Better schools through health: learning from practice

A lot of dialogues that develop in the safety of our e-counselling website would neverhave happened in the office of a school physician, gynaecologist, psychiatrist orpsychologist. Many service users clearly say that they would never have gathered thecourage to open up face to-face, or would not even have sought help. The majorityof questions deal with subjects that preoccupy teens the most: being in love, dating,curiosity about the first sexual experience, contraception, love problems, temporaryfamily disputes. They are followed by more severe issues stemming from poor selfimage.The most difficult and pressing questions the adolescents ask us touch thesubject of suicidal thoughts, suicide attempts, self-harming behaviour, depression,eating disorders, sexual abuse and teen pregnancy. About 5.5% of questions involvethe most difficult subjects.E dialoguehey!what I wanna know is, which are the best pills you can use to kill yourself? does it hurt? will apack of sleeping pills do the job? how much, so it’s all over 100%? been thinking about suicidea lot... really hope you can give me some kind of answer, ‘coz I can’t handle it anymore ...fallen angel, 17, www.tosemjaz.netThe main limitation that comes with web counselling is the absence of face to-facecontact i.e. lack of social and visual clues. The counsellor doesn’t see the client. Theirface is hidden, eye contact is impossible, body language is not visible, the personalityand energy can only be guessed at. In fact, the communication is even more restrictedthan with phone conversations. Contact is reduced to written messages. Language isthe sole communication channel. A message example: »Been cutting myself for a year.I want to stop.« Such messages are sometimes the only thing the counsellors have towork with. They will try to respond to such curt words (perhaps indicative of severalproblems) in a way that will encourage the user to speak up again. E counsellors arenot a virtual shoulder to cry on. Serious problems are never easy to solve and theteens have to work hard. E counsellors carefully and suitably support and motivate theadolescents. They explain possible problem-solving scenarios and available sources ofhelp.Benefits of web counselling:••••••••••••Anonymity (promotes openness while expressing problems)Easy access to experts (from the safety of the teenager’s room, no referrals,no waiting rooms)One e counsellor can help several teenagers with a single answerInsight into others’ experience and problem solving approachesA quick ‘first aid’ effectNetworking of institutions, experts and usersLimitations of web counselling:•• Limited communication (insight via written word only)•• Limited possibilities for establishing a therapeutic relationship•• On-line relationships are insecure and can be broken off at any moment44