Text-Based Crisis Counseling: An Examination of Timing, Pace, Asychronicity and Disinhibition

Abstract

Texting-based crisis counseling is increasingly used to reach young people in acute crisis. Drawing on the online disinhibition effect (ODE), this U.S. study explored how asynchronicity and invisibility contribute to how users reveal their presenting problem and engage with counseling. A random sample of 49 text crisis line sessions with youth averaging 18 years was used to assess response lag times and flow as well as their impact on the session. Interviews with crisis counselors provided supplemental context. Content analysis identified patterns in the presenting problem, reasons for response lags, and patterns in how the sessions ended. The overall duration of text sessions was substantially longer than that of voice calls, to cover comparable content. Users frequently multitasked or become engaged in other activities between texts, creating a more disjointed flow. This also allowed the user to take time with responses to difficult questions. Counselors had to match their pace with users, make decisions when to discontinue the session, and use intentional language to develop a therapeutic connection. In line with the ODE framework, the findings suggested that the invisible nature of texting allowed users to reach out for help at the moment they needed it, regardless of their location. Implications for using texting-based interfaces are discussed.

Keywords

• online disinhibition effect
• text-based counseling
• crisis intervention
• telehealth
• mental health