
Numerous studies have been carried out to examine the
effectiveness of online therapy. Chat and email counseling
have been found to be effective in treating a variety of issues
such as feeling loneliness (Hopps et al. 2003), depression
(Richardson 2012), panic disorder (Carlbring et al. 2007),
insomnia (Strom et al. 2004), and smoking cessation
(Stretcher et al. 2005). There is also evidence for the effec-
tiveness of therapeutic support and counseling delivered
through a range of synchronous and asynchronous ICT
modes in treating eating disorders (Newman et al. 2011;
Simpson et al. 2005; Simpson et al. 2001). Robinson and
Serfaty (2001, 2008) report significant improvements in
bulimic symptoms and a significant reduction in the number
of clients fulfilling DSM-IV eating disorder criteria at a
3-month follow-up.
Although these studies use different approaches, meth-
ods, and objectives and there is a concern over forming
generalized conclusions (Richards and Viganó 2013),
online counseling has been found to be as effective as face-
to-face counseling (Barak et al. 2008).
Online counseling relationship
The counseling relationship is referred to by a number of
terms such as the therapeutic relationship or working alli-
ance (Bordin 1994). Although earlier studies on the ther-
apeutic relationship in online counseling showed mixed
results (Mallen et al. 2005a, b), Richards and Viganó
(2013) have reported on several more recent studies in this
area that indicate positive developments, especially as
more studies on CMC mental health programs using the
chat modality are now available.
Studies measuring working alliance using the working
alliance inventory (WAI) show positive results (Prado and
Meyer 2004; Cook and Doyle 2002). Those who completed
the treatment scored significantly higher than those who
abandoned the treatment early (Prado and Meyer 2004).
Using WAI, Leibert et al. (2006) found that alliance pre-
dicted respondent satisfaction with online counseling.
However, face-to-face clients rated higher than online
counseling clients in levels of therapeutic alliance. In
another study, while there was an equivalent alliance score
from face-to-face clients and online clients (email and
chat), online clients reported (qualitatively) experiencing
strong bonds with their therapists and benefiting from the
effect of disinhibition (Cook and Doyle 2002).
Ekberg et al. (2013) and Beattie et al. (2009) studied
online text-based CBT counseling with respect to thera-
pist–client interaction in the quasi-synchronous chat
modality. Ekberg et al. found that a therapeutic relationship
was established, and that counselor–client interaction led to
the establishment of rapport, information gathering, and
later a move in a task-focused direction. The authors sug-
gest that online therapists can adapt interactional practice
used in face-to face therapy to facilitate change in the
client. While Ekberg et al. demonstrated how therapists are
able to establish rapport at the initial stage of text-based
online therapy, Beattie et al. (2009) found that participants
develop a virtual relationship with the therapist, and that
there is a process of communication of thoughts and
emotions via the online medium. Harris et al. (2012) also
found an element of relationship development in email
counseling, examining how online counselors used text to
attempt to persuade young clients to shift from an online to
a telephone modality.
In a study on three CMC health counseling automated
programs, Barrazzone et al. (2012) found that a therapeutic
alliance was established in three stages: establishing,
developing, and maintaining. The study also found evidence
of therapeutic features across the three programs. Examples
include accessibility, generating belief in the helpfulness of
the session, empathy, warmth, and unconditional accep-
tance. There was also evidence of a collaborating frame-
work, client empowerment, guidance, responsiveness, and
rupture repair. These features emerged in different stages of
the relationship development. The authors conclude that the
findings suggest that at least some CMC programs allow for a
therapeutic alliance to be fostered with users, and that alli-
ance factors are certainly present.
Dunn (2012) extends existing research into the nature of
asynchronous (email) online counseling relationship and
explores the possibility that this approach may facilitate
online and face-to-face engagement using reflexive study.
Dunn’s study highlights themes such as ‘‘time to think,’’
‘‘anonymity,’’ and ‘‘disinhibition’’ which she considers as
critical. The author also reported that email counseling had
encouraged the participants of her study who suffer inhibit-
ing shame and fear of engagement to experience change and
growth in online therapeutic relationship which had facilitate
some of them to brave face-to-face counseling which they
have avoided in the past. The unique features of email
counseling had allowed such growth in clients which the
author described as a powerful psychotherapeutic shift.
Although the research to date is largely positive, further
research is needed to understand the nature and dynamics
of the online therapeutic relationship.
The current study
Because of the abundant evidence of the demand for online
counseling and its usefulness, particularly for clients ‘‘who
were comfortable with Internet communication and those
123
 Author's personal copy
who liked to reflect on their own experience through
writing’’ (Beattie et al. 2009), we believe that online
qualified and experienced therapists or counselors may be
effective if they apply a modified face-to-face counseling
model to online counseling sessions. This category of
counselors can provide a rich qualitative data regarding the
development of the therapeutic relationship in online
counseling inquiry. Patton (1990) suggested, in a qualita-
tive inquiry, to use a purposeful selection strategy to get
‘‘information-rich’’ cases, among those who ‘‘possess a
certain degree of expertise about the domain of inquiry’’
(Romney et al. 1986, p. 326). Therefore, this study aimed
to explore counselors’ conception of their online counsel-
ing relationship based on their experiences conducting
online email counseling. Specifically, we were interested in
determining how experienced counselors describe their
work with online clients or the description of online
counseling process from counselors’ perspectives. We
developed interview questions to highlight patterns in
terms of how online counseling relationships are concep-
tualized and how such counseling relationships are man-
aged including how termination is approached. We also
examine how the online counselors perceive and deal with
the new features of online counseling.
Methods
Research design
Following the suggestions of Creswell (2002) and Marshall
and Rossman (1999) with regard to methods for exploring
and understanding the interaction between two individuals,
we adopted a grounded theory approach to explore the
experience of online counselors in e-counseling sessions.
This method is useful for data collection and data analysis
that are intended to identify the formation of hidden pat-
terns to explain phenomena under investigation (Creswell
2002, 2008; Glaser 1998).
We first formulated a broad research question that
involves examining how counselors view the process and
the nature of the counselor–client relationship in
e-counseling and in the absence of nonverbal cues and
messages. Therefore, the experiences of online coun-
selors represent the main data for the analysis of
meaning in e-counseling interactions. To collect data
based on the experiences of the participants, the study
was conducted in a quasi-naturalistic environment.
A Web site was developed for the study, and clients and
qualified and experienced counselors were invited to
participate in the study.
123
A. Salleh et al.
Participants
The study participants comprised six qualified counselors
(three males and three females) and 59 volunteer clients.
Counselor participants
Initial contact was made with several practicing counselors
who were competent in using computers and who had
experience with online counseling. Fifteen counselors were
identified in several states of Malaysia. Ten counselors met
the study criteria, and nine counselors agreed to participate
in the study. However, only data from six counselors were
used because three counselors were not actively engaged
online during the study. The sample size of six is consid-
ered sufficient according to Sobal who suggested for
grounded theory study sample of five to eight as adequate
to gather rich and saturated data (Sobal 2001) while
Romney et al. (1986) recommended four participants who
possess a certain degree of expertise about the domain of
inquiry is quite sufficient in providing complex and accu-
rate information within a particular cultural context (p.
326).
Table 1 displays the demographic data for the six
counselors. The age of the counselors ranged from 35 to
49 years, with a mean of 42 years. Three counselors had
postgraduate training, and three counselors had only
undergraduate training in guidance and counseling. All
counselors had substantial experience in counseling prac-
tice, with a range from 4 to 18 years and an average of
11 years of experience. The average experience in any type
of online counseling was two and a half years. All coun-
selors were Malay ethnic who were also Muslim.
In Malaysia, counseling training and practice are mon-
itored by the Malaysian Council of Counselors, which was
established under a provision of Malaysian Counseling Act
580 in 2000 and is responsible for recognizing, registering,
and issuing licenses for qualified counselors in Malaysia.
The council recognizes 3- and 4-year undergraduate
counseling programs. Therefore, all of the participants
were regarded as qualified counselors.
Client participants
One of the research team members visited several teaching
institutions in Malaysia, met with teacher trainees, and
introduced the e-counseling Web site which was known as
Kaunseling Maya (KM), which translates into ‘‘virtual
counseling’’ and it was developed and tested for the study.
The trainees were also informed that KM offered two
modes of counseling: email and chat (none of the client
participant use chat modality); the homepage, or main user
 Author's personal copy
Online counseling using email: a qualitative study

each counselor consented to participate in the study. Only data from six participants were analyzed, as the other three participants were not actively engaged online. Age ranges are used to
K1, Counselor1; K2, Counselor2; K3, Counselor3; K4, Counselor4; K5, Counselor5; K7, Counselor7; and K10, Counselor10. The numerical order of the counselors was initially assigned when
interface, contained the name of the Web site, a brief

guidance and counseling

introduction of the counseling service, and some images
pertaining to the esthetic function. The KM Web also

Bachelor’s degree in

School counseling
displays information on the e-counseling procedure and a
table of the counseling schedules of nine counselors.
Information on the training and educational background of

18 years
3 years
46–50 the counselors as well as information on the e-counseling
Male
K10

procedure, ethics, and risks was also posted on the Web

AI

site. In other words, clients were provided with information

on what to expect and how to assume their roles as
guidance and counseling

e-counseling clients.
Bachelor’s degree in

The teacher trainees were encouraged to use the

School counseling

e-counseling service before deciding to participate in the

study. Hence, the number of clients was not determined at
this point, and other trainees who enjoyed using e-coun-
7 years
2 years
35–40

seling but were not willing to participate were allowed to

Male
UF
K7

use the Web site.

We screened the information communication technol-
Islamic studies; guidance

ogy (ICT) skills of both the counselors and clients, after

Bachelor’s degree in

they agreed to participate in the study, using a brief form

and counseling
Islamic studies

on which the participants indicated their competencies in

the following areas: basic computer operating skills, such
1 ‘ years

as using a mouse, typing on a keyboard, and accessing the

Female

4 years
36–40

Start menu, as well as skills in using email and attach-

HO
K5

ments, file and folder management, word processing,

Internet search Web sites, and Yahoo! Messenger chat.
Bachelor’s degree;

Users who demonstrated a moderate level of ICT compe-

Master’s degree

tency were invited to participate in the study. The potential

Guidance and
counseling

clients were also briefed on the availability of technical

1 ‘ years
12 years
Female

support and professional support during the study. A

36–40

nonparticipating counselor was appointed to assist the

K3

JA

clients in emergency situations, and two ICT experts were

Counseling education

appointed to help clients and counselors with technical

Bachelor’s degree;
Master’s degree

problems that could disrupt communication during the

session. Technical measures were employed to reduce
client frustration resulting from technical failures or the
10 years
Female

3 years

lack of ICT skills, both of which could indirectly affect the

41–45
RY
K2

development of the counseling relationship. Given the

risks of the third party receiving or stealing the information
Table 1 Counselors’ demographic information (6)

Counseling; guidance

shared during online session (Mallen et al. 2005a, b), a

Bachelor’s degree;
Master’s degree

written informed consent form was provided to each

and counseling

potential counselor and client, who then reviewed all of the

risks, ethics, and responsibilities of the researchers, coun-
15 years
4 years

selors, and clients. Each counselor and client was asked to

41–45
Male
AB
K1

sign the consent form before beginning the study. This step
was taken to ensure that the counselors and clients were
Experience in counseling

aware of all potential e-counseling risks.

preserve confidentiality
Academic qualification

counseling sessions
Experience in virtual

After a brief trial, record shows that 107 clients visited

the Web site and received services during the 16-week
study, and 59 of these clients agreed to participate in the
Respondent

study by returning the signed informed consent letters.

Major

Forty-eight of these individuals did not agree to participate

Code

Age
Sex

in the study but continued using the e-counseling service.

123
 Author's personal copy
Twelve of the 59 clients were males, and 47 clients were
females. Their ages ranged from 20 to 55, with an average
of 33.5 years. The majority of the clients was under
35 years old and was not married. Only 13 female clients
were married, and none of the male clients were married.
The marital status of two female clients was unknown.
Procedure
As has been described in the previous section, counseling
Web site known as KM was developed at http://ramlan
hamzah.com using a tripod flat form for easy application,
and the site was tested before being launched for the study.
The e-counseling procedure was initiated when a client
makes an appointment with a counselor from the list of
counselors on the Web site by suggesting a time and date
via email or chat room sessions. Then, a counselor
responded to the client’s email, noting the details of the
appointment in a logbook or a record that was electroni-
cally provided by the research team. Next, counseling
occurred via email. The e-counseling sessions were
expected to develop naturally, and the client and counselor
were to continue their relationship as each situation
demanded. There were no expectations for the frequency or
duration of the sessions. Only the counseling structure and
ethics were used as guidelines. The study was conducted
during a period of 20 weeks, which included a 4-week pilot
study to test the usability of the e-counseling Web site,
given that the Web site was developed for this study. After
16 weeks (following the 4-week pilot test), the total
number of emails was determined to 280 interactions, but
only 206 email interactions from the 59 clients who agreed
to participate were processed. As specified in the consent
letter that was signed by the counselors, research team
member maintained regular communication with the
counselors and monitored the email transactions between
the clients and the counselors with the assistance of two
nonparticipating counselors and an ICT technician who
monitored and occasionally reported the technical aspects
of the service to the research team.
Data collection and analysis
The main data sources for this research were (a) the focus
group interviews with the counselors; (b) email interac-
tions, which comprised client emails and the response
emails of counselors; (c) the self-reflective journals of the
counselors; and (d) the researcher’s audit trail (Pidgeon and
Henwood 2004). As the study focused on the experiences
of counselors in conducting e-counseling with clients, the
main source of data was obtained from counselors, as in the
work of Daly and Mallinckrodt (2009). The client emails
were included as reported by the counselors in the focus
123
A. Salleh et al.
group and in their journals. Henceforth, we use the term
‘‘participants’’ to refer to the counselor participants only.
Interview
Interviews were conducted in small focus groups and
repeated individual interviews (Creswell 2005; Giddings
and Wood 2000; Worthen and McNeil 1996) with the
participating counselors. Focus groups are considered pri-
mary and secondary data collection sources (Yin 1994) and
are increasingly used in qualitative research. This method
facilitates open discussion using group interactions (Bar-
bour and Kitzinger 1988) and thus can provide additional
factual, cumulative, and detailed information. Fontana and
Frey (1994) suggested that data could also be validated by
participants. The focus group method was considered
appropriate for the current study because it enabled us to
collect rich data on the experiences of the counselors.
Following the suggestion in the work of Krueger (1994),
two focus group sessions (with 2–4 participating coun-
selors per group) were conducted in an face-to-face format.
Focus group data were collected immediately after the
16-week program concluded.
All participants were contacted via email for the inter-
view appointment. The interview protocol was developed
following the recommendation of Fontana and Frey (1994)
to use a common statement (protocol) for all the respon-
dents, stay on the same topic as in introduction, follow the
sequence of questions or protocol, do not suggest any
answer neither interpret the questions. The open-ended
questions were designed to enable the researcher to further
explore the experiences of the participants in conducting
e-counseling sessions.
One interview session was conducted for each focus
group to examine the perceptual patterns, opinions, and
attitudes of the participants regarding the implementation
and process of online counseling (Krueger 1994). Adopting
the client-centered approach of Rogerian therapy (Rogers
1980), the interviewer assumed the role of facilitator in the
semi-structured interviews, which were guided by the
interview protocol. This approach allowed the interviewers
to examine the perceptions of the group members and the
meaning of their e-counseling experiences. The interview
protocol led the discussion in focus groups to the following
topics: (a) how e-counseling processes are conceptualized;
(b) how clients are engaged in e-counseling sessions,
including a discussion of the issues and readiness of the
clients and the responses of the counselors; and (c) how the
counseling relationship is managed, including how termi-
nation is approached. The duration of each focus group
session ranged from one hour to one and a half hours. All
sessions were conducted in a closed room and were
recorded on video.
 Author's personal copy
Online counseling using email: a qualitative study
The approach and techniques that were used in the
interview sessions generated a variety of issues regarding
the different experiences and reflections related to partici-
pation in online counseling.
Counselors’ self-reflective journals
All participating counselors agreed to maintain a journal
of their counseling sessions to record their thoughts,
feelings, interpersonal and intrapersonal concerns, and
perspective on theories following each e-counseling ses-
sion. Journal writing was found to be an excellent method
for capturing the psychological and personal experiences
of the counselors. Connelly and Clandinin (1990) reported
that journal writing is effective for imparting phe-
nomenological experiences. The clients were not required
to maintain journals, as the focus of the study was on
counselor perceptions of their experience in conducting
online counseling.
Researcher memoranda
A memorandum is a researcher’s note on a concept that
was developed during the investigation process. In this
grounded theory approach, the memorandum writing by the
researchers in this study provided a monologue and
reflection in the search for a theory and in the generation of
new ideas or understanding of the data. Memorandum
writing is critical during data collection and draft prepa-
ration because this in-depth writing assists researchers in
understanding the data and enhancing the screening pro-
cess (Charles 1990).
Data validation
All interviews were recorded and transcribed. The fol-
lowing methods were employed to maintain the authen-
ticity and validity of the data:
i. Member checking: After the initial coding, the data
were sent to all of the participating counselors for
verification. Then, the participants were invited to a
face-to-face meeting to examine and verify all
properties of the initial themes that were identified
by the researcher (Creswell 1998, 2002; Guba and
Lincoln 1988; Merriam 2014).
ii. Audit trail: The researchers also recorded all of the
research activities to establish an audit trail, which
also served as a research quality control method
(Punch 2005; Merriam 2014).
iii. Triangulation: Finally, the data from the various
sources were triangulated using a constant compar-
ison method (Stake 2010).
Interpretive analysis
The data were analyzed by using a thematic approach to
the three levels of the coding process: open coding, axial
coding, and selective coding (Corey 2005; Giddings and
Wood 2000; Ivey and Ivey 2007).
Open coding was the first category of analysis to ini-
tially extract meaning from the data from various sources.
All of the materials, which had been transcribed, edited,
and validated, were read line by line (Chamberlain 1999;
Giddings and Wood 2000) to identify concepts or themes
(Creswell 2005) during the initial open-coding procedure.
Two techniques were applied: the constant comparison of
data method suggested by Strauss and Corbin (1998) and
the thematic analysis approach suggested by Creswell
(2008) at the phases. The initial open coding resulted in
273 themes. The second phase of coding (i.e., axial coding)
was used to establish linkages among the themes that were
identified during the open-coding process and to determine
which themes have broader meanings. These themes were
grouped and regrouped to obtain the most logically
meaningful categories, and various linkages were estab-
lished to generate subthemes. Seventeen subthemes were
generated at this stage. The third phase (i.e., selective
coding) was used to establish linkages among the 17 sub-
themes to form categories or main themes (Creswell 2005).
Using five elements that were suggested by Creswell, we
examined the linkages among the themes and subthemes by
considering the situational causes, phenomena, strategy,
context, and outcomes/consequences in conjunction with
the intervening strategy that was recommended by Strauss
and Corbin (1998). The organization of themes according
to the interaction sequence revealed a pattern that appeared
as flows and stages of events within the e-counseling
interactions. The sequential and content approaches were
combined and resulted in the identification of five main
themes comprised the stages and characteristics of the
e-counseling relationship.
Results
The general analysis shows that the participants (coun-
selors) presented several common initial reactions to the
experience of online counseling. First, most participants
considered online counseling to be a unique approach
because it provided them with time to prepare responses.
This online counseling experience (Beattie et al. 2009;
Dunn 2012) was explained in various ways; for example,
the counselors reported having time to think, read, and
reread the emails from their clients; prepare drafts; engage
in writing and planning; and even research the issues of
clients. The participants also described the stages in
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counseling that indicated a beginning and an end of a
relationship as well as their own and the clients’ feelings,
thoughts, and actions.
Table 2 classifies themes to indicate their placement
across the phases of the online counseling process based on
our interviewees and other records. Within each theme,
subthemes are indicated by subheadings under each sub-
theme. The participants described a process that comprised
the following five main themes: (1) the initial establishment
of a virtual relationship, (2) structuring, (3) the development
of a text relationship, (4) text reinforcement, and (5) termi-
nation of the process. Several subthemes describe each
specific main theme. The following discussion presents the
online counseling experiences of the participants according
to these five online counseling themes.
The initial establishment of a virtual relationship
With respect to this theme, the participants described their
online counseling experiences by discussing their reactions
to the clients’ initial emails. The participants used the
following four terms to describe these experiences: the
initial reading (of the clients’ first emails), extended read-
ing, initial acquaintance, the development of an initial text
relationship, and the recording of initial thoughts.
The initial reading (of the clients’ first emails)
The participants reported that they began reading the initial
emails from their clients in the following manner: ‘‘as soon
as I see (receive) an email, I would immediately open it,
read the whole email and highlight sentences’’ (K2:41).
According to another participant, ‘‘in the first email, the
client would normally tell me about all their problems. At
Table 2 Themes and
Themes
subthemes
1. Initial establishment of virtual relationship
2. Structuring
3. The development of a text relationship
4. Text reinforcement
5. Termination of the process
123
A. Salleh et al.
this stage, a lot of unclear things are presented’’ (K10). He
continued as follows: ‘‘I would see what the main issue is
presented in the first email. Most of the letters (emails) that
I received would present at least one main issue’’ (K10).
Anxious clients introduced themselves briefly and pre-
sented their problems. The following excerpt captures
some of the content of the initial email of an anxious client,
as reported by K7: ‘‘in the first email, the client just
mentioned his name and started telling me about his
problem…he said, ‘if you can help me, I would be very
grateful, […] Are you certain that you can help me because
I am facing a real big problem’’ (K7).
Overall, the participants agreed that the focus of the
initial reading was to identify the primary issues of the
clients, particularly because some clients wrote extensively
about unclear issues.
Extended text reading
After the participants developed a general understanding of
the client issues as presented in the emails, most partici-
pants described reviewing the emails again and collecting
their thoughts on the clients’ problems, as described by K1
in his journal: ‘‘I read (the email) from beginning to end to
get an overall picture of the client’s issues. I will read twice
or three times, and while reading, I will highlight important
points’’ which was supported by K2. This extended reading
was possible, according to most of the participants, because
the nature of the email mode allows for the delayed
response.
Initial acquaintance
Most participants agreed that they began to write their
responses to the clients’ initial email only after the
Subthemes
1.1 Initial reading of clients’ first emails
1.2. Extended text reading
1.3. Initial acquaintance
1.4. Developing an initial relationship via texts
2.1. Structuring via Web site and email
2.2. Structuring the concept and service content
2.3. Structuring email counseling schedule
2.4. Structuring in situation of a crisis
3. 1. Therapeutic relationship
3.2. The focus on the written email texts
4.1. A plan for action
4.2. Client’s appreciation and expression of satisfaction
5.1. Client’s issues processed
5.2. Summary
 Author's personal copy
Online counseling using email: a qualitative study
extended reading. The interviewees used terms such as
those used in greeting notes and showed an appreciation of
the client efforts to seek help using online means (K2). The
participants described how they introduced themselves to
clients and became acquainted with them by asking about
their background and demonstrating attentive skills (K3).
Developing an initial text relationship
The idea of developing an initial text relationship was
described by the participants when they introduced them-
selves to the clients: ‘‘There is trust at the early stage, as I
have developed the relationship by introducing myself and
have also explained the purpose of counseling, which is to
help the client.’’ (K7). In their initial responses to the client
emails, the participants thanked and greeted the clients and
introduced themselves, and some participants explained the
purpose of the counseling (K1).
Structuring
The interviewees discussed the following types of struc-
turing: (i) structuring via the Web site and email, (ii)
structuring the concept and services content, (iii) structur-
ing the email counseling schedules, and (iv) structuring
in situations of crisis.
Structuring via the Web site and email
Most of the participants viewed the information related to
online counseling that was posted on the KM Web site as a
structuring process that was provided by the Web site. One
participant stated as follows: ‘‘for me, the statement (in-
formation) via the website is the best structuring method.’’
Although the participants admitted that the information
posted on the KM Web site provided clients with structure,
they also extended this structuring; as K2 explained,
structuring ‘‘can be done in many ways; it can be done
using email and not necessarily just in one email. In my
case, I didn’t do it in one email; there were stages (of
interaction)’’ K10 discussed the need to ‘‘get an under-
standing of the definition of online counseling’’ as part of
his structuring process.
Structuring the concept and services content
In addition to continuing to structure the concept and ser-
vice content, the participants added to the structuring
process by discussing the roles and limitations of the client
and the counselor. K10 clarified the roles of clients by
informing them as follows: ‘‘We will discuss and examine
this issue together, with the hope that you are the one who
will be working on this problem.’’ While acknowledging
the effort of his client, K2 emphasized that he expected
sincerity from the client: ‘‘I am here to listen, and at the
same time, I need more information and your sincerity in
sharing [your concern] with me.’’
Structuring the email counseling schedules
The matter of online counseling schedules was also
brought to the group’s attention when some participants
discussed establishing a schedule for email responses, as
reflected by K7’s statements: ‘‘I have already informed
him/her within a week. If he/she didn’t reply, he/she may
not agree… []..But, we have decided to respond within a
week’’. K3 also emphasized that a schedule is important: ‘‘I
must set a schedule, (I) need time, and I need to be there (at
the computer desk)…because I need a few days to reply to
the email.’’
Structuring in situations of crisis
The final issue related to structuring was the participants’
awareness of the importance of preparing for an emer-
gency. Most of them agreed that information on the loca-
tion of clients and complete background information are
crucial. The following two statements by K7 and K1 are
examples of emergency concerns: ‘‘this (client’s complete
address) also can help me to identify his/her location in
case of an emergency, such as a suicidal attempt, abuse and
so forth’’ (K7) and ‘‘in case of emergency, this information
is extremely important, so the client can be contacted using
telephone or other methods’’ (K1).
The development of a text relationship
The idea of developing a deeper text relationship emerged
from the participants’ description of their reactions to client
emails following the initial acquaintance. This category of
deeper relationship comprised two major themes: (a) the
therapeutic relationship, which included trust, and (b) the
focus on written email texts (Table 2). These themes were
discussed at length.
Therapeutic relationship
The theme emerged as the participants spoke during the
interviews and used phrases in their journals such as the
feeling of being in a relationship, listening, acceptance,
empathy, trust, intimacy, and other related terms listed in
Table 2. Some of these expressions also reflected the car-
ing attitude of the participants toward their clients. For
example, K2 stated as follows: ‘‘once we have chosen to
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become online counselors, we need to devote time (to our
clients), as they (the clients) had put their trust in us, and
this became an opportunity for us to communicate with
them (clients).’’ Some counselors even claimed that they
felt more comfortable conducting email counseling com-
pared with the face-to-face mode.
Several participants reported initial doubts regarding
whether their attitudes and feelings toward their clients
could be communicate and understood by the clients in the
texts. K1 shared his doubt in his journal: ‘‘Before I began to
write, the first thing that came to my mind was the question
of how I could let my client know that I am caring and
attentive.’’ However, most participants expressed belief
that trust was developed at an early stage and that the Web
site structuring influenced the cultivation of clients’ con-
fidence in their online counselors and thus encouraged
them to seek help from these counselors. One participant
made the following claim: ‘‘I knew, I could feel something
from his writing, although I didn’t see his facial expression
or nonverbal elements.’’ This experience was echoed by
another participant, who remarked in her journal that ‘‘I
feel like I was talking to her, and I feel like she was lis-
tening to what I had written, and I feel close.’’ The par-
ticipants also discussed their observations of clients’ email
texts and offered the following observation: ‘‘clients
accepted us and had confidence in us because they were
ready to tell us everything that they had on their chests in
the second emails.’’ K7 reported an example of a client’s
trust in the relationship
‘‘In a subsequent email, he began to describe all sort
of personal issues, including his mother-in-law,
characteristics of his wife, cancer issues, telling me
what he has been doing, that he had been under a lot
of pressure, especially with his brain cancer.’’
Evidence of clients’ trust in the relationship was observed
by the participants through the positive changes in the
clients that were reported in emails. The following excerpts
contain information on the clients’ gains concerning their
insight and ability to make decisions:
‘‘Thank you for responding to my last email. Your
email has helped me to realize something. When I
reread my previous email with some words high-
lighted [by you] then, I could see what is happening
to me’’.
When the clients exhibited trust, they showed that they
were ready or willing to cooperate. K10 offered the
following observation: ‘‘in the second email sent to me, the
client had usually already understood what he was
supposed to do. At this stage, clients are ready to make
choices. Clients appear to be cooperative.’’ Thus, the
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A. Salleh et al.
counselors believed that they had engaged in therapeutic
relationships with their clients.
Focusing on email text
The participants used various techniques in writing email
texts to draw the attention of their clients to a specific issue
or topic. The techniques that they used included various
language styles, the repetition of phrases, different text
colors, and emoticons. K1 emphasized the use of multiple
elements in the texts by ‘‘paying attention to writing,
content, language, writing style, repeated sentences, and
the consistency of the writing’’ (K1:51). K7 also utilized
different techniques to send different types of messages.
Text reinforcement
The theme of text reinforcement emerged as participants
talked about how their emails containing intervention plans
reinforced clients gaining insight into their problems,
reassessing their previous goals, and agreeing to implement
the plan. The theme comprises two major subthemes:
(a) counselor’s plan for action and (b) client’s appreciation
and expression of satisfaction. Within these themes, the
participants described that they had received responses
from clients who reported signs of satisfaction. The clients
also expressed their appreciation of the counselors’ help.
A plan for action
The development of action plans was an important strategy
for resolving the issues that were presented by the clients.
The counselors described that they engaged in planning,
studied various aspects of the clients’ issues carefully,
performed research, planned actions, and allowed ample
time for clients to take action. The counselors and clients
collaborated to make decisions regarding the clients’
problems and to develop feasible action plans. For exam-
ple, when discussing a client’s problem, K10 implied that a
collaborative process was used:
‘‘From your email, we can draw a conclusion that
being honest is important []. There are few things that
you may want to consider: a) Do you need to be honest
to your future husband about your financial situation?
b) Do you need your future husband to help you to
ensure the [wedding] ceremony goes smoothly?’’
Furthermore, the participants agreed that they allowed their
clients ample time, as reported by K3: ‘‘we allow them
time to think and opportunities to make decisions. We give
them space.’’
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Online counseling using email: a qualitative study
Client’s appreciation and expression of satisfaction
The participants reported that most of the client responses
were positive and thus reinforced the effectiveness of the
online sessions. The counselors also discussed the clients’
appreciation of their counselors’ assistance and expressed
their own satisfaction with the sessions.
‘‘The client usually responds and thanks me while
saying he/she will contact me again in the future on
other matters.’’
K7 shared the progress of his clients based on his client’s
explanation in his email:
‘‘I think I have found a solution to my problem; I will
do what we discussed last time and what I have been
thinking in the last few weeks; I will give my wife
another chance to change.’’
Termination of the process
As reported by the counselors, the online counseling ses-
sion ended when clients’ issues were processed, and the
counseling process summarized. In client’s issue pro-
cessed, the counselor reported that they received signal
such as clients’ expression relief and satisfaction with the
session.
Client’s issues processed
With regard to receiving signals about when clients
expressed relief and felt satisfied with the sessions, exam-
ples were provided in the focus group interviews and in the
journals. Some participants stated that after the clients’
problems were answered (K6:27), there was no further
response (K5). The following excerpt from K5’s journal
reflects general views regarding understanding when cli-
ents’ problems were answered:
‘‘The clients usually informed [me] that their prob-
lems were resolved and they feel relief. They did not
make further comments, so I assumed the problems
were solved and [they] had agreed to what we have
discussed.’’
The online counseling sessions were then concluded when
the participants (counselors) observed various signs or
signals that a session was ending. The termination of the
sessions was described by some participants as writing a
conclusion for clients.
With respect to concluding the session, K7 wrote in his
journal: ‘‘I would send a message that the counseling is
coming to an end. I would make an overall conclusion and
finally end the session.’’ K3 shared what she wrote in her
final email to a client:
‘‘I ended the session with a review of all of the ses-
sions, from the first session that I had conducted, and
made a conclusion. I also mentioned things we agreed
upon, and I helped my client to see the whole session
from the beginning to the point [when] he/she made
his/her decision.’’
The results of this study show that the participants strongly
believe that there is a process of helping relationship took
place although they do not see the clients face to face.
Discussion
This qualitative study explored an online counseling or
therapeutic relationship using the email modality. While it
limits to counselors’ perspective, the study extends and
supports the existing evidence by looking at how online
counseling using email was developed. Counselors’ expe-
rience including what they interpreted the clients’ email
content was the basis of this understanding. The findings
show the therapeutic relationship develops in email
communication.
The study found that there is a basis to show the online
therapeutic relationship develops in several phases through
email communication with three major phases such as
establishment, development, and termination supporting
Barrozzone et al.’s (2013) three-phase model of therapeutic
relationship of establishing, developing, and maintaining,
although their study was on automated CMC health service
programs. The online counseling stages as perceived by the
counselors may have influenced by their face-to-face
training and experience as suggested by Ekberg et al.
(2013) that virtual counselors may adapt their face-to-face
counseling skills when conducting online counseling.
There is a possibility this applies to counselors in this
study.
As in the Ekberg et al. (2013) and Harris et al. (2012)
studies, our findings also provide substantial evidence to
support that online communication between counselor and
client moved from initial questions to obtain information to
a deeper mode in which the counselor moves to check the
client’s perspective and to share feelings (Ekberg et al.
2013; Harris et al. 2012). Counselors in this study also
thanked their clients for seeking help and for introducing
themselves, although it is not exactly in the same way the
counselors in the Ekberg et al. study performed these tasks.
This study found substantial evidence of the ‘‘structur-
ing’’ process, suggesting counselors may have adapted the
structuring practice in face-to-face counseling. Dunn
(2012) found structuring is important in online counseling
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 Author's personal copy
process. In structuring, there is evidence to suggest coun-
selors took steps to discuss ethical issues by obtaining
personal information, including the location of the client in
case of an emergency where the client may be in danger or
harming others (Mallen et al. 2005a, b), and the possible
risks of email counseling, such as the Internet connection
might be hacked or the client’s email might be accidently
exposed to others.
There are concerns about the uncertainty in getting a
response from the other party in the online counseling
relationship; time delay which is built into the asyn-
chronous email counseling process can cause a blank
screen (Suler 2004). To avoid waiting and not knowing
when the client’s email would come, the participant of the
study decided to set a response schedule. K3 for example
emphasized that a schedule is important: ‘‘I must set a
schedule’’ which is in line with Suler (2010) suggestion
concerning the scheduling of response time. Counselors in
this study also found ‘‘reflective zone’’ (Suler 2010) time to
be a positive feature, as it enabled them to make a more
organized intervention.
Direction for future research
The number of email interactions between the counselors
and clients was relatively small compared with the average
number of interactions in short-term, face-to-face therapy,
which is defined as 16 sessions. Most relationships
involved in the present study have an average of three
interactions: three client’s email and three counselor’s
email. There is no evidence of dropping out, while there is
substantial evidence indicated by counselors that there are
signals of the session is coming to an end, and either clients
or counselors wrapping up the session with counselors
welcoming future contact and clients thanking the coun-
selors for their helps. Other studies (Ekberg et al. 2013;
Zelvin and Speyer 200) also indicated online counseling
sessions were relatively small in numbers; Zelvin and
Speyer (2004), for example, came out with only four
interaction email counseling models, while Ekberg et al.
(2013) found that the mean length of chat therapeutic
treatment was 6.8 session. Even single session of online
counseling was found feasible and effective (Richards
2009; Efstathiou 2009). Perhaps, the small number of email
counseling sessions in the present study is due to the large
amount of counseling issues covered in each email,
implying it is more ‘‘efficient’’ modality for arriving at
some sense of completion after a relatively small number
of exchanges between client and counselor. As reported by
the participants, even in the first email clients were already
expressed several issues while the participants themselves
had the opportunity to read clients’ email several times and
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A. Salleh et al.
doing some research before embark on client intervention
plan. As writing itself is therapeutic because it can be
cathartic (Sheese et al. 2004) foster a sense of psycholog-
ical safety (Wright and Chung 2001) allows clients more
time to process the content (Cook and Doyle 2002) and
facilitate further reflection (Beattie et al. 2009); therefore,
clients’ large volume emails with all the facilitative char-
acteristics and counselors’ thorough intervention approach
may have enabled them (the clients) to gain insight into
their situations and resolve their issues without needing a
lengthy session. Our data also indicate that email coun-
seling session has higher volume compare to chat session.
Individual client’s email word count has an average of 980
and counselor’s email 1550. This brings the total word
count for the average of three interaction sessions of client–
counselor pair to a significant large volume. Ekberg et al. ’s
study (2013) revealed that the average chat post of chat
therapeutic session was 47.4, and the average word counts
was 1229 (Ekberg et al. 2013) which shows chat session
volume is smaller than email session. These findings have
offered some evidence on trend in email counseling inter-
actions, which is significantly small in number but large
and comprehensive in volume. This important finding,
however, clearly requires more support to gain a greater
understanding of the nature of online counseling interac-
tions, the role of text-based counseling, and the role of
counselor’s intervention strategies in clients’ healing
process.
There was such a strong apparent preference for email-
based support as none of the client use chat modality
although our study offered both modalities. As the clients
were all Malays who are also Muslim, the cultural and
Islamic factor may have influence their help-seeking
behavior (Ball et al. 1992). Malay belongs to one of Asian
cultures who accept a social emotion of ‘‘malu’’ (shame
propriety—hypersensitiveness to what other people are
thinking about oneself) and regarded it as element of basic
goodness (Mastor et al. 2000). As a collective society
(Rafaei 1976), professional help-seeking for emotional
problems is perceived as foreign to the Asian people as
they would prefer to use social support among close others.
Compared to American sample, Japanese shows a greater
reluctance to seek professional help (Mojaverian et al.
(2013). The preference for email-based support by the
client in the present study could have been due to the
factors of anonymity and privacy which are in agreement
with their culture and values. On the other hand, chat
modality has been perceived as lack of privacy and security
and the fear being caught while conducting online chat
sessions has become main concerns even among American
(Young 2005). It is highly likely that the clients who hold
to the social emotion of ‘‘malu’’ may not want to take any
risk of being exposed in chat session. However, as our
 Author's personal copy
Online counseling using email: a qualitative study
knowledge on client’s cultural-related attitude toward
online counseling is almost none, studies on this particular
area are highly justified.
In addition, we did not collect data from clients (through
interviews or journaling) for reasons that were previously
explained, although earlier studies suggested that data
collected from clients would enhance the findings of
counseling relationship studies. Data from clients could
also include counseling outcomes from the client per-
spective. We also recognize the inherent limitations of
purely text-based counseling methods relative to multi-
sensory e-counseling approaches, such as video counseling
(e.g., Skype counseling). These limitations could guide
future research on online email counseling.
Conclusion
The findings of the present study enhance current knowl-
edge in counseling relationship with more understanding of
developmental stage particularly in email counseling as
most studies available were on quasi-synchronous chat
modality. While new understanding of the email counsel-
ing relationship is highlighted, these studies also support
evidences, indicating distance counseling limitations also
offer advantages to both clients and counselor. However,
due to small sample size, it limits the generalizability of
our findings. It is especially important to replicate this
study with a larger sample and more diverse groups to be
able to attain more evidence of the development of an
email counseling relationship
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