Terry Hanley - School of Environment, Education and Development

Terry Hanley
Student No: 0544357
Research Proposal Resubmission - 2006
The Working Alliance in Online Therapy with Young People
The quality of the working alliance between therapist and client is viewed as a major
predictor of the success of therapy. This study has set about exploring what it means to create a
working alliance and to examine what form it takes in online therapeutic relationships with young
people. Initially the proposal provides a brief summary of the key relevant literature regarding
the working alliance, the mediated therapeutic relationship and offering online therapy to young
people before stating the rationale and research questions that underlie the study. It then goes
on to describe the mixed method methodology which is being implemented before outlining the
timescale that the project is working within.
The Working Alliance
There are many hundreds of approaches to counselling and psychotherapy but a central
unifying factor of them all is the relationship between counsellor and client. Recent research
suggests that it is the strength of this relationship that proves to be a major determinate in how
successful therapy will ultimately be (for example see, Bambling & King 2001; Martin, Graske, &
Davis, 2000; Horvath & Symonds, 1991). An often used and accepted term that has been
coined to describe this common factor in the therapeutic relationship is the working alliance
(Bordin, 1994; 1979; also see Clarkson, 2003).
The working alliance, as defined by Bordin (1979), is a negotiated, collaborative feature of
the helping relationship. The term itself reflects the process that both the therapist and client
enter into with the hope of creating change; “the powerful joining of forces which energizes and
supports the long, difficult, and frequently painful work of life-changing in psychotherapy”
(Bugental, 1987: 49). Bordin breaks this down into key components and identifies the three
following aspects to it: (1) agreement between client and therapist on the goals of the therapy;
(2) the client’s agreement with the therapist that the tasks of the therapy will address the
problems the client brings to treatment, and (3) the quality of the interpersonal bond between the
client and the therapist. This model of alliance has proven incredibly important in the world of
psychotherapy and influenced the development of several integrative models of therapy (for
example, see Egan, 2002; Norcoss & Goldfried, 1992) and led to the development of a well
respected therapeutic tool, notably the Working Alliance Inventory (WAI; Horvath & Greenberg
[1989]; Horvarth [1981]).
The Working Alliance in Mediated Therapy
Given the reported importance of the working alliance within therapy, delivering services
mediated through technology such as the telephone or computer proves controversial. Critics
warn of running the risk that the ‘space between the two parties’ becomes filled with nothing but
hardware (Robson & Robson, 1998) and question whether therapeutic interactions may just get
reduced to mere advice giving when face-to-face (f2f) interactions are translated to the electronic
medium (Pelling & Renard, 2000). Others more directly note the lack of non-verbal
communication to be a major hurdle in offering mediated therapy (Banach, & Bernat, 2000;
Hackerman, & Greer, 2000). Other practitioners/researchers view the lack of f2f contact as a
challenge to overcome rather than a factor that disables working in alternative media (for more
discussion on this point see Haas, Benedict, & Kobos [1996] regarding telephone counselling
and Rochlen, Zack & Speyer [2004] regarding online counselling).
In recent years a small number of studies have entered the territory of examining the
working alliance in mediated adult therapy. These have been the work of Reese et al (2002)
who specifically focused upon the delivery of telephone counselling, Prada and Meyer (2004)
and Reynolds, Stiles and Grohol (2006) who focused upon email therapy, and Cook and Doyle
(2002) who focused upon online counselling in general (both asynchronous and synchronous
provision). In all of the cases the WAI was used to assess the quality of the working alliance
except the work of Reynolds et al (2006) in which the Session Evaluation Questionnaire, (SEQ;
Stiles, Gordon, & Lani, 2002) was used. Although each of these studies acknowledges
weaknesses, generally due to the limited number of participants in the study, they have all
reported working alliance scores equivalent to those found in f2f studies. Interestingly, in the
only study comparing working alliance using videoconferencing and f2f counselling the
videoconference condition reported significantly lower alliance levels than did those in the f2f
condition (Hufford, Glueckauf, and Webb, 1999).
A number of small scale qualitative pieces of work have also contributed greatly to our
understanding of online therapy. For instance, Brice’s case study of his work with a student who
wished to continue meeting whilst on a summer break from university displayed the potential to
sustain existing therapeutic relationships using email (Brice, 2000). Likewise the frank and open
discussion by Ainsworth (1999), reflecting upon her own experience of seeking out and being an
online client, provides us with a rare insight into what it means to be involved in intimate
therapeutic relationships online. Both Anthony (2000) and Hanley (2004a) conducted similar
pieces of work examining online practitioner’s perceptions of mediated therapeutic relationships.
Both conclude that the Internet was seen as a place where practitioners can develop and sustain
intimate therapeutic relationships; it is noteworthy to highlight that the concept of telepresence
(“the perceptual illusion of nonmediation” [Lombard & Ditton, 1997]), a term more commonly
used in the cyber-psychology field, was highlighted as a central factor in the developing
relationships of appropriate depth. These studies can act as good qualitative indicators that a
working alliance can be established online. Similar reflective pieces have been conducted and
reported findings akin to those online regarding the practice of telephone counselling (for
examples see, Sanders & Rosenfield, 1998; Robson & Whelan, 2006).
The quantitative and qualitative studies combine to provide us with a rich and evolving
picture of the online therapeutic relationship. However, despite this growing body of research,
this area is still a study in its infancy and there are many questions still to be answered. One
such area is that of examining the potential of working with different client groups, an area that is
particularly evident with regard to working with young people.
Offering Online Therapy to Young People
Offering therapy to young people is on the increase in the UK. Studies have shown
young people to be in need of such psychological services (BMA, 2003) and that counselling can
be effective at helping adolescents cope with life stressors and reduce psychological distress
(NICE, 2005; Cooper, 2005; Sherry, 1999). Given the increase in computer usage and Internet
access in recent years (75% of young people now have access to the Internet at home and 92%
have access at school [Livingstone & Bober, 2004]) it is therefore unsurprising that a number of
youth counselling services have gone online (see Hanley [2004b] as an example). This foresight
appears vindicated by King et al’s (2006a) consultation with young people about the motivations
for accessing such services. In this work clients reported that they found the Internet to be a
comfortable and safe space to seek out support. A counterpoint to this argument may however
be that in reaching out for support online, young people may actually be escaping from contact
and perpetuating their isolation rather than connecting fruitfully with others (Wolak, et al, 2003).
To date there have only been a handful of studies focusing upon the development of etherapy for young people. Many of these focus upon the ethical considerations (Suler, 2005) or
practical difficulties of regulating work online (Hanley, 2006); they generally do not examine the
effect the change in medium has upon the therapeutic working alliance.
Two studies have focussed upon the development of a working alliance with young
people using technology. The first of these was the work of Hufford, et al (1999). In this study
the research examined the development of a working alliance using videoconferencing.
Findings suggested that, although therapy was deemed successful, the working alliance proved
much weaker than those formed with an f2f control group. The second study of relevance, and
one which this study can draw much comparison, is the work of King et al (2006b). In this
naturalistic study King and his colleagues compare the online working alliance to that developed
over the telephone. In doing so the research group found that it was possible to create a
working alliance of sufficient quality to have a positive outcome in both conditions. However, it
was also noted that the telephone condition saw the development of significantly stronger
alliances than the online condition.
Presently the research into offering online therapy to young people is thin on the ground.
This would appear to be a major deficit in a climate where online counselling for this client group
is a growth area, and one that is, at times being exploited (The Guardian, 2006). The research
by King et al (2006b) proves promising and would appear to display that it is possible to create
an adequate working alliance with young people online. It does not however tackle the more
qualitative issue of how counsellors can work to strengthen the alliances that they make in this
Rationale and Research Questions
The strength of the working alliance is accepted as a major determinant of the
effectiveness of therapy. A major concern with the practice of online therapy is that, due to the
lack of physical presence, this alliance will not prove of an appropriate quality to facilitate
therapeutic change. Evidence to the contrary has begun to emerge but this has numerous
limitations. With this in mind, this research focuses upon young peoples’ perceptions of the
online therapeutic relationship so as to gain a greater insight into what it means to develop a
working alliance using this medium. More specifically the study focuses upon the following
research questions:
RQ.1. Do young people accessing online counselling in the UK report evidence of a
strong working alliance?
RQ.2. What are the key features of the working alliance that young people report after
experiencing online therapy?
RQ.3. Given that the client does not meet the counsellor f2f, will the bond (mutual liking)
component of the alliance prove to be relatively weak compared with the goal and task
(collaboration) component of alliance?
RQ.4. Is there a link between client reports of positive therapeutic outcomes and a strong
working alliance?
This study utilises a mixed method design to gain a greater understanding of the online
working alliance (for further discussion on using mixed method design see Johnson &
Onwuegbuzie, 2004; Cresswell, 2003). It will combine the use of a quantitative working alliance
measure with one qualitatively minded open questionnaire and two semi-structured interviews to
gather data focusing upon the online working alliance and the outcome of therapy. The
purposes for adopting this pluralistic design are as follows:
to allow for triangulation of the findings – notably checking the results of the quantitative
method with those of the qualitative method and vice-versa.
To provide a more complete picture of the phenomenon being examined – collecting
quantitative data does not always prove congruent with the relational nature of the
therapeutic relationship (Goss, 2003). The qualitative element of the study will therefore
allow for the collection of rich data that will add ‘meat to the bones’ provided using the
Therapeutic Alliance measure.
More specifically the study intends to focus upon the online working alliance to develop a greater
understanding of how it manifests in this medium. To do so participants will be asked to
complete the youth version of the newly devised Therapeutic Alliance Quality Scale (TAQS - see
Appendix 1; see Bickman et al [2004] for a discussion of the earlier version). This is a 13 item
questionnaire, each question being rated on a five-point scale, that has been developed using
the Rasch measurement model and based upon the three key aspects of the working alliance as
defined by Bordin (1976); Bond, Task and Goals. This equates to three subscales: (1)
mutuality/empathic qualities; (2) the collaborative relationship; and (3) attitudes towards
treatment/setting (Bickman et al, 2004). As this is an instrument devised within the US, an
amended UK friendly version (predominantly altered for spelling differences) is presently being
piloted with a f2f youth counselling service in this country. To compliment this quantitative data,
participants will then be asked to take part in a follow up online semi-structured interview. This
interview will be loosely based upon the questions posed in the WAI (see Appendix 2).
To gain a sense of whether the online working alliance can be used as a predictor of
therapeutic outcome each client will be asked to complete a short evaluation questionnaire (see
Appendix 3) and invited to take part in an online interview. The possibility of introducing a
separate quantitative tool to measure the outcomes of therapy was considered. However the
most relevant tool, notably CORE-YP, a youth friendly version of CORE (Barkham, et al, 2006),
is still being validated and will not be available for use until 2007. The CORE-YP questionnaire
will however be used as the basis for the interview schedule evaluating the therapy (see
Appendix 4).
Please note that all of this study is to be conducted online. The purposes for doing so are
firstly acknowledge the difficulty that would be faced in attempting to access online clients f2f,
and secondly to retain congruence with the phenomenon being examined (see Mann & Stewart
[2000] for a comprehensive discussion of using online methods).
This study is working closely alongside a developing online counselling service for young
people in Cheshire. This service has been developed for 11 to 19 year olds and service data
statistics suggest that the usage of it spreads throughout this age range. All clients who meet
one-to-one with a counsellor will be asked to complete the questionnaires being used and to
take part in the interviews being conducted. It is intended that the overall study will follow the
progress of between 30 and 40 clients.
Young people will be recruited once they access the one-to-one online counselling
service. In doing so they will be asked to register and provide some basic demographic
information (age, sex and the locality in Cheshire that they live). They are also asked to choose
a username. At this point they will then be able to make an appointment with a counsellor. All
individuals who meet with a counsellor will be asked to complete the TAQS; this will be sent
automatically after the first session. In answering the questionnaire individuals will also be given
the opportunity to meet for an interview to discuss their experiences of the service – where
possible this will be conducted within a one-week period of them agreeing to take part and use
the same platform that they received counselling. Finally once the counselling relationship has
ended clients will be asked to complete the evaluation questionnaire and again be asked if they
would be willing to discuss their experiences of counselling with a researcher (see Appendix 4
for a table outlining this procedure).
The process described above will be repeated until 30 to 40 clients have participated in
the project. As it is anticipated that not all clients will go through the whole process (for instance,
clients may choose not to complete questionnaires or to attend interviews) it is acknowledged
that the project will have to remain flexible to allow for discrepancies.
Data Analysis
So as to break the data up into manageably sized chunks the data will be analysed at
three distinct periods within the project (see research timescale for the periods planned). During
each of these periods the data analysis will be split into 2 major components; the qualitative
element to the study and the quantitative element to the study. Each of these is introduced
below followed by a discussion of how these will be brought together.
Quantitative Analysis
The data collected from the TAQS questionnaire will be used as a numerical assessment
of the quality of the working alliance. An analysis examining the relationship between each of
the key subscales will be undertaken to assess this quality. This can then be viewed
independently within this study or compared to normative data provided by those devising the
measure and the findings from the f2f pilot study. Presently the guidance for using this measure
has yet to be published and so caution in explaining the exact nature of the analysis is made
here. Full details of the instrument are to be published towards the beginning of July.
Qualitative Analysis
The data collected from the interviews and the evaluation questionnaire will be analysed
for key themes using a Grounded Theory approach (Strauss & Corbin, 1998). A detailed line-byline analysis will be used to generate initial categories, this will be conducted using the
qualitative research aid Atlas.ti. Accompanying this more strategic approach, the technique of
‘embodied categorisation’ will be used (Rennie, 2005). This latter technique, which can be
described as “an approach to interpretation in which subjectivity is drawn on productively”
(Rennie, 2005, p.22), will enable the researcher to remain focused upon the true depth of the
meaning within the transcripts, a factor that West (2001) warns us can get lost in the systematic
reductionism of Grounded Theory. As new categories emerge the researcher will also utilise the
constant comparison method (see Strauss & Corbin, 1998; Maykut & Moorehouse, 1994) to
manage the new categories.
Bringing the findings together
Both the quantitative data and the qualitative data will be used to complement, or display
inconsistencies within the findings. Table 1. outlines how each set of data gathered will be used
to answer the Research Questions.
Table 1.
RQ.1. –
RQ.2. –
RQ.3. –
RQ.4 -
Quantitative Data (working alliance measure)
And Qualitative data (working alliance interview)
Qualitative Data (working alliance interview)
Quantitative Data (working alliance measure)
Quantitative Data (working alliance measure)
And Qualitative data (working alliance interview & outcome
questionnaire and interview)
Ethical Considerations
This project is working within the ethical framework devised by the British Association for
Counselling and Psychotherapy (BACP, 2002). This is further informed by the same
organisation’s ethical guidelines for research (Bond, 2004) and ethical guidelines for offering
online counselling and psychotherapy (Anthony & Jamieson, 2005). Essentially these guidelines
revolve around doing no harm to those involved in the study. As this work intends to directly
work with young people some specific ethical issues are tackled below.
Conducting a piece of research with young people raises numerous issues around
informed consent. In general it is recommended that written consent from a primary care-giver
is sought before undertaking research with this client group (Dent et al, 1997), however there are
exceptions to this rule and this study falls into this category. The reasons for stating this are
twofold. Firstly seeking consent to gather the views of young people around certain topics can
potentially put them in a vulnerable position. Here the work of Allen (2002), whose work focused
upon the views of young people around elicit drug use, is noted as a precedent. In this case
consent was obtained from the young people themselves so as to avoid confrontation with
parental figures around the subject matter. A direct comparison with the sensitivity of the topic
of this project, notably the issue of mental health and counselling, can be made. This leads
directly to the second point. The service that is being researched works with the view that any
young person can access it without having to obtain carer-consent. This proves common
practice in youth friendly mediated counselling services such as ChildLine; these organisations
working with the Gillick principle at the centre of any counselling contract developed with young
people (see Daniels & Jenkins [2000] for a discussion on this topic). Thus, so as to provide safe
and anonymous environment for young people to discuss their experience of online therapy and
to remain congruent with the service provision being examined, consent to participate in the
study is being sought from the young people themselves.
Working with clients or ex-clients can prove controversial. Much of this concern relates to
there being potential to unnecessarily interfere or make the individual revisit therapeutic work.
Following discussions with the organisation it is felt that finding out more about the service being
offered and its efficacy is essential, notably for developing good practice and obtaining continued
funding, and therefore not gathering the views of clients would pose similar ethical questions.
Thus where contact with this group occurs it must be approached sensitively. It should be noted
that the researcher working on this study is a trained therapist with experience of working online
with young people. Although it is acknowledged that the researcher will not be providing therapy
he will be well placed to direct individuals to appropriate services if issues arose where further
support was felt necessary.
Using the Internet as a research tool also raises a number of specific ethical issues.
Researchers working in this medium need to be aware of both technical considerations
regarding computer-mediated groups and communities and more common codes of conduct
(Bloor et al, 2002). With regard to this, the researcher is very computer literate and aware of the
ethical frameworks mentioned above.
Contribution to Academic Literature
This work enters into several uncharted waters. Below the key areas this research
touches upon/adds to are highlighted before noting the potential dissemination routes for
findings in this area.
1) It is anticipated that this research will impact directly upon the developing field of
online counselling. The work that is being undertaken will provide a greater
understanding of the processes engaged in by online counsellors and further our
knowledge about what it means to create an online working alliance. There will be an
emphasis upon gathering rich qualitative data regarding online counselling
relationships and triangulating this with that provided by the quantitative measure.
This will contrast to the current trend of studies whose focus has been to specifically
measure outcomes of the therapy and ignore the ‘voices’ of clients.
2) The study will contribute greatly to our understanding of offering online counselling to
young people. It will further our understanding about specific challenges faced in
developing an online working alliance with young people.
3) In conducting the whole project online the work will add to the knowledge base
regarding online research methods. This will include adding to the literature about
online interview techniques and distribution of online questionnaires. More specifically
this can be seen as a significant inroad into gathering the views of young people
regarding sensitive issues such as mental health.
It is predicted that this work will appeal to a wide variety of audiences. Specific journals that are
actively publishing research in this area include the British Association for Counselling and
Psychotherapy’s research journal (Counselling and Psychotherapy Research), the British
Journal of Guidance and Counselling, the Journal of Counselling Psychology, the Journal of
Critical Psychology and Psychotherapy Research. In addition to this, and accounting for the
increase in e-literature of an academic nature, the author intends to develop an online resource
and publish material on the website created to host this research project. For evidence of the
author’s own eagerness to disseminate his findings and that there is an audience for work in this
area please see Appendix 5 for a list of publications and conference presentations that the
author has already completed within his time as a PhD student.
Nov.05April 06
Familiarise myself with the organisation, create strong links and negotiate access
Familiarise myself with the technology to be used
Pilot technology with practitioners
Complete research Proposal
May 06July 06
June 06July 06
Aug.06Oct. 06
Nov. 06
Dec. 06
Jan. 07Jun. 07
July. 07
Aug. 07
Nov. 07
Dec. 07
Jan.08May 08
May 08
Pilot TAQS questionnaire with a UK f2f sample
Get Questionnaires online and ready for use
Pilot period for testing the online research methods
Continue collecting data
Reflective period and time for amendments
Data analysis #1
Preliminary data report to the organisation
Continue collecting data
Data Analysis #2
Second report to organisation
Continue collecting data
Data Analysis #3
Final report to the organisation
Writing up period
Thesis hand in
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Appendix 1
Please note this is the original transcript, an alternative version using UK English will be
prepared for this project.
Therapeutic Alliance Quality Scale (TAQS) - Youth Version
People have different kinds of experiences with their counselor. This experience
might also differ from one session to the next. Please think about the session or
meeting you just had with your counselor. Below are several questions about this
Please read each question carefully then check the box that best matches your
answer to it – either “Not at all,” “Only a little,” “Somewhat,” “Quite a bit,” or
Your parent/caregiver and counselor will not see any of your answers. The most
your counselor may see later is a number that combines all of your answers into
one score. If there is more than one counselor in this session, please complete
these questions about the counselor who is also completing a form.
1. Did you feel respect for your counselor in this session?
2. Did this session head in the direction than you wanted?
3.Did you understand the things that your counselor said in this session?
4. Did you trust your counselor in this session?
5.In this session, did you agree with what your counselor wanted you to do?
6.Did you and your counselor work on problems together in this session?
7.Were you willing to listen to what your counselor had to say during this session?
8.In this session, did you feel that your counselor would stick with you no matter how you
9.Did your counselor pay attention to what you said in this session?
10.Did your counselor work on the things you wanted to work on in this session?
11.Did your counselor make you feel like you could truly be yourself in this session?
12.In this session, did you agree with your counselor about what is important for you to work on
to become better?
13.In this session, did you feel that your counselor understood what it feels like to be you?
Appendix 2
The Working Alliance Inventory – Short Revised Version
Goal Scale
___and I are working towards mutually agreed upon goals.
We agree on what is important for me to work on.
___and I collaborate on setting goals for my therapy.
We have established a good understanding of the kind of changes that would be good for me.
Task Scale
What I am doing in therapy gives me new ways of looking at my problem.
I feel that the things I do in therapy will help me to accomplish the changes that I want.
As a result of these sessions I am clearer as to how I might be able to change.
I believe the way we are working with my problem is correct.
Bond Scale
I believe___likes me.
___and I respect each other.
I feel that___appreciates me.
I feel___cares about me even when I do things that he/she does not approve of.
Note: Clients instructed to substitute (mentally) therapist’s name for ‘‘___’’.
Appendix 3
Evaluation Questionnaire for Young People
This is a questionnaire to find out what you thought of Kooth’s online counselling service – it
should only take you about 5/10 minutes to complete.
The answers that you give will be used by a research project looking into the service and fed
back to the management of Kooth. In doing so your user name will not be linked to your
comments or fed back directly to the counsellor you have worked with!!!! Therefore please feel
free to answer the questions as honestly as possible.
What is your username?
Have you met with a counsellor using the chat room? y/n/dk
Have you messaged a counsellor through the site? y/n/dk
Have you used the forums to chat to a counsellor? y/n/dk
Please rate Kooth’s online counselling service: [scale 1 = rubbish – 5 = excellent – also include
haven’t used the service]
What did you find most useful about meeting with a Kooth counsellor? [please feel free to say as
much or as little as you want in the box below]
What did you find least useful about meeting with a Kooth counsellor? [please feel free to say as
much or as little as you want in the box below]
Would you recommend the counsellors to a friend who needed to talk to someone? y/n/dk
If no who would you recommend to your friend? [please type in the space below]
How do think could the service be improved? [please type in the space below]
Are there any other comments that you would like to make about the service? [please type in the
space below]
Finally, would you be willing to meet online for a short interview to chat further about your
experience of meeting with a Kooth counsellor? y/n
Thanks for taking the time to complete this questionnaire!!!!
Appendix 4
These questions are about how you have been feeling OVER THE LAST WEEK.
Please read each one and think about how often you have felt like that in the last week,
then put a cross in the box you think fits.
Please use a dark pen (not pencil) and tick clearly within the boxes.
1. I've felt alone and have had no-one to help me
2. I've felt edgy or nervous
3. There's been someone I felt able to ask for help
4. I've felt really tired and not interested in anything
5. I've felt able to cope when things go wrong
6. I've thought of hurting myself
7. I haven't felt like talking to anyone
8. My thoughts and feelings distressed me
9. My problems have felt too much for me
10. It's been hard to go to sleep or stay asleep
11. I've felt really close to someone in my life
12. I couldn't stop thinking about my problems
13. I've thought I have no friends
14. I've felt unhappy
15. Unwanted thoughts or memories have upset me
16. Other people have got on my nerves
17. I've thought the future will be good
18. I've done all the things I wanted to
The rating scale used
Not at all
Only occasionally
Most or
all of the time
Appendix 5
Table Outlining the Procedure
Therapeutic Alliance
Brief Details
Alliance Interview
End of Therapy
& Outcome
Appendix 6
List of Publications and Conference Presentations during PhD Study
Developing Youth Friendly Online Counselling Services in the United Kingdom: a small scale
investigation into the views of practitioners - peer reviewed paper in Counselling and
Pyshcotherapy Research (CPR)
Technically incompetent or generally misguided: learning from a failed counselling research
project - peer reviewed paper in CPR
Editorial - for 'therapy and technology' special edition of CPR A day in the life.
A worm's eye view of doing counselling research: Do Mice Eat Worms? - research
methodologies contribution to CPR
Counselling in-schools project: evaluation report by Mick Cooper - research review in CPR
 2006
Society for Psychotherapy Research. (Edinburgh) - Research ‘Blogs’ and Asynchronous Focus
Groups: Examining the challenges of generating qualitative data online
Association for University and College Counselling (Bangor) – Using Technology to Support
Students in Higher Education
British Association for Counselling and Psychotherapy (Glasgow) - Developing Youth Friendly
Online Counselling Services in the United Kingdom
 2005
S.P.R. (Montreal) - Online Counselling: a heuristic study examining the relational depth of
computer-mediated relationships
University of Manchester – The transition between M.A. and Ph.D.
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