Introduction

Over the past 10 years the range of treatment options for individuals seeking help for problem gambling has risen rapidly. Free services for gamblers and their family and friends are now well established in Australia and operate across multiple platforms (including via the Internet, telephone and face-to-face). Compared with email, online real time text-based counselling (also referred to as synchronous, instant or real time chat) has the most rapid uptake across a range of health disorders. This form of counselling approximates a traditional therapeutic approach to the extent that it is a one-on-one interaction in real time with a professional gambling counsellor. However, there is an absence of the visual and oral cues that comprise elements of other Internet-enabled counselling options (e.g., video conferencing), or traditional face-to-face counselling.

The rise in online treatment options is partly due to the reluctance of people with gambling problems to seek traditional counselling as well as the rapid expansion of Internet access and Internet-based treatment options. Internationally and in Australia, it is reported that between 8% and 15% of people with gambling problems seek help (Productivity Commission, 2010; Suurvali, Hodgins, Toneatto, & Cunningham, 2008). Barriers to help-seeking include individual issues such as confidence or readiness to change, shame or stigma and structural issues such as distance from counselling centres (Evans & Delfabbro, 2005; Gainsbury, Hing, & Suhonen, 2013). Responding to these issues can be complex. Barriers to help-seeking have been well established for over 10 years, yet the rates of usage for face-to-face counselling and helplines still remain ostensibly the same (Productivity Commission, 2010).

Advantages of online counselling

The absence of verbal and facial communication elements is attractive to many people who use online text-based counselling. Online counselling is frequently chosen over telephone or face-to-face counselling because it provides access to:

• a private, discrete and anonymous exchange with a professional;
• an immediate response;
• a response at a time and place that is convenient;
• an interaction involving typing instead of talking; and
• an easy way of accessing a service system.

These findings come from the first large-scale studies of online gambling counselling, involving clients of the Australian national service, Gambling Help Online (Rodda, Lubman, Dowling, Bough, & Jackson, 2013; Rodda, Lubman, Dowling, & McCann, 2013). Online counselling is especially valued by people experiencing strong feelings of shame, embarrassment and stigma about their problems. The anonymity afforded by online counselling can circumvent these individual issues. It also addresses structural issues associated with opening hours, travel, cost and wait lists, with 24-hour access from a location of the client's choosing (e.g., home, work or a library) at minimal cost and no waiting time.

Characteristics of people who access online counselling

People who access online gambling counselling are mostly new to treatment. Research shows that almost 70% of these clients had never previously spoken to anyone about their gambling (Rodda & Lubman, 2014). Compared to face-to-face or telephone services, online counselling attracts more males, young people and people who make sports bets and wager on horse and dog racing. As well, around 20% of online clients prefer placing their bets online - this is much higher than seen in those accessing face-to-face services.

Almost all new online treatment seekers report high readiness to change (Rodda, Lubman, Iyer, Gao, & Dowling, 2014). However, they also report low confidence to resist gambling urges. This suggests that interventions aiming to increase readiness are not optimal for most gamblers seeking help online. Approaches that develop and support self-confidence are more appropriate.

Online counselling also attracts affected family and friends of people experiencing gambling problems, with female partners under 30 years of age being the most likely of this group to seek help online (Dowling, Rodda, Lubman, & Jackson, 2014). Like the gamblers who use online counselling, family and friends are usually new to treatment seeking (81%), and report a history of emotional (98%) and relational distress (96%). As such, online counselling is an attractive service option for new treatment seekers, males, those who gamble online and family or friends of problem gamblers.

Online counselling experiences

People with gambling problems who engage in online counselling typically respond positively to a single session. This appears to be the case even for those presenting with high levels of gambling-related distress (Rodda, Lubman, Cheetham, Dowling, & Jackson, 2014). Clients of the service usually request strategies, support and ideas to better manage their problems. Analyses of sessions suggest they typically involve a detailed discussion of the person's history and, to a lesser extent, developing and exploring future options and strategies.

Eighty-five per cent of people with gambling problems who use online counselling recommend the service (Rodda, Lubman, Dowling, Bough, et al., 2013). A single session of online counselling can have an immediate effect resulting in a reduction in distress and increase in confidence to resist gambling urges (Rodda, Lubman, Dowling, & Jackson, 2013). Service users evaluate the character of sessions as deep and meaningful and rate the exchange as easy and comfortable. These findings are equivalent to those reported in ongoing counselling work as well as face-to-face settings for other conditions (Reynolds, Stiles, Bailer, & Hughes, 2013). Taken together, these findings contribute to the growing body of evidence across online, telephone and face-to-face settings suggesting that even a single session of counselling can make a difference to people with gambling problems. Online counselling appears a viable, effective and welcome option that supports help-seeking and is comparable in efficacy to the first session of a traditional in-person approach.

Where to next?

Online real time text-based counselling is attracting a new cohort of treatment seekers who report positive experiences of this new modality. To further advance the field, there is an urgent need for evaluation of the long-term effectiveness of online single session interventions as well as longer-term online engagement as this may be the only help, or the only type of help, accessed. Gamblers report positive experiences but the suitability of using face-to-face therapeutic approaches and service models in a text-based environment needs to be further understood.

Future online counselling enhancements could include interventions matched to client motivations for help-seeking (e.g., a preference for online counselling versus facilitating access to other services) and the development of online programs aimed at enhancing self-efficacy. It is important to understand whether and how online counselling may increase uptake of further treatment, services or support from family and friends. Research is also needed to: (1) ascertain whether there are benefits to participating in more than one online counselling session; (2) whether benefits are sustained over time and for whom; and (3) who might benefit from additional online or telephone support (i.e., SMS, online self-help and support forums). Differences in the uptake of online services by gender and age, as well as differing gambling preferences, also need to be examined to allow for greater targeting of interventions and health promotion campaigns, as well as more tailored website content.

References

• Dowling, N. A., Rodda, S. N., Lubman, D. I., & Jackson, A. C. (2014). The impacts of problem gambling on concerned significant others accessing web-based counselling. Addictive Behaviors, 39, 1253-1257.
• Evans, L., & Delfabbro, P. (2005). Motivators for change and barriers to help-seeking in Australian problem gamblers. Journal of Gambling Studies, 21, 133-155.
• Gainsbury, S., Hing, N., & Suhonen, N. (2013). Professional help-seeking for gambling problems: Awareness, barriers and motivators for treatment. Journal of Gambling Studies, 30, 503-509.
• Productivity Commission. (2010). Gambling Report Number 50. Canberra: Productivity Commission.
• Reynolds, D. A. J., Stiles, W. B., Bailer, A. J., & Hughes, M. R. (2013). Impact of exchanges and client-therapist alliance in online-text psychotherapy. Cyberpsychology, Behavior, and Social Networking, 16, 370-377.
• Rodda, S. N., & Lubman, D. I. (2014). Characteristics of gamblers using a national online counselling service for problem gambling. Journal of Gambling Studies, 30, 277-289.
• Rodda, S. N., Lubman, D. I., Cheetham, A., Dowling, N., & Jackson, A. C. (2014). Single session web-based counselling: A thematic analysis of content from the perspective of the client. British Journal of Guidance and Counselling, 43, 117-130.
• Rodda, S. N., Lubman, D. I., Dowling, N., & Jackson, A. C. (2013). Real time chat interventions reduce distress and increases confidence to manage problem gambling. Paper presented at the International Society for Research in Internet Interventions, Chicago.
• Rodda, S. N., Lubman, D. I., Dowling, N. A., Bough, A., & Jackson, A. C. (2013). Web-based counseling for problem gambling: Exploring motivations and recommendations. Journal of Medical Internet Research, 15, e99.
• Rodda, S. N., Lubman, D. I., Dowling, N. A., & McCann, T. V. (2013). Reasons for using web-based counselling among family and friends impacted by problem gambling. Asian Journal of Gambling Issues and Public Health, 3, 1-11.
• Rodda, S. N., Lubman, D. I., Iyer, R., Gao, C., & Dowling, N. (2014). Subtyping based on readiness and confidence: the identification of help-seeking profiles for gamblers accessing web-based counselling. Addiction, 110, 494-501.
• Suurvali, H., Hodgins, D. C., Toneatto, T., & Cunningham, J. A. (2008). Treatment seeking among Ontario problem gamblers: Results of a population survey. Psychiatric Services, 59, 1343-1346.