Reasons for using web-based counselling among family and friends impacted by problem gambling

The impact of problem gambling is broader than its effects on the gambler, with estimates suggesting up to seven people close to the gambler are also typically adversely affected (Productivity Commission 2010). Impacts experienced include cash flow problems and debt, poor mental health, lowered quality of life (Kalischuk et al. 2006), increased tension within relationships and interpersonal conflict (Dowling et al. 2009; Hodgins et al. 2007;Kalischuk 2010). In addition, family and friends report confusion over how to manage the problem gambling (on a daily basis as well as long-term), and particularly struggle with putting boundaries around spending (Patford 2007a). These effects have been most frequently studied among the intimate partners and children of problem gamblers, but extended family members and friends are also affected, although probably generally to a lesser extent (Heineman 1989;Kalischuk et al. 2006; Moody 1989; Patford 2007b).

Despite a range of symptoms associated with problem gambling, there is limited research exploring the role of family and friends in the treatment of problem gamblers or the efficacy of treatment for this group. It has been proposed that family and friends may be significant in assisting gamblers seek help (Clarke et al. 2007), and in some cases, reduce harms associated with problem gambling (Hodgins et al. 2007;Ingle et al. 2008). Interventions designed to improve the functioning of the family and friends of problem gamblers have included Community Reinforcement and Family Training (CRAFT), which has been previously found to be effective in reducing alcohol use (Hodgins et al. 2007; Makarchuk et al. 2002), as well as treatments that specifically aim to increase the coping skills and decrease the distress of family and friends (Rychtarik & McGillicuddy 2006).

While structured interventions show some efficacy, most family and friends typically engage in much lower intensity interventions, such as self-help, self-regulation, telephone or online support (Hing et al. 2013). Despite this, family members delay contacting helplines for a range of reasons, some of which relate directly to service characteristics (Hing et al. 2011). These include a lack of awareness that helplines cater for family members, that they are free, as well as issues around shame associated with problem gambling and wanting to manage it within the relationship (i.e., partner, parent, sibling, etc.).

Brief interventions with family and friends are largely unreported, despite them comprising approximately 15-20% of callers to helplines and web-based services internationally (Clifford 2008;Rodda & Lubman 2012b;Wood & Griffiths 2007). For example, over recent years, web-based counselling has been offered to anyone in Australia affected by problem gambling. Gambling Help Online offers 24/7 immediate real-time chat, email support, community forums and self-help information via its website (gamblinghelponline.org.au). This website was visited 60,729 times by 47,333 visitors in 2010–11, and pages for family and friends are viewed frequently, including those that provide information on helping others (n = 10,188 page views) and how to offer practical help (n = 2893 page views). Approximately 15% of web-based clients receiving counselling are family and friends of people with problem gambling.

Previous research suggests web-based interventions are attractive due to their potential for anonymity and convenience (Cook & Doyle 2002;Young 2005), as well as their accessibility and availability (Wood & Wood 2009). While this research has almost exclusively involved clients involved in ongoing treatment or members of forums, there is limited knowledge on those engaged in single session brief interventions. Two studies have sought to identify the reasons why people choose web-based counselling over telephone or face-to-face. The first, involving young people contacting a generalist help online service, found privacy and an emotionally safe environment (e.g., reduced exposure, privacy, control), and issues around time were motivators for using the service (more time to reflect) (King et al. 2006). The second study, involving people with problem gambling, found anonymity and confidentiality, convenience, service system access, therapeutic medium and professional support to be the main motivators (Rodda et al. 2013).

Although studies on barriers to treatment and interventions are important, there are several constraints that may limit their generalisability to family and friends seeking single session brief interventions. There has been a focus on longer term and appointment-based treatment programs for family and friends, with little investigation of their help-seeking preferences. Furthermore, while many studies have identified reasons for seeking help, few have identified reasons for seeking help from a particular type or mode of service, and none involving family and friends.

This study aimed to understand the reasons why family and friends chose to engage in web-based counselling, with a particular emphasis on investigating why they did so over other modalities (i.e., face-to-face and telephone). A qualitative methodology was adopted because of our focus on understanding the perspectives of family and friends, and because it is a valuable approach for exploring such issues in under-researched areas.

This exploratory study provides a first look at the reasons why family and friends choose web-based counselling over telephone or face-to-face services, and why they would recommend it to someone else experiencing concerns about a family member’s or friend’s problem gambling. As expected, themes around ease of access and privacy and anonymity emerged as well as characteristics inherent in the therapeutic medium. Similar to previous research involving gamblers seeking help online (Rodda et al. 2013), we also found web-based counselling provided a pathway into services and that the intervention provided was viewed as helpful and a reason for recommendation.

Five themes emerged that describe the reasons family and friends choose and recommend web-based counselling. First, ease of access was the most widely reported reason for using web-based counselling. This included being able to access services immediately and without an appointment at any time of the day or night. Similar to other studies involving affected family and friends (Hodgins et al. 2007), 70% of our sample was the intimate partner of someone experiencing problem gambling. Previous research suggests the proximity of intimate partners to the gambling problem make them particularly vulnerable to interpersonal conflict and increased distress (Hodgins et al. 2007; Patford 2009). Our research suggests family and friends value support at times of high stress and distress, along with advice on how to manage problem gambling. In addition, participants reported financial barriers to accessing other forms of treatment, particularly in relation to telephone contact. Increasingly, mobile phones have replaced landlines, with an associated loss in free-call access. Family members of problem gamblers may be especially vulnerable to any costs associated with help-seeking given the incidence of debt and financial problems (Downs & Woolrych 2010).

Second, web-based counselling was chosen and recommended due to its potential for privacy and anonymity. Privacy was a concern when talking about the impact of the gambling without the gambler or others overhearing the conversation. While previous research has found confidentiality commonly related to privacy in help-seeking (Hing et al. 2011), we found participants were more concerned about being able to talk discreetly. For other participants, there were significant issues associated with the shame and stigma of problem gambling that were alleviated via anonymity. Although shame and stigma has been repeatedly found to be a barrier to treatment for people with problem gambling (Evans & Delfabbro 2005;Hing et al. 2011;Suurvali et al. 2009), there has been little research on the embarrassment felt by family and friends about a loved one’s problem gambling, as well as their role in helping or hindering the problem (Bellringer et al. 2008). However, there is some evidence to suggest family members experience guilt and self-blame (Dickson-Swift et al. 2005), possibly due to the hidden nature of problem gambling (especially in the case of internet gambling which often occurs in the home) (Valentine and Hughes 2010). Family and friends are often the first people from whom gamblers seek advice (McMillen et al. 2004), attesting to the importance of also providing a safe space for families to obtain their own support and advice.

Third, the characteristics of the therapeutic medium were a reason for using and recommending web-based counselling. Participants described increased openness and honesty, where the interaction was devoid of any visual or aural cues and entirely text based. For many family members, this was their first time speaking with someone about the gambling problem and they were overwhelmed with emotion, but were able to express these thoughts and feelings online. This is consistent with previous work indicating users of web-based services feel more comfortable expressing themselves online compared with on the telephone (King et al. 2006). Previous research has also found that the characteristics of the online environment are likely to lead to greater self-disclosure due to anonymity, particularly when sharing difficult information (Beattie 2006; Leibert et al. 2006).

Fourth, we found being able to easily access the service system was a reason for choosing web-based counselling. Family and friends described a preference for web-based counselling as their only means of obtaining professional support and advice, with over three-quarters of the sample seeking help for the first time. Our sample did not differ to the wider population of family and friends accessing web-based counselling, and they were more often first time help-seekers compared with gamblers accessing the same service (Rodda & Lubman 2012a, b). The value of web-based services to this population is apparent given reasons for access associated with discreteness, anonymity, convenience and ease of access. Previous research suggests that family and friends are not a homogenous group and a range of interventions need to be developed (McMillen et al. 2004). This suggests the best approach may be one that addresses a range of issues from financial to relational, involving different types of interventions (e.g., self-help, professional support). Whether family and friends prefer these types of interventions to be available online warrants further investigation and indeed has implications for the configuration of treatment and services.

Finally, helpfulness of web-based counselling was a reason for recommending the service to other people affected by problem gambling. Helpfulness was expressed in terms of the counsellor listening and providing empathic and non-judgemental support, as well as providing expert advice and information. Helpfulness in the current web-based setting is possibly influenced by the immediacy of the intervention, delivered at a time and place that is accessible (i.e., not embarrassing, discrete and comfortable). As described by Stiles et al. (2002), evaluations necessarily involve a relationship between the evaluator and the event or object being evaluated, and that relationship necessarily changes over time. For example, those finding strategies helpful were possibly in a different place in their help-seeking journey than those who valued information or being able to tell their story. Indeed, previous research has shown that 73% of helpline calls had a preference for information and that 84% of callers were satisfied with this assistance (Hing et al. 2011). Understanding what factors predict helpfulness in a counselling session would be useful information for counsellors.

This study is the first to explore the reasons family and friends access and recommend web-based counselling. However, there are several limitations that need to be considered. Participants were older than the population from which they were drawn; as such, they may not be representative of younger people who use the service. Nevertheless, the age of most participants was under 40 years, which is younger than reported elsewhere (Hing et al. 2011; Hodgins et al. 2007). Second, while this descriptive study sought to represent the reasons for choosing web-based counselling, the data were collected at the conclusion of a counselling session and may have been influenced by the experience of the online session by participants. These findings could be enhanced via the development of a service preferences screening tool offered to all clients prior to a counselling session commencing.

Few family and friends access Australian counselling and support services, despite their availability. Indeed, an inquiry into problem gambling by the Australian Productivity Commission (2010) suggests governments need to develop education campaigns that encourage family and friends to seek help earlier. Our findings have a number of key implications for family and friends, support services and funding bodies. First, given families’ and friends’ preference for services that are easy to access, private and anonymous, as well as the reported benefits of accessing support online, the web-based counselling platform could be expanded to provide a broader range of interventions to assist family members and friends affected by problem gambling. However, to do this effectively, research is needed to examine the benefits of current service delivery across all modalities (i.e., online, telephone, face-to-face), so as to determine what is working for whom and where there are opportunities to better target service provision. Integral to this process is the development of a navigation tool to assist family and friends, as well as clinicians, in determining the most appropriate treatment options. As the service system continues to expand, providing practical advice on how to navigate its breadth and depth becomes increasingly important. Ultimately, this relies on the development of greater knowledge of the fit between service and client characteristics. Finally, the utility of providing time-sensitive emotional support needs to be better understood. Whether interventions provided during a time of crisis empower family and friends to better manage the impacts of problem gambling needs to be further examined.