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17 Feb 2021


Our team recently examined the current research on asynchronous counseling. Asynchronous counseling is delayed communication that does not occur face-to-face between clinicians and clients throughout the course of treatment. The two primary forms of asynchronous counseling are chat-based counseling and self-guided modules. In chat-based counseling, clients and clinicians participate in chat exchanges. When using self-guided modules, clients complete modules, and their clinician provides feedback. All forms of asynchronous counseling include the client and clinician choosing when it is most convenient for them to interact. Because asynchronous counseling does not occur face-to-face, it is sometimes referred to as technology-based counseling, as clinicians and clients rely heavily on emails, text messages, or instant messages on a website or app to communicate. The convenience of asynchronous counseling allows clinicians to treat clients that would not typically participate in face-to-face therapy, which is discussed in more detail below. Particularly, amid the coronavirus pandemic, asynchronous counseling offers a unique approach for clients to seek treatment while also maintaining their health and safety. In our recent report, we gathered existing research on the effectiveness and benefits of asynchronous counseling and considerations for its implementation.

Asynchronous Counseling: Effectiveness and Benefits

Regardless of the type of asynchronous counseling, most research indicates that it is an effective form of treatment. More specifically, asynchronous counseling has been able to help people with a variety of presenting problems such as depressive symptoms, anxiety symptoms, problems with cannabis use, and gambling. Researchers and clinicians expect that one reason why asynchronous counseling is beneficial to clients is because of the time delay between responses, giving both the client and clinician time to create thoughtful and deliberate responses. Like other mental health services, however, effectiveness can vary based on a variety of factors. Factors that can impact the effectiveness are the severity of symptoms, readiness for change, level of comfort with using technology, and level of education and literacy. Therefore, it is important to discuss such considerations before committing to treatment.

There are many reasons why an individual would benefit from utilizing asynchronous counseling as an alternative to face-to-face treatment. One reason asynchronous counseling may be beneficial compared to face-to-face treatment is that it accommodates clients who cannot attend in-person treatment or are not near a treatment center. For instance, some clients may not have reliable transportation or may live too far away to attend face-to-face treatment. Alternatively, others simply cannot find the time to attend treatment. Additionally, clients who value privacy throughout their treatment process may prefer asynchronous counseling as opposed to attending in person. By participating in treatment online, clients can eliminate potential stigma of seeking treatment and receive the assistance they need from the comfort of their own home. Asynchronous counseling offers a solution to each of these barriers. By utilizing it, clients can access treatment from anywhere, avoid stigma, and have a convenient treatment option.

Considerations for Implementation

As with any mental health service, there are considerations for implementation. Some of the most primary concerns are that of safety, privacy, and technological issues. Clients who experience a crisis or emergency may not have access to immediate assistance when participating in asynchronous counseling. However, clinicians can provide clients with resources within their community to assist them in an urgent situation. In addition, client privacy is essential in all mental health services. To maintain privacy and confidentiality in asynchronous counseling, encrypted messages and password protected communication are utilized. Although these precautions ca n decrease the likelihood of a breach of privacy, like most technology platforms, clinicians cannot guarantee total security.

Technology makes asynchronous counseling possible, but it can also pose a challenge to receiving services if the client or clinician have technical problems. Clinicians cannot guarantee problem-free treatment, but clients and clinicians can create a contingency plan to handle technological issues when they arise. For example, clinicians and clients can figure out an alternative timeframe, or method of communication (e.g., switching from email to text messages) if any technology issues arise. It is important for clinicians to have conversations with their clients about safety, privacy, and technology concerns prior to beginning treatment. By discussing the possible issues and creating contingency plans, both clients and clinicians will be prepared if a problem arises.

During these unprecedented times, asynchronous counseling is extremely valuable for individuals who need to access mental health services from home. Asynchronous counseling offers a different avenue for clients to access mental health services while maintaining their safety and still overcoming barriers. Existing research suggests that asynchronous counseling is an effective mental health treatment option under certain conditions. Military REACH’s report on asynchronous counseling provides additional information on current research, suggestions for best practice, and considerations for implementation.

Read the Military REACH team’s full report on asynchronous counseling, Understanding asynchronous counseling: A review of effectiveness and implementation considerations, to access the citations used in this piece and to learn even more on the topic.

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