Exploring new frontiers in e-therapy

The two-year research project will explore how young people give and receive support for psychological stress through social media and, as the principal investigator, Kerry is the first to admit that the internet remains something of “a dark continent” for researchers because so little is known about how support works in online environments.

Funded by the Faculty of Science Research Development Fund, the research will also have an interdisciplinary focus with Associate Professor Susanna Tranka from the Faculty of Arts engaged as associate investigator. “Anthropologists are really good at understanding cultures and how people operate in culture, psychologists can join with them quite well to get interventions that fit culturally with people,” says Kerry.

In recognising that there is real potential for difficulties like trolling, cyber bullying, grooming and “other awful stuff ”, Kerry says “the internet’s not going away anytime soon, so we might as well look at what can work in that environment.” After all, she says that all social relationships have risks. “They can be cruel, they can be unkind, but people can also be loving and kind and supportive.”

The motivation for the research came from the observation that while young people have the highest rates of mental health problems and suicide, they actually make the least use of formal psychological support. Indeed, one Australian study found that only about 20 percent of young people with mental health problems actually accessed mental health care.

“I came from the perspective of thinking that if they’re not using these services, what are they doing,” says Kerry. “How does it work for young people, do they look after themselves, do they look after each other?”

Previous research into help seeking has identified several barriers to youth engagement with mental health services. These include the potential stigma associated with having problems, worries about being judged by adults and fears about the loss of autonomy when engaging with adult professionals. 

Given that the majority of young people prefer to rely on their friends and their own networks, Kerry says “if we can learn what they’re doing it might put us in a better position to set up mutual peer support networks for young people, to engage better with them in online environments, to offer them support – because it’s clearly where they’re going.” 

Existing research literature has tended to focus on the negative effects of digital communication, whether it be through texting or engagement with social media. However Kerry believes that there is not enough realisation of how much connection and sense of belonging people get in those environments and how it has become an important way of feeling connected in the world.

While there is still a need to develop professional resources which psychologists and psychiatrists and counsellors need to provide, she reasons that if young people are already providing a lot of mutual support in their own networks, “is there some way we could understand how it’s working and build on that because it’s a great resource.”

The overall aim of the research is to gain a clearer understanding of how young people understand the process of giving and receiving support for psychological distress through social media, however engaging with them for research purposes is easier said than done.

Past experience has taught Kerry about the challenges of simply getting to talk to young people face-to-face. “A lot of people are anxious, they’re not that comfortable speaking to an adult about personal stuff,” she says. They also operate in a “fluid environment” in which making an appointment to meet at a specific place and time is fraught with difficulty because in their world everything changes all the time.

As a result, a two-phase study has been designed which will use fluid, online and immediately available media that young people feel comfortable with. In addition to a targeted online survey of around 200 people which will be advertised through Facebook, there will be an anonymous online interview with 30 participants which will provide an opportunity to explore different ways of gathering data like emoji and other distinctively online expressions. 

To avoid the ethical challenges of conducting research with young people without parental consent, the target age of participants is 16-21 years. “If you have to start getting parental permission it takes on a different feel,” says Kerry. “I feel like I won’t be able to get access to their own accounts, I’ll get more carefully worded responses and so on.” While slightly younger people might face more risks, she says those 16 and over have experience and a bit of distance and might reflect on what it was like when they were younger as well as what they are doing now.

Another challenge is data analysis which would normally involve a standard thematic analysis technique to capture the meanings. However the presence of ‘idiosyncratic text speak’ such as shortened words and messages, plus the use of visuals, memes and songs might encourage a new analytical approach. “In a way the method is partly educating me about how people talk online,” says Kerry. “I’m going to be pushing myself to try and find helpful ways of looking at that.”

One solution has been the engagement of a ‘cultural translator’ in the form of summer scholar, Katie Smith, who will sit alongside Kerry to help her decipher what’s going on in the online environment. “It is like entering another culture. We talk a lot about working at cross cultures and the need to understand the rules and the way things work there.”

In terms of impact, the research is expected to contribute to new knowledge around youth social media use and it has the potential to influence policy and practice by providing the foundation for targeted peer-to-peer online support networks that can be used in first-line interventions in the community.

In that regard, Kerry acknowledges the role of organisations like Youthline and Rainbow Youth and says that her findings could be used to train online support people and also help educate and support young people in schools. “Maybe we can teach them about recognising when somebody’s in distress online, and maybe we can teach them about the best way to respond when you see that.” 

Part of her interest is also in making it safer for young people. “I’m not oblivious and I’m not romanticising all the good that can happen, but we’ve got to know more and we’ve got to come at it from inside – not from outside.”

As a clinical psychologist and a former President of the New Zealand Psychological Society, Kerry says that youth mental health is a priority and that reaching young people is a complex problem. In a broader sense, she says that core problems such as child poverty need to be addressed as well as the ‘gap’ between what young people are told they should be achieving in their lives and how hard it is for them to get that.

“There’s a lot of pressure on young people,” she says, “and we’ve got poorly equipped services in the District Health Boards. People there are really struggling to meet the need. Part of the problem is that we haven’t got enough community-based services.” 

Another key issue is accessibility to support networks and e-therapy that doesn’t involve talking to parents or doctors or mental health professionals. “It’s about accessibility on their own terms and not having to step into a big system that’s going to carry them away and in which they’ll lose control,” says Kerry. That means having access to e-therapy at any time including the middle of the night when someone is isolated and alone. “They’re now operating in a world where all of their contacts are available 24/7 and that’s what they’re used to.”

With her bookcase crammed with tomes written by Sigmund Freud and Carl Jung, Kerry says that the great psychoanalysts grappled with the context in which they lived just as she does now. “That’s the thing with psychology and therapy, it’s got to stay alive. We can’t just go with what’s always been, it has to change with the times and we have to change.”