Digital mental health: locations and contexts in youths’ presentation of self in video consultations— a qualitative study

Abstract Background The long-established use of video consultation in mental health services has undergone significant historical development. This study reveals and discusses how video consultations influence youths’ presentation of self in video consultations and in different locations and contexts. This phenomenon will be examined in light of Goffman’s theory of frontstage and backstage in relation to the sense and impact of place, or placelessness, concidering mental health situations. The aim of this study was to explore whether and how therapy through a screen was experienced and to reveal challenges and opportunities that result from using digital tools to communicate in a therapeutic context. The study employed a hermeneutic-phenomenological approach to gain an understanding of youths' life-world experiences with video consultations in therapy. 33 qualitative interviews were performed with youths in the age between 16–23 years. The recruitment was carried out between mid-august 2021 and end of march 2022. All had participated in VC sessions with their therapist during the COVID-19 pandemic. The analysis followed an abductive approach, where iterative cycles between the empirical data and theoretical framework helped uncover both unexpected and novel insights into the youths' experiences with VC. Results The findings revealed two main themes to guide our investigation: 1) therapy through a screen versus F2F therapy and 2) different physical contexts for therapy through a screen. The findings show that youths’ experiences with the use of video consultations in therapy are diverse and heterogeneous. Conclusions Face-to-face communication may reduce ambiguity and uncertainty through the use of body language and eye contact. Face-to-face communication requires less cognitive effort to process and involves greater psychological distance than digital communication. The advantages of using video consultations include avoiding school days, avoiding long travel distances, connecting faster when needed, and having shorter conversations to catch up on challenges in collaboration. The implications of location and context may also impact youths’ presentation of self.