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Understanding asynchronous counseling: A review of effectiveness and implementation considerations

APA Citation:

Frye-Cox, N., O’Neal, C. W., Wendling, S., Nichols, L. R., & Lucier-Greer, M. (2020). Understanding asynchronous counseling: A review of effectiveness and implementation considerations. Auburn, AL: Military REACH

Abstract Created by REACH:

Request: The Office of Military Community and Family Policy (MC&FP), specifically, the Military Community Support Programs team, requested a literature review to examine research on asynchronous counseling, with a focus on: • Advantages and disadvantages of asynchronous treatment, • General effectiveness, particularly compared to synchronous counseling, • Potential factors that may alter treatment outcomes, such as therapeutic approach, • Technical features necessary to deliver therapy, and • Best practices. Section 1 defines technology-based treatments and describes elements of asynchronous counseling communication, drawing specific attention to the purpose of communication, mediums used to communicate, type of communication, and degree of engagement. This section also distinguishes between synchronous and asynchronous counseling. Although they differ, both forms of counseling may be used together through blended counseling. Section 2 provides a summary of existing literature that addresses whether asynchronous counseling is effective, as well as potential factors that may alter its effectiveness. Although asynchronous counseling has been shown to be effective at improving a variety of client outcomes (e.g., depression, smoking cessation, gambling), it is necessary to identify how efficacy may vary between asynchronous counseling and traditional face-to-face counseling depending on client characteristics (i.e., symptom severity, readiness for change, education level, technological literacy, social stigma concerns, geographical location, and daily schedule) and therapeutic factors, such as the amount of time invested by the clinician and the clinical approach (i.e., cognitive behavioral therapy, acceptance and commitment therapy, and psychodynamic therapy). Clients with moderate symptoms who are ready to change, literate, and comfortable with using technology are likely to benefit from asynchronous counseling. Asynchronous counseling may also be an appealing alternative to face-to-face counseling for potential clients who reside far from counseling services, are concerned about stigma associated with seeing a clinician, or who have schedules that limit availability. The therapeutic context may also influence client outcomes. Although the different therapeutic approaches generally produce similar positive results for clients, research demonstrates that clinicians who invest more time into treatment tend to have clients who report fewer mental health concerns and are less likely to drop out of treatment. Section 3 focuses on logistical, ethical/legal, and educational considerations related to the implementation of asynchronous counseling. Logistical considerations are structured around the timeline of treatment, with an emphasis on informed consent and intake assessment, communication and technology concerns, as well as posttreatment boundaries and client attrition rates. Ethical/legal considerations center primarily around client safety and privacy, as well as strategies to mitigate such concerns. Educational considerations highlight the need for proper training of clinicians. Although many uncertainties exist across each consideration, the implementation of asynchronous counseling has become increasingly feasible.


Mental health

Branch of Service:

Multiple branches

Subject Affiliation:

Military families
Military non-medical service providers


Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
Very old (85 yrs & older)


Review of Literature


Frye-Cox, Nick, O’Neal, Catherine Walker, Wendling, Sara Beth, Nichols, Lucy R., Lucier-Greer, Mallory

Publisher/Sponsoring Organization:

Military REACH

Publication Type:

REACH Publication

Author Affiliation:

Department of Human Development and Family Studies, Auburn University, NF
Department of Human Development and Family Science, University of Georgia, CWO
Department of Human Development and Family Studies, Auburn University, SBW
Department of Human Development and Family Studies, Auburn University, LRN
Department of Human Development and Family Studies, Auburn University, MLG


asynchronous counseling, best practices asynchronous counseling, technology-based treatment


Auburn, AL

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REACH Publication Type:

Research Report


This product was developed as a result of a partnership funded by the Department of Defense (DoD) between the DoD’s Office of Military Family Readiness Policy and the U.S. Department of Agriculture/National Institute of Food and Agriculture (USDA/NIFA) through a grant/cooperative agreement with Auburn University. USDA/NIFA Award No. 2017-48710-27339, Principal Investigator, Mallory Lucier-Greer.

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