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ORIGINAL PAPER
What Young People Want: A Qualitative Study of Adolescents’
Priorities for Engagement Across Psychological Services
Kerry Gibson
1
•Claire Cartwright
1
•Kelly Kerrisk
1
•Julia Campbell
1
•
Fred Seymour
1
Published online: 18 September 2015
Springer Science+Business Media New York 2015
Abstract This article examined commonalities in ado-
lescents’ priorities for engagement with psychological
support in the context of contemporary youth culture in
New Zealand. These were explored across a range of dif-
ferent services including a face-to-face hospital-based
mental health service, a face-to-face school-based coun-
seling service, a telephone counseling service and a new
form of counseling using mobile phone text. Interviews
were conducted with 63 young people aged 13–18 who had
used at least one of these services. A thematic analysis
identified that there were common priorities for partici-
pants across the different services including their need to
keep control; not to have their parents involved; to have a
relationship with a counselor which was more like a
friendship than a professional relationship; to talk freely
and be listened to; and to have the service be accessible and
flexible enough to fit around their lives. Text and telephone
counseling were seen to be particularly appropriate for
meeting some of these needs. Professionals working with
young people should consider offering a suite of options
for psychological support, allowing young people to bal-
ance their different needs and priorities and thus facilitate
their engagement.
Keywords Adolescence Psychological services
Counseling Psychotherapy E-counseling Youth
culture Text counseling
Introduction
A major challenge in adolescent mental health is how to
facilitate young people’s engagement with the psycholog-
ical services available to them. Research has indicated that
adolescents seldom make use of these services and tend to
rely more often on informal sources of support (Rickwood
et al. 2005). Furthermore, their use of psychological ser-
vices has been subject to high drop-out rates (Block and
Greeno 2011). There may be a variety of explanations for
this phenomenon but one contributor might be that services
have not always been developed to match well with young
people’s priorities and concerns (McGorry et al. 2013).
Historically young people have not often been asked
about their experiences of psychological services (Duncan
et al. 2007). This seems to parallel a broader trend which
has eschewed client perspectives due to concerns that they
give unreliable feedback about what is effective about
counseling and therapy (Elliott and James 1989). This is
particularly true in relation to children and young people
who have been seen for many years as being unable to offer
legitimate feedback on their experience (Prout 2007;
Zirkelback and Reese 2010). However, there is an
increasing body of research which has drawn attention to
the value of client views in general. This literature has
moved beyond simply acknowledging characteristics of
clients that impact on therapy outcomes to recognizing that
clients are active participants in any therapeutic process
and that their engagement is central to the success of the
intervention (Bohart 2000).
The limited research on young people’s priorities has
suggested that they might well have strong ideas about
what they want from psychological services. There appear
to be three main areas of importance for adolescents. Their
first concern is for the therapeutic relationship which they
&Kerry Gibson
kl.gibson@auckland.ac.nz
1
School of Psychology, University of Auckland,
Private Bag 92019, Victoria Street West, Auckland 1142,
New Zealand
123
J Child Fam Stud (2016) 25:1057–1065
DOI 10.1007/s10826-015-0292-6
value, often above other therapeutic ingredients. Young
people want a genuine sense of connection with their
therapist (Bolton Oetzel and Scherer 2003). They also
prefer this relationship to contain a degree of mutuality and
for their therapist to be non-judgmental, empathetic and
caring (Binder et al. 2011; Everall and Paulson 2002;
Hollidge 2013).
A second area of importance for young people appears
to be their desire to use counseling to freely express their
thoughts and their emotions (Harper et al. 2014; Midgley
et al. 2014). For young people, relative to adult clients, this
seems to be more important than problem solving or other
therapeutic tasks (Dunne et al. 2000).
A final set of concerns for adolescents relate to their
need for autonomy and control within the therapeutic
encounter. Young people seem particularly conscious of
their lack of power in relation to adults including coun-
selors (Gibson and Cartwright 2013; Hanna and Hunt
1999). Their concern is to have an equal relationship over
which they are to exercise control (Binder et al. 2011; Bury
et al. 2007; Everall and Paulson 2002; Freake et al. 2007).
This also manifests in the particular concerns young people
seem to have about privacy and confidentiality (Gulliver
et al. 2010).
The available studies on young people’s experiences
have used samples taken only from one particular coun-
seling or psychotherapy service. Freake et al. (2007),
however, noted that it may be valuable to look across a
range of different services to ascertain whether there are
commonalities in what adolescents regard as important. In
their review of 54 studies they looked at services that
ranged from those in mental health to those addressing
more general health issues. To date, however, there is no
research which has explored different forms of psycho-
logical service to see whether there are commonalities in
adolescents’ priorities across these and whether there are
differences in the extent to which services are perceived to
meet their needs.
Researchers have pointed to developmental issues
underlying the different priorities that young people have
in relation to therapy and counseling (Hollidge 2013).
Concerns such as establishing identity and autonomy have
been recognized as central in structuring models of therapy
appropriate to adolescents (Sauter et al. 2009). Contem-
porary youth researchers, however, recognize that these
developmental tasks are not fixed and are shaped and
influenced by the changing contexts in which young people
live (Wyn and Harris 2004).
There are some significant contextual issues that need to
be taken into account in considering the development of
young people in New Zealand and other contemporary
Western countries. In these settings adolescents may be
subject to contradictory pressures which, on the one hand,
reinforce their individual responsibility and autonomy but
on the other, increasingly subject them to surveillance and
monitoring of their behavior and psychological experience
(Graham 2014; Kelly 2000). Young people may be given
the message that they should take control of their lives and
have responsibility for their choices but are simultaneously
constrained by institutions which are governed by the
agendas of adults (Sharland 2006). In this context young
people may value opportunities to exercise their agency
and experience frustration at their inability to effectively do
so (Gibson and Cartwright 2013).
Establishing an identity remains an important concern
for adolescents but this is shaped by contemporary culture
in which young people are subject to increasing pressures
to succeed and make the most of themselves in the face of a
less certain future (Furlong and Cartmel 2007). Young
people may be more anxious than ever about creating an
acceptable identity and experience concerns about being
judged for their inability to do this.
Finally, significant changes in the nature of communi-
cation through contemporary forms of communication
technology may also affect the way that adolescents
negotiate this sensitive period of development. New forms
of technology may offer greater potential to connect to
others. This shapes communication between young people
in ways that often exclude adult participation (Green 2003;
Ito 2005) and challenges traditional notions of how rela-
tionships work (Turkle 2011). New forms of communica-
tion technology also enable more fluidity and immediacy in
social arrangements and this may also influence the way
that young people engage with their social world (Wyn
et al. 2005). In the fledgling use of these new communi-
cation technologies for therapeutic purposes, they have
been found to be attractive to young people insofar as the
anonymity reduces anxieties around social judgement and
facilitates the more open discussion of sensitive topics
(Callahan and Inckle 2012; King et al. 2006). But while
access to new communication technology has also brought
with it increased opportunities and expectations for young
people to reveal themselves, it has also paradoxically,
heightened tensions between the desire for self-expression
and concerns about privacy (Livingstone 2008).
Furthermore, the context of psychological help has
significantly altered in recent decades. In an attempt to
better meet the diverse needs of adolescents, a plethora of
services has been developed. No longer is help limited to
face-to-face counseling or psychotherapy and there is a
broad array of options being made available for young
people. In the New Zealand context these range from face-
to-face counseling and psychotherapy services, telephone
counseling services and, in recent years, services enabled
by use of the new communication technologies such as
internet and mobile phone text counseling services. This
1058 J Child Fam Stud (2016) 25:1057–1065
123
raises questions about the extent to which young people’s
priorities remain consistent across these different modes of
intervention and whether these services are seen by them to
have different potential to match these.
If psychological services are to be better adapted to the
priorities of young people themselves it is important that
we use research to ascertain their views. This may, how-
ever, be challenging as traditional research methods often
leave researchers to shape the agenda of the research
inquiry, unwittingly closing down the voices of young
people (Claveirole 2004). This research draws from a
project which specifically aimed to explore young people’s
experiences of a variety of forms of psychological inter-
vention from their own perspective and with minimal
intrusion from the researchers. The project was named ‘The
Mirror Project’ from its intention to hold a mirror up to
mental health professionals so that they might better see
how their practices are understood by the young people
they work with. In the course of conducting open-ended
explorations of young people’s experiences with psycho-
logical services we became aware that participants were
implicitly voicing those aspects of the process which they
felt to be important for their engagement and those that
made it more difficult for them to do this. In this paper we
explore common priorities and concerns that emerged
through interviews with young people who had used a
range of modes and sites of counseling including a hospi-
tal-based mental health service for adolescents and children
(MHS), school counseling services (SCS) and telephone
and mobile phone text counseling delivered by a Non-
Governmental Organization (NGO). In addition to exam-
ining potential commonalities in adolescents’ priorities
across the services we also explored whether they saw
differences in the ability of the different services to meet
these.
Method
Participants
In New Zealand, government funded mental health services
are offered through local hospitals and are intended to meet
the needs of young people with more serious mental health
problems. Parents are involved in the referral and are
usually expected to attend the initial assessment sessions.
School counseling is offered by those schools which can
afford it. These are located on-site and students can make
an appointment with the counselors directly themselves.
Both the telephone and text counseling services were
provided by the same national youth NGO and are intended
to offer community-based support to young people. Tele-
phone counseling is a well-established mode of counseling
(Reese et al. 2002) but mobile phone text counseling is a
more recent service development (Gibson and Cartwright
2014).
Sixty-three young people who had experienced at least
one of a range of psychological services were recruited to
take part in the study. They were recruited from a MHS
(11), from two SCSs (22) and a telephone counseling (9)
and text counseling service (21). Participants ranged in age
from 13 to 18 with an average age of 16. There were 44
young women and 18 young men in the sample with one
preferring to be described as ‘gender fluid’. The gender
imbalance in the sample may reflect the greater tendency
for women to seek help for psychological distress (Rick-
wood and Braithwaite 1994) (see Table 1for summary of
participants).
The different settings required different methods of
recruitment. Those from the MHS were given information
about the research by their therapists at the end of their
therapy or learned about the study from posters in the
waiting room. Text and telephone counseling participants
received information about the study via a text from the
NGO responsible for the service and may also have learned
about it from information on the NGO website. All those
who had used one of the SCSs in the previous 18 months
received a letter from their counselor informing them of the
study. Potential participants were asked to contact the
researchers directly if they wanted to take part in the study
and their counselors and therapists were not aware of who
had participated. Our intention had been to recruit only
those who had finished an episode of counseling or therapy
within the previous 18 months, but it turned out that par-
ticipants seemed to have a more flexible relationship with
psychological services than we had anticipated and many
of them considered that they were still engaged in with the
service, even if they had stopped for a while. The duration
since their last engagement with a service varied from the
day before the interview to just under 18 months
previously.
There was a wide range in the type and duration of
therapy offered. In the MHS participants reported therapy
lasting between 3 months and 3 years, involving a mixture
of family and individual therapy approaches. In the SCS
the duration was reported as ranging from a few sessions to
extending over several years. This was largely with the
young person alone. Participants using these services ran-
ged from those who had used them once (4) and those who
described themselves as ‘regular’ users.
Although we had intended the participants to talk about
a specific psychological service we found that there were
very few participants who had not experienced more than
one kind and they frequently included references to, and
comparisons between, the different services they had
used.
J Child Fam Stud (2016) 25:1057–1065 1059
123
In accordance with New Zealand law, consent was
sought from parents for young people under the age of 16
and others were able to provide their own written consent.
Given the significance of confidentiality for participants the
researchers were alert to the importance of this throughout
and to the sensitivity of the subject matter. The study was
approved by the University of Auckland Human Partici-
pants Ethics Committee.
Procedure
All participants were interviewed using an in-depth narra-
tive-style open ended interview that asked them to tell the
story of their experience with the psychological service in
their own words (Riessman 2008). If they struggled to
begin they were asked to talk about the ‘the first time they
had used [a particular] service….’ The interviewer used
prompts to facilitate further elaboration or to develop the
account but tried not to introduce new directions into the
young person’s account. This was designed to develop a
participant-led account of their engagement within which
young people felt able to elaborate freely about the aspects
of the psychological service that were important to them.
Most interviews were conducted face-to-face with the
interviewer (45 participants) while the remainder were
conducted via telephone or Skype call at the participants’
request. Interviews took between 30 and 105 min with
most taking about 45 min. The interviews for text and
school counseling participants were conducted by the first
author while the mental health service and telephone
counseling/interviews were conducted by two other authors
under team supervision.
Data Analyses
Data was initially fully transcribed for analysis and the
researchers immersed themselves in reading and re-reading
the data. For this we used Braun and Clarke’s (2006)
approach to thematic analysis underpinned by an inter-
pretive epistemological stance (Morrow 2005). This
approach notes the importance of coming to the data with a
clear research question and identifying elements from the
data that address this. In this case our research question
was: ‘What aspects were priorities (or concerns) for
participants in their engagement with psychological ser-
vices?’ The data relating to each service was originally
coded separately either by the first author or another
member of the research team working under the first
author’s guidance. The first author then trawled through the
codes identified in each of separate data sets, developing
these into themes that reflected common areas of priority
for participants across the different services. Consistent
with guidelines for qualitative research, we used the con-
ventions of ‘many’ ‘several’ and ‘few’ to give an indication
of the extent to which a theme was present across partici-
pant interviews without suggesting that these might be
statistically generalizable. We also noted where there were
views that contradicted or challenged any particular theme.
The interpretive framework within which the research
was conducted recognizes layers of interpretation within
which both the participants and researcher’s meaning mak-
ing is reflected (Yanow 2006). However, we were particu-
larly concerned that our views as researchers would not
supersede those of our participants and were alert to this in
the process of analysis. The ‘trustworthiness’ of the research
was achieved by carefully reviewing the codes and themes
between members of the research group to achieve some
consensus on the extent to which they provided an honest
reflection of the data, were reasonably coherent and con-
veyed meaningfully different ideas (Morrow 2005). Differ-
ences in opinion on these areas were resolved through
collective discussion in a manner similar to that described by
Hill and her colleagues (Hill et al. 2005).
Results
Keeping Control
Many participants prioritized their ability to retain control
over their choice to engage in with the psychological ser-
vice and in the pace by which their engagement progressed.
They also wanted to direct the focus of intervention and
were concerned that professionals should not try and tell
them what to do or think:
I sort of didn’t want to go into counseling and hear
something that I don’t want to hear…It was helpful
Table 1 Participant
information Setting Delivery mode Men Women Fluid Total
Mental health service Face-to-face counseling 5 6 11
School counseling service Face-to-face counseling 7 15 22
NGO service Text counseling 4 16 1 21
NGO service Telephone counseling 8 1 9
Total participants 17 45 1 63
1060 J Child Fam Stud (2016) 25:1057–1065
123
when they would sit down with me and say you get to
choose the direction in your life. (SCS Participant)
The notion of ‘choice’ was emphasized through many of
the interviews and having this was often depicted as a
precondition for engaging in counseling.
In general those who had used the MHS had been
referred with their parents’ involvement and had had less
control over their choice to engage than in other services.
Even there, however, participants found more subtle ways
to exercise control over their participation:
I guess it was a choice if I would say anything or not.
I just wasn’t really in the mood to talk at all sort of
thing, because being the fact that I didn’t want to be
there in the first place. (MHS Participant)
Those who had used the text and telephone counseling
highlighted the way these services allowed them to exercise
their control and retain their autonomy perhaps more than
other services. They especially appreciated the way that they
were able to initiate contact and choose when to end it. One
participant, for example articulated her freedom to stop the
contact when she did not like what her counselor was saying:
‘‘I’m like I’m not listening to this and yeah then I hang up.’’
On the whole, it seemed that participants valued control
equally across the settings but felt more able to enact this in
modes which did not involve face-to-face contact with
counselors.
No Parents Involved
Participants generally emphasized the importance of pri-
vacy and most often seemed concerned about this in rela-
tion to their parents. It seemed to be a fundamental concern
for many of the young people in this study that their parents
did not know what they had spoken about in counseling
and, in many cases, that parents did not know that they had
used a counseling service at all. Participants gave a variety
of reasons for this including that their problems related to
their parents, they involved behavior they felt their parents
would disapprove of, they were concerned about ‘worry-
ing’ their parents or simply felt uncomfortable with their
parents knowing ‘personal stuff’ about them. Where
expectations about this were breached this was often
regarded as an unforgiveable breach of trust in the thera-
peutic relationship. Although confidentiality in counseling
would normally only be breached when there were safety
issues at stake, some participants described fearing that
their parents would somehow find out about what they had
said in counseling. One participant described her disillu-
sionment with counseling after she had agreed to her
counselor’s request to invite her mother into a session:
[The counselor] shared things with my mum that
were personal to me and that I thought would be kept
sort of private and confidential and I just didn’t like
that. (SCS Participant)
In the MHS the standard processes required that parents
were always involved at some point in the therapy process.
Most participants said they found this deeply
uncomfortable:
I wasn’t keen on having that meeting that day
because I don’t want to be there and because my
parents were there and I was kind of put off…So it
got kind of hard during that first session because I
didn’t say anything…I wouldn’t say anything. I’d
just sit there and listen to them and only give half of
what needs to be said with one word answers. (MHS
Participant)
Only a very small number of participants from the mental
health service said they had found sessions involving their
family useful.
School counseling seemed to allow a greater degree of
privacy but a few participants still expressed concern that
they might be pressured to involve their parents in some
way. Most of the participants using the text and telephone
counseling service emphasized that they had chosen to use
this mode of counseling specifically because it allowed
them to make contact with a counselor without their par-
ents’ knowledge. Text was particularly valued because
participants could use it silently at home without their
parents’ awareness: ‘‘I felt text was a more secretive and a
more protected way of talking to someone’’ (Text Coun-
seling Participant).
With most participants valuing the opportunity to have
counseling without their parents’ involvement, services
such as text, telephone and school counseling which
allowed this seemed to provide an easier route to initial
engagement.
More Like a Friendship
Almost all participants spoke about the importance of
having a good relationship with their counselor. They
seemed particularly to value aspects of the relationship that
positioned their counselor as a friend rather than as a
professional and emphasized the importance they attributed
to the ‘genuineness’ of this relationship:
She treats me like a friend as well which that’s not
part of her job. They don’t need to treat you like a
friend but she does. She asks about my life and how
I’m doing, not just about my problems. When she
J Child Fam Stud (2016) 25:1057–1065 1061
123
asks me about my life I know she’s genuinely asking
me because she’s interested. (SCS Participant)
In contrast, participants referred dismissively to mental health
professionals who appeared to be ‘‘just doing their job.’’ They
also spoke less favorably about any sign of hierarchy in the
relationship. A few participants spoke of appreciating an
‘adult perspective’ but objected to any indication that the
counselor was exerting authority over them.
Participants particularly liked it when their counselor or
therapist revealed themselves as ‘real people’. Many spoke
fondly of moments where a counselor had revealed
something of themselves through humor or self-disclosure,
especially when this showed their counselors to be less
than perfect themselves. In contrast many feared the
potential to be ‘judged’ by their counselors or therapists for
being ‘weird’ or ‘immature’. This was particularly difficult
in situations where participants felt that these judgements
might be held against them:
I have some pretty freaky thoughts, which are like
um, like and I don’t really want to tell [my school
counselor] about them because she will be like oh
that’s not the girl I know sort of thing. (Telephone
Counseling Participant)
In face-to-face counseling sessions, this relationship were
described as taking time to develop. Initial caution felt by
many participants was gradually replaced by trust as they
came to accept that their counselor would not evaluate
them or their behavior negatively.
Both text and telephone counseling involve anonymous
communication without access to non-verbal relational
cues and the services do not generally facilitate a client’s
access to the same counselor each time they call/text.
Surprisingly, however, relationships appeared equally
important for participants in these interactions and most
felt that they had been able to establish a ‘real relationship’
with their counselor:
[Saying goodbye] was a weird feeling, just that I kind
of felt as though I was losing a friend. But then …
they sort of said that if there is ever anything else
don’t hesitate. So I kind of felt as though I still had
them. (Text Counseling Participant)
While most text counseling clients did not register the shift
between counselors as disruptive to the development of a
relationship, those who used telephone counseling seemed
to find this more difficult, perhaps because the change in
counselor was more obvious through the medium of voice
than through the written word.
Only a very small number of the text and telephone
participants felt that they would have preferred face-to-face
communication and some felt that the anonymity of this
form of counseling reduced their initial fear of being
judged and actually allowed for a more immediate and
better connection with their counselor: ‘‘But if you are
texting them you don’t know what they are like and you
can’t judge them and they can’t judge you’’.
A genuine relationship seemed a priority for participants
across all the services with text and telephone counseling
providing the added benefit of anonymity.
Talking and Listening
Most participants prioritized the opportunity to ‘talk’ in an
encounter with psychological services and saw the main role
of the counsellor as someone who would listen to them: ‘‘To
be honest I just like to talk. I just like having someone listen
to me’’. (SCS Participant). Participants explained the value
of this kind of expression as a kind of catharsis:
It just makes me feel better about myself now that I
don’t have anything that I have to hide or bottle up.
(MHS Participant)
Talking seemed as significant for telephone and text
counseling participants as they were for those who had had
face-to-face counseling. Text communication may not
always be seen as a tool for comprehensive communication
but those who had chosen to use this method spoke about it
being an especially comfortable form of expression for
young people. Several explained that this was because young
people were more familiar with this mode of communication:
I think it’s just because my generation is used to
texting and it’s easier for us and more convenient,
and it feels like it’s just the same as talking.
Many of those who had used the text service spoke about
how using text was sometimes preferable to talking face-
to-face because it decreased their fear of being judged and
the discomfort of talking directly to an adult:
I guess texting is much more comfortable because
when they talk I can’t look directly in their eye. I
have to look everywhere in the room, which is quite
awkward. (SCS Participant)
Some also felt that text improved the clarity of commu-
nication and felt more confident expressing themselves this
way:
On the phone like you say something and then she’ll
hear it the wrong way and it’s like oh well you’ll have
to explain it. But with the texting it’s like you can say
it and then it’s up to them to decide what it is and
then they will probably ask and I’ll be like yeah or
no. (Telephone Counseling Participant)
1062 J Child Fam Stud (2016) 25:1057–1065
123
However, not all participants who had used text counseling
felt that this could replace face-to-face communication and
a very small number of these said they still preferred the
contact of a voice or a physical presence.
Talking appeared to be a priority equally across all the
services, with ‘talking’ easily being adapted to a text for-
mat which also addressed some of the constraints these
young people felt in talking openly with adults.
Accessible and Flexible
Most participants expressed their wish for psychological
services that could fit around their life and their needs. Unlike
formal mental health services text and telephone counseling
were described as being most appropriate for meeting par-
ticipants’ needs in the moment that they arose: ‘‘In the situ-
ation and you can text or call someone and they are there
instantly, which I think is really good.’’ (Telephone Coun-
seling Participant). Some participants emphasized how they
valued this in contrast to the availability of a regular weekly
face-to-face session, as one participant put it: ‘‘[Text coun-
seling] is not like every so often. It’s just like whenever you
need it.’’ (Text counseling Participant).
Some participants also spoke about how they appreciated
the School Counseling service because it also allowed some
degree of flexibility insofar as clients were able to request an
appointment when they needed it. However, in the MHS
where appointments were set up at regular times in advance
participants were unable to actualize this priority. One of the
telephone counseling participants who had clearly also
experienced regular face-to-face counseling session
emphasized what they saw as the disadvantage of this:
You would be talking to them and you wouldn’t be
feeling any of the proper emotions because you are
trying to recount what happened ages ago. (Tele-
phone Counseling Participant)
Participants also seemed to value the flexibility of being
able to stop counseling when they wanted to and begin
again as the need arose. Apparent drop-outs from psycho-
logical services did not always seem to be related to
dissatisfaction with the process but more often seemed a
response to the waxing and waning of the participant’s
need:
Recently over the last couple of months I stopped
going for a little bit, but not because of any reason. It
was kind of because I got busy and forgot about it.
And then I was like ‘Yeah I’m going to go back’.
(SCS Participant)
Text and telephone counseling seemed to provide the most
flexibility for participants to disengage with the counseling
process according to their need:
When I get real angry I take my phone and start
texting, and then when they reply I am like: ‘Oh I
don’t feel angry anymore.’ (Text Counseling
Participant)
Some participants related to concerns that they would get
locked into a counseling relationship beyond the point at
which they found it useful.
Participants valued having services available when and
where they needed them. Text and telephone counseling
services seemed to fit well with this need for flexibility
while ‘on-demand’ school counseling services provided a
more accessible face-to-face option than could be offered
within the more formal mental health service.
Discussion
This research suggests that adolescents may have common
priorities and concerns that affect their engagement with
psychological services across a spectrum of modes of
delivery. As with previous research, our study suggested
that young people have a strong investment in forms of
support which allow them autonomy and over which they
can exercise control (Binder et al. 2011). The increasing
emphasis on ‘choice’ in public health messages to young
people seems to have been strongly appropriated by par-
ticipants in this study (Shoveller and Johnson 2006). This,
however, clashes with some of the threats to their auton-
omy which they perceive in their relationships with adults
in face-to-face services. Text and telephone counseling
may be a particularly attractive option for young people,
allowing them to by-pass adult control and use these pri-
vately and retain their sense of autonomy. The involvement
of parents in counseling may be a particularly difficult
issue for young people and, for all its advantages (Kaslow
et al. 2012), may work against young people’s initial
engagement in a helping process. Psychological services
that the young person can access on their own, such as text,
telephone and school counseling may be particularly
important in facilitating their engagement.
The importance of the therapeutic relationship suggested
in this study coincides with the findings of other research
(Bolton Oetzel and Scherer 2003). In our research however,
the idea that the investment in relationships is also present
in text and telephone counseling is perhaps more surpris-
ing. It is possible that text may allow a more effective way
of establishing a relationship than in telephone counseling
where any changes in counselor are more disruptive. Text
counseling might also allow more space for participants to
imagine the therapeutic relationship they most desire
(Gibson and Cartwright 2014). In general the young people
seemed to value relationships that were closer to a
J Child Fam Stud (2016) 25:1057–1065 1063
123
friendship and challenged hierarchies of usual professional-
client relationships. A concern about the potential critical
judgments that may be made also seems to make the
anonymity of the text and telephone services particularly
attractive.
As other research has suggested, talking was also a pri-
ority for young people in this study (Midgley et al. 2014).
However, while face-to-face talking was seen as valuable,
participants also suggested the potential for new forms of
communication technology to offer different ways for young
people to express themselves, especially for those that find
face-to-face communication with adults too confronting.
In the context of a communication technology which
allows immediacy and flexibility in social arrangements (Ito
2005), it is not surprising that these expectations have flowed
into the participants’ expectations for counseling. It may be
useful to have approaches to therapy that allow for different
uses in both structured and more flexible formats. The data
also suggests those studying the cause of the high drop-out
rate might also consider that this is part of a ‘drop in drop out’
engagement process characteristic of adolescents. Services
which allow flexible routes back into re-engagement after
‘drop-out’ may be useful to young people.
This research confirmed many of the findings of previ-
ous research in relation to young people. However, it also
located these in the context of a changing social context
within which longstanding priorities for adolescents take
on different expressions and new possibilities emerge. This
suggested that in our current context young people may
benefit from a suite of options that facilitate their
engagement with psychological services. The availability
of ‘choice’ for adolescents may allow them to balance
some of the tensions they experience between their dif-
ferent priorities and concerns.
This research was limited by the unevenness of the
samples representing the different forms of counseling. The
fact that participants volunteered to talk about a particular
psychological service might suggest that the sample over-
represents those who are more positive about this service
and may exclude more negative views on the potential of
any to address young people’s priorities. The findings also
reflected the specificity of the New Zealand context, but
may have conceptual relevance for other similar contexts,
especially those in which the new communication tech-
nologies are being considered as a means to reach young
people. Comparisons between different samples cannot be
easily made on the basis of the small samples used in
qualitative research. This kind of research is, however, able
to highlight areas of potential difference based on an
enhanced theoretical understanding of how young people’s
priorities might play out across a range of different
contexts.
Future research might explore some of the thematic
areas described here in greater depth. Given the relative
newness of text counseling there is also much to be dis-
covered about how and whether this form of counseling
works for young people. Finally, it might be valuable to
conduct more systematic quantitative research with larger
samples exploring the extent to which young people
endorse the priorities described here and the relative
weighting they assign to these. If data on engagement
could be captured during usual clinical practice, this would
also remedy the potential bias in self-selected samples.
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