• Rowena Rheinberg

Student thesis: Doctor of Counselling Psychology


Background and objectives: the growth of internet access over recent decades has led to a seismic shift in the delivery of mental health treatment. Online therapy (sometimes known as e-mental health) is now commonplace both in the UK and abroad, with treatment modules frequently based on CBT formats. However, with the discovery that the addition of therapist guidance and support can significantly improve treatment effectiveness, what has become known as "blended therapy" (a combination of online and offline components) is now commonplace. This new area of psychological treatment has given rise to an extensive literature base but although studies have explored the delivery of online-only therapy to young people, research on young people's blended therapy is less common. The voice of counselling psychology is scarce in this field, and therefore the objective of this study was to explore staff's experiences in delivering a young people's blended counselling service and to identify the benefits and challenges of providing mental health care to young people in this way. Method: a qualitative design was employed, in which semi-structured interviews were conducted with twelve staff attached to a children and young people's blended counselling service in the UK. Findings: Thematic Analysis was chosen to analyse the interview data, and four global themes were developed, namely: (i) becoming a blended service; (ii) online counselling: "How could that possibly be safe?"; (iii) open access: therapy sans frontieres; (iv) making it work: logistical complexity.. Conclusions: the research provided a novel insight into the opinions and experiences of staff involved in delivering a blended counselling service. The participants described how the service could enhance youth-friendly counselling and improve access to mental health care by offering a choice of mediums from which to access therapy. As one participant described this, it is "as simple as choosing peas or beans". Certain advantages were identified as being inherent to the "online" part of the service, and in extending anonymous, accessible support to young people. However, participants reported that managing risk and safeguarding clients was a delicate balancing act in which ethical questions were often raised. A number of challenges to blended therapy were identified including logistical problems, staff training and problems due to the way in which mental health services are contracted in the UK. Suggestions for further areas of research and improving practice within a blended service model were proposed. This study suggests that blended therapy could enhance youth mental health care, particularly if it could be integrated technically and organisationally into the wider social service and health systems.
Date of Award31 Dec 2020
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorTerry Hanley (Supervisor) & Erica Burman (Supervisor)


  • young people's counselling
  • youth mental health
  • adolescent mental health service
  • young people's therapy
  • blended counselling

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