21 International Peer Reviewed Journal A Document Analysis on the Efficacy and Ethical Considerations of Online Counseling WILLIAM JO SE M. BILLOTE http://orcid.org/0000-0002-4762-7551 williamjosebillote@gmail.com Batanes State College Basco, Batanes, Philippines MARIE FE E. ESCOTO http://orcid.org/0000-0003-4631-3398 mariefeescoto@gmail.com Batanes State College Basco, Batanes, Philippines RYAN G. PONCE http://orcid.org/0000-0002-7615-5194 ryangutierrezponce@gmail.com Saint Dominic College of Batanes, Inc. Basco, Batanes, Philippines TRIXIE ELAINE G. PONCE http://orcid.org/0000-0002-4337-1747 elaineonearth@gmail.com Saint Dominic College of Batanes, Inc. Basco, Batanes, Philippines ELISEO A. PAMA http://orcid.org/0000-0002-0496-8604 elypama@gmail.com Saint Dominic College of Batanes, Inc. Basco, Batanes, Philippines Vol. 43 · January 2021 DOI: https://doi.org/10.7719/jpair.v43i1.714 Print ISSN 2012-3981 Online ISSN 2244-0445 22 JPAIR Multidisciplinary Research RIZZALIE MORNE V. MONTOYA http://orcid.org/0000-0002-5291-087X reezamorne@gmail.com Saint Dominic College of Batanes, Inc. Basco, Batanes, Philippines JOAN M. QUIBAL http://orcid.org/0000-0002-5208-7705 jquibal75@gmail.com Saint Dominic College of Batanes, Inc. Basco, Batanes, Philippines . ALJON QUILOAN http://orcid.org/0000-0002-2251-2993 quiloanaljon20@gmail.com Saint Dominic College of Batanes, Inc. Basco, Batanes, Philippines MARILYS G. PONCE http://orcid.org/0000-0002-6573-4924 marilys.ponce@gmail.com Batanes Electric Cooperative, Inc. Basco, Batanes, Philippines MARIANNE JEAN M. ADAM http://orcid.org/0000-0003-1427-3264 adammariannemiguel@gmail.com Department of Education – Division of Baguio City Baguio City, Benguet, Philippines Originality: 100% • Grammar Check: 98% • Plagiarism: 0% ABSTRACT The current situation brought about by the pandemic and technological advancements has resulted in a significant rise in the number of people who participate in online settings. Research into online counseling practice is This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. 23 International Peer Reviewed Journal significant as it is given the relative newness of the techniques. With this trend in guidance and counseling, this research aims to find out the different concerns and issues when providing online counseling and online therapy’s efficacy. The research design involved utilizing the qualitative research method in addressing the research question, and document analysis was employed. This research’s specific documents include outcomes-based studies, process studies, and self- report studies in guidance and counseling. After examining and analyzing literature from the three categories of study, online therapy appears to be clinically efficacious. Online counseling was more convenient and less inhibition in disclosing confidential issues during online sessions. Keywords — Counseling Psychology, Online Counseling, Trends in Guidance and Counseling, Qualitative Study, Efficacy, Ethical Considerations, Document Analysis INTRODUCTION As the number of people seeking help with psychological difficulties increases, the number of guidance and counseling services has also dramatically increased. Since the number of people with access to the Internet has increased rapidly, millions of people now can communicate electronically through the mail, distribution lists, real-time chat rooms, and other resources. This increase has led to the generation of a new important way of communication. Access to the Internet has enabled the construction of virtual communities.  The current situation brought about by the pandemic and the technological advancements of the 21st century has resulted in a significant rise in the number of people, whether students or employees participate in online settings. Add to this are the different challenges and pressures, emotionally and mentally, brought about by the pandemic among young people and adults. Because of this, online counseling has also become a trend. As professionals, counselors are expected to uphold a certain set of ethical standards, even in online settings. This ensures that clients are socially, mentally, and emotionally succeeding (American School Counselor Association [ASCA], 2016). The number of people with access to the Internet is increasing rapidly. Millions of people can now communicate electronically via electronic mail, distribution lists, real-time chat rooms, and other facilities. This has led to the generation of a new important communications medium. It has enabled the 24 JPAIR Multidisciplinary Research construction of virtual communities, and Rheingold (1993, as cited in Popoola, 2012) argues that these new communities can be a valuable supplement to existing social structures. Intimate exchanges can take place between people who may never physically meet. The high level of intimacy that can sometimes occur has been widely discussed. Another area of expansion is the number of people seeking help with emotional difficulties. Because of this, the number of guidance and counseling services that are offered has grown dramatically over the last twenty years. Research into online counseling is significant as it is given the relative newness of the techniques. Healthcare expenses continue to rise, and online therapy cut costs because sessions are conducted over the Internet. Additionally, because of the pandemic restrictions, those that live in remote areas or under strict restrictions can now use the Internet as a medium of communication as it allows access to mental health workers living in adjacent places or even in neighboring areas (Bouchard et al. 2000). Online counseling is defined as the delivery of therapeutic interventions in the World Wide Web, where communication between a trained professional and client is facilitated by computer-mediated communication technologies. Other terms for online counseling include Internet or online therapy, web counseling, e-counseling, e-therapy, e-mail therapy, cyber counseling, and Internet counseling. Similarly, Mallen and Vodel (2005) defines online counseling as any delivery of mental and behavioral health services by a licensed practitioner to a client in a non-face-to-face setting using distance communication technologies such as e-mail, chat, and videoconferencing. Online counseling dates back many decades, and therapists have used mail correspondence and the telephone to maintain contact with clients. However, this practice was the subject of irregular and limited research interest (Perle, Langsam, & Nierenberg, 2011). Today, this topic sees renewed involvement cause by the massive growth of the Internet and today’s current situation brought about by the pandemic. Unlike telephone-based therapy, computer technologies are far more flexible and have advantages, such as seeing the therapist’s face in video conferencing. Clients can now schedule via e-mail, look up pertinent medical information, and join online support groups (Mallen, Vogel, & Day, 2005).  A study by Alshaabi (2020) found that several practitioners have developed their initiatives to help with psychological first aid to improve the general psychological state of the community during the outbreak of COVID-19 through online counseling. Therapists, psychologists, counselors, and educational 25 International Peer Reviewed Journal practitioners have opened online services to help the community as they experience psychological disorders during the outbreak. In Malaysia, online counseling is considered to supplement traditional mental health counseling services. If online counseling is effectively developed, it can help reach underserved mental illnesses that are isolated (Zamani, Nasir, & Yusooff, 2010). Similarly, a 2012 study by Microsoft found that Singapore had the highest rate of cyberbullying globally and students had been victimized on online social media platforms (Kit et al., 2017). Because of this, online counseling has been used to empower young clients with coping skills. Additionally, qualitative studies suggest that some Filipinos are reluctant to seek professional help because of loss of face or shame. The fear of being labeled as ‘crazy’ and tarnishing the family’s reputation was a hindrance to seeking professional help. This makes Filipinos prefer online counseling because of the anonymity it provided (Hechanova et al., 2013). This study’s results will significantly contribute to counselors as online counseling is time-saving, convenient, and accessible. Contact in online counseling can transcend geographical boundaries and time zone. Therapy becomes available and within reach at any given time. For clients, counseling can be more convenient and accessible. It offers convenience and remote access, serving clients with mobility, time restrictions, or anyone seeking help who is reluctant to see a counselor in-person. Those in remote areas, those traveling and re-locating in foreign countries, those with the language barrier, those physically disabled, or caregivers can arrange an appointment at their own convenience.   FRAMEWORK One of the debates in the online counseling literature is where it can be as effective as face-to-face treatments. Lester (1974) proposed that online counseling’s unique qualities include the clients’ ability to control the treatment’s pace and remain anonymous. These would allow those who would otherwise seek treatment to feel more comfortable. Other specific potential benefits of working with clients through the Internet include lower costs and increased convenience. This suggests that online counseling can be a catalyst for individuals to seek treatment, especially if they are unwilling or not capable of attending face-to- face sessions. On the other hand, Williams (1971) suggested that anonymity can be a possible disadvantage in online counseling as communication may become devoid of personality.  26 JPAIR Multidisciplinary Research Online counseling can be used to attain outreach, prevention, short-term treatment, and relapse intervention, all of which are important in counseling psychology. Thus, online counseling’s effectiveness can be established by comparing the relative changes in a client’s state and condition after participating in online counseling with the relative changes in those treated in traditional counseling. Clients’ satisfaction should also be measured because they are the ones who will or will not benefit from the counseling psychologists provide. Additionally, examining the process, intervention, and outcome of online counseling can lead to a deeper understanding of the most significant challenges for online counseling and whether it is possible to connect with a client through distance-communication technologies meaningfully. Process, intervention, and outcome studies explore the benefits of contextual and nonverbal cues, the working or therapeutic alliance, and the person-environment interactions. The client and counseling psychologist are not in the same location. These are all critical factors related to the counseling’s efficacy (Wampold, 2000). OBJECTIVES OF THE STUDY With this trend in guidance and counseling, this study aims to determine the different concerns and issues when providing online counseling and online therapy’s efficacy. METHODOLOGY Research Design The research design involved the utilization of qualitative research method in addressing the research question. Generally, qualitative research aims to gain insight and explore the depth, richness, and complexity inherent in the phenomenon (Creswell, 2007). Within this qualitative study, the researchers employed document analysis to pursue the goal of this research. Document analysis is a systematic procedure for reviewing or evaluating documents – both printed and electronic (computer-based and Internet-transmitted). Document analysis requires that data be examined and interpreted to elicit meaning, gain understanding, and develop empirical knowledge (Corbin & Strauss, 2014). The analytic procedure entailed a survey of the different literature regarding online therapy and looked for tentative agreement regarding its efficacy.   27 International Peer Reviewed Journal Sources of Data The inclusion criteria were used in selecting the documents that were analyzed and reviewed. Inclusion criteria are a set of predefined characteristics used to identify subjects included in a study. Inclusion criteria make up the selection or eligibility criteria used to rule out the study’s target population. Inclusion criteria should respond to the objective of the study and are critical to accomplishing it.  The inclusion criteria were used in selecting the documents that were analyzed and reviewed. In selecting documents for the analysis, the following were considered: the types of documents to be reviewed, which documents would be included, and the time of publication and release of those documents. First, the types of documents that were reviewed were journals, articles, reports, and publications that are either written or electronic. Second, in selecting documents, those studies that are non-experimental were chosen because of the difficulty of conducting controlled experiments when client-therapist confidentiality must be maintained. Hence, self-report surveys were chosen as it appears to be that these convenience samples are predominant. Most of the documents will come from surveys and interview studies or documents. Third, the publication was also considered so as to track changes and progress in policy and practice over time. Researches and documents regarding online therapy only span a limited time period. This research primarily included studies conducted over the past twenty-five years and attempted to include only the most up-to-date information.  This research’s specific documents include outcomes-based studies, process studies, and self-report studies in guidance and counseling. Outcomes-based studies represent an important aspect of psychological research methodology and are crucial in determining online therapy’s real-world effects (Hunsley & Lee, 2007). A convincing claim of the efficiency of online counseling needs concrete shreds of evidence. Process studies are those that approached the problem of researching process variables by using the relationship construct. This is called a working alliance. This is defined as the collaboration between client and therapist that enhances psychological healing. On the other hand, self-report studies are common sources of information in clinical psychological research. Studies under this turned to record and analyzing quantitative and qualitative information from interviews and questionnaires. A limitation of using this is its incapacity to answer clinical efficacy directly. However, these types of studies can discern differences between therapeutic methods and the efficacy of online counseling.   28 JPAIR Multidisciplinary Research Data Analysis Given the multitude and variety of documents, a thorough review was the first step in the analysis. Content of documents concerning the research objectives was digested and summarized. The focus was on information common among the studies, which identified the efficacy and ethical consideration in online counseling. Furthermore, the process involved a careful, more focused re-reading and review of the data. Analysis of data in a systematic way was then follow based on the guide questions.  After the collection of documents, the researchers as analysts determined the relevance of documents to the research problem and purpose. Also, the researchers ascertained whether the content of the documents fits the framework of the study. It was deemed necessary, as well, to determine the authenticity, credibility, accuracy, and representativeness of the selected documents. Documents were assessed and selected based on completeness, in the sense of being comprehensive (covering the topic completely or broadly) or selective (covering only some aspects of the topic). The researchers determined, too, whether the documents were even (balanced) or uneven (containing great detail on some aspects of the subject and little or nothing on other aspects). Given the variety of documents under each study, a thorough review of the documents was done. The researchers looked into the documents’ contents and assured that each document discussed the efficacy of online counseling, ethical considerations and challenges, and best practices in online counseling.   RESULTS AND DISCUSSION The succeeding sections present the data, analyses, and interpretation. Outcomes-Based Studies  Based on the research under outcomes-based studies, there are barriers for participants in teletherapy, as Perle and colleagues (2011) noted. Although computer technology can increase the access of therapy among technology- literate groups, it can also reduce the pool of potential users, especially among those who are less technology savvy or has limited access to technology, such as ethnic minorities, the elderly, and the low-income sector. According to the corroborated outcomes-based studies, since online therapies call for computer literacy, this factor can exclude people under the mentioned demographic groups that either lack access to technology or lack the needed skills to use computers. 29 International Peer Reviewed Journal Consequently, an outcomes-based study conducted by Cohen and Kerr (1999) has been the very first research that has measured therapeutic outcome. They looked at the differences between the two groups. One group was assigned to computer-mediated counseling, while the other group was assigned to face- to-face counseling. The outcome-related aspect of the study was derived from the administration of an anxiety inventory. This was done at the end of the counseling session. The participants in this study have reported that they suffered from anxiety. This aimed to measure the improvement of the two groups’ anxiety. After the data have been subjected to data analysis, the researchers determined that both groups had the same decrease in anxiety symptoms. Thus, there were no functional differences between the two comparison groups. The findings from their study have shown that online counseling can be substantially similar to traditional face-to-face counseling. Similarly, Murphy and colleagues (2009) conducted a study that examined the interplay between online counseling modalities and client observations. In this study, the researchers concluded that clients were satisfied with online counseling after analyzing the data. With these studies, outcomes-based literature appeared to support the efficacy of online therapy. Based on the studies› findings under this category, online counseling appears to produce therapeutic changes in a client similar to traditional therapy.  Process Studies A study by Cook and Doyle (2002) has conducted comprehensive process- based research on online therapy. In this study, the alliance in online therapy was compared to traditional therapy alliance among 15 participants. According to the participants’ comments, most of them preferred online therapy since being anonymous allows them to express their thoughts and feelings in more depth. This study has been one of the first attempts to assess the effectiveness of distance therapy. Another study by Germain and colleagues (2010) investigated online counseling in treating post-traumatic stress disorder. This study examined the benefits of online counseling in improving mental health care access and other practical benefits. Based on the data gathered, it was found out that online counseling is not a replacement for traditional face-to-face therapy but serves as a supplement. 30 JPAIR Multidisciplinary Research Moreover, Reynolds et al. (2013) have examined if there was a difference in the degree of alliance with therapists in online counseling and in-person counseling. The researchers have observed that online interaction was less stressful for clients. They demonstrated that clients in online settings have a stronger alliance with their therapists than in the traditional therapeutic environment.  In another literature, Bouchard and colleagues (2000) emphasized that online counseling is as effective as traditional therapy. It also possesses certain benefits, especially to those people diagnosed with agoraphobia. These people can lead a person to avoid the public placed due to panic and fear. This situation makes seeing the therapist difficult. Online counseling can be a useful tool to ease the strong agoraphobic tendencies of a client.    Self-Report Studies Under self-report studies, a study explored by Hertlein, Twist, and Mihaloliakos (2015) sought to understand the perceptions of technologically facilitated therapy among mental health workers. The researchers have surveyed the mental health community using questions related to their perception of its ethical risks. Results have shown that issues of confidentiality and therapeutic relationship effects were the main concerns. The study deemed that this posed significant problems in implementing this trend, but mental healthcare workers were interested in using technology training in the future. On the other hand, Mishna, Bogo, and Sawyer (2015) conducted a pilot study to investigate the perspectives of Master in Social Work interns regarding online counseling. The findings of the study show that online counseling was more convenient during certain times of the year. There was also less inhibition in disclosing confidential issues during online sessions. However, participants have suggested better training. It reduces uncertainties during online counseling, such as inadequate emotional connection with clients and frustration by the lack of face-to-face contact.   CONCLUSIONS After examining and analyzing literature from the three categories of study, online therapy appears to be clinically efficacious. According to the process studies, the alliance is not affected by the online counseling setting and process change. Client participants from the three categories have given a positive response and assessment of online counseling. On the other hand, there are still 31 International Peer Reviewed Journal reservations about the use of online counseling. Therapists were concerned about the possible negative effects of online counseling, particularly ethical standards. A common theme from the studies regarding the concerns of therapies was the loss of valuable non-verbal information.  Additional research should be explored in determining the extent of these concerns and their effect on counseling and the practices to address clients’ issues and problems effectively. There is also a need for future research into the different domains of online therapy, such as investigating the influence that disciplinary orientation has on online counseling. Also, future researchers must also consider the subjectivity of the author of the documents selected as well as personal biases so that documents can be evaluated based on its original purpose. Researches on ethical concerns facing online counselors are still emerging. However, researchers agree that dealing with legal and ethical factors is one of the most difficult areas when providing online counseling services (Mullen et al., 2014). Because of the growing popularity of online counseling services, there is a need to conduct more research on the efficacy of online counseling and the different concerns and issues to ensure that ethical considerations are addressed when providing such services.    TRANSLATIONAL RESEARCH Results of this study and future studies in online counseling can bridge the gap that existed with traditional face-to-face therapy around issues on accessibility, convenience, and affordability as it can serve as an alternative therapy. Those residing in areas where there are no counseling services can benefit from the accessibility of online counseling. Results of the research can overcome barriers that may preclude these people from seeking therapy. Students or children can also access this as they seem to be more comfortable with using the Internet. At present, anyone who has access to the Internet can utilize such services at their convenience. Even when therapies are not available, e-mailing them can give clients the perception that they still interact with their therapist. On the other hand, this trend in guidance and counseling can reduce the hassle of scheduling and setting appointments. It creates opportunities for therapists to extend their services to more clients because appointments can be scheduled anytime and reach a larger geographical region. For individuals who are hesitant with the traditional method, this study’s results can help them find online counseling more suitable, especially those experiencing social phobias. 32 JPAIR Multidisciplinary Research Generally, when ethical procedures have been developed for online counseling, this can now be more economical for both the therapist and the client. For those who cannot afford to rent commercial spaces, online counseling can lower costs than traditional counseling. Online therapists should be comfortable with computers and communicating via text. Although the studies have not dealt with the personality attributes of what it means to be a successful online counselor, it is expected that those who can be considered the best online therapists are strong visualizers who have the ability to be flexible, patient, and creative. Of course, the most important and essential factor is that online therapists should acquire additional specialized training in practicing online therapy, either through self-study or formal workshops and seminars, to handle different situations involving ethical concerns issues. LITERATURE CITED Alshaabi, T., Arnold, M. V., Minot, J. R., Adams, J. L., Dewhurst, D. R., Reagan, A. J., ... & Dodds, P. S. (2021). How the world’s collective attention is being paid to a pandemic: COVID-19 related n-gram time series for 24 languages on Twitter. Plos one, 16(1), e0244476. Retrieved from https://doi. org/10.1371/journal.pone.0244476 American School Counselor Association. (2016). 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