N = 42, ageM = 13.5, SD = 2.3), parents  and teachers  from the UK. Data were analysed with thematic analysis. Findings focused primarily on social media use impacts and indicated that processes underlying impacts experienced by adolescents may be conceptualized on a severity continuum. Stakeholder consensus on perceptions of challenges and perceived harms formed the second theme, with impacts further analysed as relating to time displacement, peer judgement, sensory overload and context of the adolescent with functional , cognitive , and emotional consequences . A third theme formed was individual vulnerabilities predisposing poor mental health outcomes. The final theme related to impacts dependent on context and meaning attached. Findings suggest a consideration of a spectrum approach encompassing a broader range of potential psychological challenges and perceived harms beyond safety concerns and addiction in understanding problematic adolescent online experiences. Understanding perceived harms can aid the objective setting of interventions and consideration of mental health literacy in school curricula.Evidence suggests that problematic use of gaming, the internet, and social media among adolescents is on the rise, affecting multiple psycho-emotional domains. However, research providing a comprehensive and triangulated stakeholder perspective of perceived harms is lacking. How are adolescent online harms experienced and conceptualized by students, parents, and teachers? The present study comprised part of a qualitative needs assessment investigation with the use of focus groups and individual interviews among key stakeholder groups assessing perceived impacts with a focus on the negative consequences and perceived harms. The study’s sample consisted of students ( Children and adolescents are increasingly engaged in technologies primarily to gather social capital, maintain constructive interpersonal relationships, and seek help online . Time spThis rise in mental health needs is fuelled, in addition to large socioeconomic and individual factors, by exposure and higher prevalence to social media , which iDespite social media addiction not being a legitimate clinical entity and, to date, a debatable psychological construct , there aPsychological harm can be defined as impacts on an individual’s well-being and psyche . The litEvidence regarding problematic internet use among adult populations refers to many different activities  with age being a significant moderator for the majority of these activities . In the Recent evidence has expanded the scope of inquiry into specific behaviours associated with problematic outcomes beyond time spent engaged in the activity: compulsive texting and diminishing academic performance ; daily iIncreasing concerns over online harms have given rise to a number of governmental and non-governmental bodies’ responses. For example, in the UK, concerns over children’s vulnerability to harmful content  iteratedThese governmental approaches for stronger intervention have been complemented by initiatives from charities and non-profit organizations to support educators, schools, and other stakeholders on media literacy efforts with a governmental intention to coordinate all these activities, assess areas of duplication and overlap, and coordinate a country-wide media literacy strategy and an overarching statutory duty of care . The UK Facebook data have confirmed a direct association between frequency and intensity of positive feedback in the form of likes with perceived well-being  can use it wherever they are, without the parents knowing what they are doing. But when I was a kid, doing a bike ride, I had to say where I had been. So there is probably an element of creating their own space a little bit” “.Teachers also referred to social media affordances of creating social spaces where adolescents expressed themselves and exercised autonomy, free from parental supervision:For introvert girls, gaming can be quite positive, the girls who are a bit autistic, we have used games like Minecraft, we have used the DS [Dual Screen] game, Brain Training, there is a place for that. But this is not like gaming with strangers or stuff like that. That has helped some girls who are introverts, because they don’t do social things, school can be very noisy for them and lonely, and it is hard for them getting the balance” “.Games, on the other hand, were viewed as offering positive outcomes overall for adolescent normative and atypical development and learning and for children faced with developmental challenges.However, apart from benefits, all stakeholder groups expressed negative impacts for adolescents on all domains of life—interpersonal, social, and academic. Therefore, challenges and harms formed the second theme.Phones have replaced the booze and drugs” .The second theme focused specifically on consensus on impacts and harms between various stakeholder groups. These were conceptualized forming four main sub-themes: (i) time displacement impacts, (ii) peer-judgement impacts, (iii) sensory overload causing hyperarousal, and (iv) context-related impacts. Impacts were perceived as having functional , cognitive , or emotional consequences  experienced both on an intrapersonal  and an interpersonal level . More specifically, perceived harms identified were primarily psycho-emotional and less safety-related , with a Time displacement impacts. Excessive time spent online was a primary preoccupation amongst parents and teachers. Students admitted spending more time online than they thought or planned for, but did not share the same preoccupation with parents and teachers over the loss of time spent on social media.Before I used my phone way more than I do now, until it was taken away. I still do now but I now notice how much I am using it. I had not realized how much I was using it, I thought I truly need it but I do not actually need it that much, it is a bit of a hassle when people send you stuff and get more catty about it and then you get it back and you are on the same pattern again” “(FG1F5).I literally use it excessively, like I do not go off my phone” “(FG6F3).It is taking time from other activities that they could have been doing, the motivation for doing other things that are fun has really gone down” “.Teachers perceived that time spent online displaced time spent on learning (Theme 1) and therefore, as potentially detrimental to academic achievement and counterproductive, but also at the expense of fun face-to-face engagement:Where there is something more interactive, to the field doing some research, you can see some of them, not all of them, they are just soooo bored and it is because they are not getting that instant gratification, there is nothing really dramatic happening…So they need these intense experiences. I have to be like an entertainment system, I had to change the tasks to make them work better but still their concentration is eroding” “.Similarly, constant stimulation from the platforms  was vieThey are so distracted in the classroom” , either in the form of internal cues (thoughts regarding online content preoccupying an adolescent) or external triggers . Concerns were expressed for the role of smartphones in distraction and the loss of focus being driven by increased social media use levels, Fear of Missing out (FoMO), nomophobia (NOMO) and online vigilance:Smartphones are a cause for distraction.. I have been looking at a lot of stuff to help them with revision, helping a lot with the studying and the best thing is ‘put your phone away, disconnect, come offline, have it timetabled in. As a parent preparing for GCSEs there was a difference with their mood, taking their gadgets away, it was still vibrating and it is the FoMO, so it does cause a lot of distraction and anxiety they have FoMO” “.Time displacement concerns raised by stakeholders related to distraction; “I find it irritating that I have to say to my son, ‘you have to put this down and do your homework’ and he says ‘I want to have a quick look at my messages’, so that is an issue and I suspect that is an issue for parents of girls as well” “.Parental accounts of distraction leading to loss of time from refraining from other more productive activities  and concurrent use while doing homework was viewed as both facilitating information search, but at the same time leading to loss of productivity. Parents believed there is a lack of knowledge and emotional readiness to block out distractions:Some students are really lethargic at times, and I don’t know if that is linked, probably it is linked to their phones, they’re not eating or sleeping properly” “.When we have meetings about achievement we ask, ‘Do you have your phone with you when you do your homework or when you go to bed?’ and a lot of the time it is because the girls are underachieving and when we ask the parents if the girls have the phone with them when they are doing homework, they have access to it and at night” “.Additionally, late sleep onset due to access to devices and poor sleep quality along with lack of physical activity and displacement of sports were primary concerns amongst adult stakeholders, but not student groups. Students instead perceived that lack of extracurricular activities led to more social media use to alleviate boredom. According to teachers, lack of sleep caused by use of devices prior or during bedtime was viewed as impacting daily performance in school. This appeared particularly difficult to control because adolescents appeared adept at deceiving parents utilising devices during bedtime.A key parental concern with social media was the struggle to use social media in moderation, which also formed an adolescent concern. Issues relating to overuse were prominent in all accounts, acting as key drivers for adolescent engagement, such as FoMO, or NOMO, constant checking of content and overreliance on reward-seeking behaviours. Addiction was viewed as only affecting a minority of students.Peer judgement impacts. These were both intrapersonal and interpersonal in nature. A major intrapersonal impact was related to anger/aggression and exposure to negative peer evaluation, social rejection or exposure to varying degrees of hateful content. Fall-outs within friendship groups were perceived to be a regular phenomenon arising from heated interactions, leading to miscommunication on chats or from lack of social skills online, resulting in inappropriate or insulting language. Teachers responded to hostile behaviours by encouraging students to reflect on such behaviours:I think it is already an issue and we address it from as early as Year 7 and we had discussions...the kind of: ‘Let’s put you in that person’s position.’’ If you say something online and it is not very kind, how would you feel if that person said it to you?’ And I don’t know whether that calmed things down or not but we did have a situation, we also sent out letters to parents along those lines and explained that we had got some issues and I needed to be talking about this because there were students that were really upset about things that were happening to them” “.an echo-chamber of emotions”  which in late adolescence was perceived as also being amplified by substance and alcohol use. However, teachers reported observing backlashes when students viewed hurtful comments. In specific instances, aggressive behaviour was treated with students deleting their own accounts in response.In a chat situation, you have girls who might have sent the message but thinking that is really nasty and think ‘I am really glad that is not me’….It is bullying no matter how you look at it, so there is an emotional side to it….in fact emotions drive all of it, anger wanting to be ‘leaf of the pack’ all those sorts of things. I think it is driven by emotions, like on Facebook, people put emotional comments, statuses, and obviously as the girls get older, it can be driven by alcohol. So for example, [Years] 11,12,13 is a whole different thing going on, so then they are driven by substances as well.” “.One teacher referred to social media as being “I deleted my account and I am finding it great. I am going back home and I don’t have to worry about it” “(FG1F2).Deletion from a group chat was viewed as liberating, particularly to female adolescents.I think girls take things quite personally, so if somebody puts a picture on their wall or says something and the problem with texting is that it can be misinterpreted…there are natural problems with girls anyway, a lot of fallouts, once a girl takes a photo and puts it on Instagram, and that makes the person upset, if it’s not the flattering photo, so it’s actually like bullying, well I suppose it is a form of bullying and bullying is kind of gone outwards now, in that it is going on the internet” “.It is quite explicit what they send online and once a young girl masturbated for a boy online and he asked for a video, there was a lot of awareness. It was a big thing” “.Therefore, aggressive behaviours emerged as a theme from and being displayed in various intensities, from milder to more prevalent and direct. Friendship fall-outs and aggressiveness on social media were viewed as relating to online disinhibition—the anonymity and lack of direct face-to-face communication facilitated in the online environment unleashing a negative attitude—and prompting misinterpretation. Gender-related differences  rendered gender-sensitive reactions to communication online, which impacted differentially:Young people playing, saying obscenities, horrible things with the characters and laughing about it—I can see a bit of that bullying over in the schools” “.Hostile behaviours were perceived as being highly prevalent also in gaming.loss of focus on the experience in the moment”  was perceived as being at the expense of the experience. Parents and teachers suggested that children were overly concerned with capturing the moment rather than living it, stripping experiences from emotional investment and encouraging idealistic strives and sinister behaviours.I think anxiety, depression, eating disorders, all that is a big thing and if you look at mental health and young people through the internet, online use can contribute to that to perform in a certain way, to be clever, to be beautiful, to be sinister all that” “.Phones and technology have the same kind of blocking effect to mental health like drugs and alcohol do. If someone is feeling anxious that might take some drugs or drink, whereas children might feel anxious and might want to take their phone. Obviously [the internet] is not so sinister like drugs and alcohol but it has the same kind of effect, a blocking effect.” “.An additional common concern amongst stakeholders related to self-representation on social media. Images were perceived as particularly impactful on adolescents with unhealthy and perfectionistic strives and pressure for flawlessness causing distress, low self-esteem, low mood and negatively influencing body image. Preoccupation with image curation for popularity and potential body image concerns/dissatisfaction were expressed. Additionally, an excessive emphasis on selfie-taking and the “Finally, contact risks involving risks of disclosure of personal information and exposure to pornographic or other harmful content  were discussed primarily by parents and teachers.Sensory overload leading to hyperarousal. Constant connectivity was also considered as leading to social and information overload and hyperarousal by all stakeholders, but primarily by adults partially influenced by multitasking. Adolescents perceived the constant flow of information and communication, but lacked experiences to make a comparison given they have grown up in the digital era. This was viewed as forming a vicious cycle, not allowing for periods of rest or reflection on the behaviour:I think there is this flood of a stimulus…When I was home, that exposure was not there…When I was young it was like don’t walk out in the dark, but now it comes to you in your home” “.We are the anxious ones, trying to protect them, give them time off it, just for their brain when they get in a difficult situation at school, that still happens. When we were younger, you went home, you may have told your mum. Then the next morning you still got a bit frosty, whereas now something happens everyone thinks it is their own business. They tell and then they fabricate and then someone from the school across the road says something else, and then from another school and no-one knows what is happening, and the young person does not have time to reflect on what is going on, it is just a constant thing” “.Context-related impacts. The most prevalent context-related impact perceived by parents and teachers was the constant checking of devices, which appeared to interfere with homework. In pursuit of instant gratification, adolescents experienced loss of sustained and uninterrupted periods of concentration and focus. The use of devices to facilitate or execute homework was a reality for many of the students. However, social media interactions were perceived as interfering with primary tasks that adolescents were unable to avoid or resist.In the meetings with girls, if the phone is there in front of them and of course they cannot leave it. They have to have it because of those strikes because they need to maintain them, so many dares, to buy likes, ‘Who likes me or my picture?’ so they are afraid to lose sight. I have had to take off phones from girls at school time to put them away because they are not allowed” “.I think there is no balance, just generally. Children sleep with their phones next to them without realizing. This is one of the first things they do when they wake up so I think just in general there is a lack of balance” “.Over-reliance on online communication at the expense of offline, lack of physical activity or gradual displacement of sports or activities, and gradual loss of offline social skills were primary concerns amongst parents and carers, including sedentary lifestyle (poor diet and risk of obesity). Constant availability and access to new content and feeds, the multiplicity of social media channels, and the presence of “online audiences” were discussed by parents and teachers as increasing the social pressures placed on adolescents and leading to lack of balance. Due to the increasing accessibility and use of tablets as educational tools, boundaries between education and recreation were viewed as blurred. Another context-related impact was the rigid expectations for instant reciprocation and emotional ambivalence or experience of distress over delayed responses, difficulty in setting boundaries in online relationships and lack of confidentiality and privacy.Being online they ruminate a lot and they get quite low mood and girls tend to empathise and sympathise so I would say there are a lot of positive things but also a lot of negative feelings” “.Μy big thing is the emotional side, and what it does to their body. There is anorexia, bulimia, everything how they perceive themselves and the world…These things have affected and worsened their emotional health and well-being” “.Actually, I think it impacts self-esteem negatively. The irony is with ‘likes’ [is that] it should boost self-esteem, but actually it has the opposite effect on it. So it brings low self-esteem. Also lots of games and apps are designed to release the endorphins. It’s like a high, so you’re potentially giving these to children, all these highs constantly, and you are matching that by continuing it. So, it is like they’re addicted to it unfortunately” “.As a result of the online pressures experienced, psychosocial correlations associated with online challenges comprised three categories: first, internalizing/externalizing behaviours with mood shifts because of media feeds; second, stress, anxiety and rumination ; and third, depressive symptoms arising from social comparison to experiences of others, self-blame and internalization of poor self-image resulting in low self-esteem and compromised self-identity. These vulnerabilities were perceived as triggered by social media and online features  and associated with mental health.I don’t think it gives poor mental-health, I think it triggers it” “.Self-harm, a lot of copycat behaviour. It is a big problem changing this, or have a problem with the sexual orientation. You don’t know there is so much, just complete overload. They self-harm and this makes them feel better temporarily and then they feel guilty and then goes a consistent cycle” “.The older students still having that lifestyle of playing too long and not sleeping properly and letting it affect their relationships. That is when they get in the deep because with ‘A’ levels [advanced school qualifications] that is much harder to do” “.Striving for perfection in own-generated content and images (airbrushed photos and reassurance of likes) was considered a key behaviour on social media generating unhealthy and maladaptive perfectionistic strives and pressure for flawlessness. These maladaptive cognitions were viewed as triggering anxiety or other emotional and mental health problems. Self-harm, body image concerns, and eating disorders were viewed as being on the rise and exacerbated by the use of social media, creating a vicious cycle of fall-outs. Habitual usage behaviours were also viewed as difficult to break in late adolescence:It might not be wrong but it comes across this way. Its all about how It’s interpreted.” “(FG2F2)The fourth theme comprised impacts, which could impact adolescents’ psychological state both positively or negatively depending on the context and meaning attached, but also striking the right balance. One such example was self-expression and freedom to set boundaries:Read more of this and no more screen time and if you are still awake you can read a book- but she will always try to break the rules” “.Self-expression was reported as a source of positive emotion for the majority of the participants, but also associated with fear concerning negative comments or negative peer evaluation. Another domain was expectancies related to online activities, which could be rewarding, but if transferred to offline contexts and life domains could lead to frustration . Increased freedom and possibilities for connection to unknown others was viewed by children as a source of opportunity to make new friends; however, it was characterized as high risk behaviour by parents or opportunities for rule breaking:Now all is so much more amplified, emotionally, particularly girls, I have seen E. cry, very emotional, very upset. I mean it is a difficult age. Anyway it’s just giving them technologies, one more thing to do with alongside with the hormones” “.Interacting socially online could be a source of support and connectedness, but could also result in the experience of negative emotions from feeling left out or disconnected. Those situations and the perception/interpretation of the situation were viewed as resulting in mood shifts, elevation or deterioration of mood:The present study examined stakeholders’ perceptions on impacts experienced by adolescents from their digital use. Findings corroborated challenges and harms evidenced in the literature ,123,124.There were no stark perceived differences in the conceptualization of harms across stakeholder groups . Context-related impacts were the least mentioned by adolescents given the lack of alternative perspective . Themes therefore appeared common in adolescent, parent, and teacher accounts. Parents and teachers presented a more generalized concern for the impacts and potential harms and stressed the contextual  and time displacement aspects of adolescent online activities  potentially due to them being the most tangible in nature and particularly given the heightened expectations during adolescence for academic achievement and its implication for occupational attainment . TeacherThe first theme comprised the conceptualization of online user experience as fluid and non-hierarchical across adolescent, parent, and teacher perspectives with positive, neutral, and negative experiences. User experience fluidity was a result of individual, social, and environmental forces as supported by the control model of engagement . TherefoThe second theme referred to stakeholder agreement on the nature of the impacts. Accounts were organized in a taxonomy of time displacement, peer judgement (content), and context-related impacts reflecting cognitive, emotional, and behavioural dimensions, consistent with prior evidence . Time diSpending more time online has been associated with problems in delivering daily activities and social interactions . DistracPeer judgement-related harms referred to aggressive and abusive communication, issues of self-representation and social rejection, cognitive rigidities associated with harms and addiction correlates, consistent with previous evidence [evidence . Gaming evidence . Accountevidence  or as anevidence , appeareevidence . Emergenevidence ,159,160.Self-representation problems, perfectionistic tendencies, and rigid expectations for instant reciprocation and for immediate rewards were also prevalent in stakeholders’ narratives. Research on self-representation and negative comparison has highlighted associations of social browsing on post-browsing negative affect, whereas awareness of image curation may act as a protective factor . AdditioSimilarly, psychopathological symptoms and negative consequences of social media use via smartphones have been influenced by FoMO and intensity of social media use , whereasContext-related impacts related to the effects of difficulty to set boundaries in online engagement or inability to find a balance between offline/online activities and patterns of use  leading to sedentary lifestyles. Issues related to sedentariness, such as poor diet and less exercise, combined with higher frequency of accessing devices and content contribute to the development of physical and mental health problems ,173. DisThe third theme discussed the correlates of those impacts, such as anxiety or depression or internalizing behaviours, emphasizing the scope of digital impacts and potential associations with mental health disorder symptoms. However, the direction of the relationships remains unclear ,177, as There is a consistent relationship across studies between cyberbullying and depression among children and adolescents ,181. ShoLimitations of the study include its small purposive non-clinical sample from one geographical area of the UK focusing on a specific developmental group, which compromises the generalizability of the findings. Exploring impacts and harms from a developmental and cross-cultural perspective or in vulnerable adolescents from youth mental health services could provide insights about universal themes and issues affecting children and adolescents. Additionally, parents of children with mental health difficulties could provide a different account about the contribution of social media in the adolescent and family life context. These insights could inform prevention programmes and media literacy curricula in an evidence-based manner, relating to the challenges adolescents encounter . Second,The present study assessed online impacts and focused on harms experienced by adolescents from a combined stakeholder perspective, providing insight and highlighting the commonalities and the differences in the perspectives. Drawing away from binary conceptualizations and embracing a spectrum perspective of psychological processes related to impacts may have important policy and prevention implications in the design of media literacy education programmes, school policies, and parental and teacher mediation. There is a need for theoretical synthesis and development of theories that account for negative impacts in normative and at-risk use, as current explanatory models focus primarily on the addictive potential of social media and technologies, but do not account for other behaviours along the continuum, such as cognitive or metacognitive impacts potentially responsible in problematic online engagement . ContinuResearch suggests that adolescents greatly benefit from the online environment, but that a minority also experience psychological challenges and harms. Understanding stakeholder conceptualizations—student, parent, and teacher—for online-related psychological harms experienced by adolescents was sought in order to develop a more coherent understanding of perceived impacts and potential harms as perceived by each stakeholder group. The findings of the present qualitative study identified positive but focused primarily on the negative impacts experienced. Adolescent online perceived challenges were conceptualised by stakeholders as running on a severity continuum from benefits to harms. There were no stark perceived differences amongst stakeholders in the conceptualization of harms; rather, differences pertained to the extent, severity and quality of social media use. Impacts were conceptualized as running on a continuum from positive to negative uses and their severity depending on the role of social media and gaming on the overall context in an adolescent’s life. Moreover, negative impacts across stakeholder groups were conceptualised as (i) time displacement impacts, (ii) peer judgement impacts (content) and (iii) context-related impacts. Concerns spanned various domains of functioning from physical , psycho-emotional , and cognitive , affecting both the individual and relationships on both an interpersonal and an intrapersonal level.The findings, therefore, suggested heterogeneous challenges and potential harms—beyond e-safety and the risk of addiction—related to emotional health and depending on personal circumstances and vulnerabilities, which may contribute to poor youth mental health and well-being. Therefore, the need for emotionally healthy schools endorsing positive mindsets and addressing these adolescent challenges requires an urgent response. Stakeholder consensus about perceived harms constitute a first step in developing an understanding of the concerns, which could be embedded in harm prevention efforts and skill development in interventions.


Online therapy has increasingly been utilised during the COVID-19 pandemic by many, including working populations. However, few qualitative studies have explored how online therapy is experienced in practice and discussed its implications for those working clients. Semi-structured interviews attended by nine integrative psychotherapists practising in California, the United States, were conducted. Thematic analysis of the transcripts identified three themes: (i) ‘Positive experiences of online therapy’, (ii) ‘Challenges experienced by therapists and clients in online therapy’, and (iii) ‘Preparation and training for online therapy’. Online therapy was assessed as being helpful, particularly in terms of mitigating against previous geographical and temporal barriers to uptake. However, due to technological disruptions and potential blurring of professional boundaries, online therapy may detract from the emotional salience of therapy, negatively impacting the therapeutic relationship and containment. Considering these positive experiences, participants expected that the demand for online therapy would continue to increase. Particularly in the occupational context, online therapy can offer interventions without fostering shame regarding mental health. The findings provide preliminary qualitative evidence that online therapy can be a useful adjunct to traditional forms of face-to-face therapy. However, therapists require more explicit training in implementing online therapy. Results are discussed in particular regarding the utility of this therapy for working clients. In 2013, the American Psychological Association published ‘Guidelines for the Practice of Telepsychology’. Analogous to this, within the UK, the British Association for Counselling and Psychotherapy (BACP) recently published good practice guidance for therapeutic working online  was not part of my master’s program or my supervision. It’s something that I’ve learnt more about, now that I’m doing it since COVID. … and it works! And it’s better than I thought it was going to be.Participant 7: Until August, I was thinking of online therapy as a poor substitute for in-person [therapy], and a limitation. … I think that there is a slight decrease in presence within therapy, and the quality of work I can do in this medium. Lately, in the last couple of months, I feel as I’ve settled more into the pandemic life in general, and also because I had some new clients come in and I’ve had some successes with them […] I’ve been considering more possibility of just maintaining an online practice for a couple of years, especially if I move. I notice myself being more open to it.Participant 5: I see [online therapy] as an adequate substitution. It seems to be working okay, and in that sense, I feel really grateful that I can keep working.In addition, some technological benefits were acknowledged for the quality assurance, including supervision as well as the development and sharing of therapeutic knowledge within therapists’ professional network and training .Participant 3: I think it offers some additional benefits in terms of the digital technology, like the ability to record. That can be used for quality purposes, for supervisory purposes, to enhance the experience of the provider, knowledge. Some of the other technology-related benefits are being able to take notes, share the screen, show a video on the spot, certain things that we can always do by ourselves, but that can be a part of the shared space in therapy.Participating therapists also reported positive aspects of online therapy from the client’s perspective, including geographical and temporal flexibility, increased access to therapy, increased number of providers  and reduced costs (T1-3: Accessibility).Participant 8: I think that online therapy does help with access to care because some people who, for example, don’t have childcare and they need help, but they can’t get away from home, they’re more easily able to access services or they’re able to find low-cost services. There seems to be more opportunity and availability online because they can be seen by providers from all over California instead of their town. So, I think there are some good pieces regarding access and equity and fairness.Participant 3: The biggest benefits, I think, are the obvious ones: the flexibility that you have, the possibility of doing therapy from your own home, well, from both ends. It increases flexibility from the provider and the client. […] It’s shifting the landscape of therapy, and it’s coming on the heels of the movement where mental health is becoming a recognised field and an important aspect for the masses, not just the traditional psychoanalytic thinking in the Victorian times where patients were from higher socioeconomics. So, there’s that—the shifting in landscape where therapy is becoming more mundane, more accessible. Online therapy has accelerated it.Online therapy is the only option for some clients due to geographical limitations  or other circumstances (such as illness or caretaking/parenting responsibilities). These aspects are particularly important for clients in employment who, in the past, did not have time or lacked geographical proximity to attend face-to-face therapy:Participant 7: [My patient] was living across the bay from me, and she’s a mom also, so with traffic and parking and everything, it was taking her between 60 and 80 min to get here. So, for her it was really just like, “I can’t do this for therapy”. I think if she hasn’t had the online therapy, she would have probably stopped working with me.Participants also offered some interesting reflections about having more control over the therapeutic situation and being less affected by potentially difficult and/or negative therapeutic experiences with clients (T1-4: Control over therapy).Participant 7: If somebody’s got a lot of energy, you can shrink the window a little bit. You can turn down the volume if someone’s voice is very abrasive. And I actually am somebody who gave up on doing couples therapy, because I find that my system, my body cannot take the amount of stress and conflict that couples bring in. Like, I just want to shut down and run away screaming! So, I have actually recently thought about doing it online because I’m not feeling that tension with my body.Overall, participating therapists evaluated online therapy more positively than expected (T1-1), and reported several advantages related to the quality assurance , increased accessibility from both therapist and client perspectives (T1-3), and having more control over therapy .The most significant limitation of online therapy identified by all participants is limited physical contact and body language, both of which can be further diminished by technological disruptions (T2-1) . This was found to have a direct impact on the development of therapeutic relationships as well as containment processes (T2-2: Lack of containment).Participant 1: When there are glitches with technology, it definitely affects the sense of containment. It is hard to rewind and get back to where a client had been, or what they had been expressing after a disruption—especially if they were crying.Participant 3: [The fact] that it requires the technology itself, it’s not equally accessible by everyone who may not have the bandwidth for the required Internet speed, good Wi-Fi, computer, some knowledge of how to set up lighting around the cameras and some technical aspects that are, you know… it falls on the provider and the client, as opposed to coming to a room where things are set up and we all kind of know how it works.Participant 9: I think that clients who have trauma [experiences] struggle more. They have a hard time to be present. Some people have more [expression] through their body language, so they need a more solid atmosphere.Participant 6: [Therapy] feels less of a ritual… How to replace it? … I can’t control how the client comes into the session, how they’re sitting, their environment, distractions. For me there’s something sacred around the container and the preparation, and so I can both prepare and have my surroundings. I obviously have less control over the client [now]. I notice it a little bit more now and so I think it’s important to do what I can do from my end to hold that.Some interesting observations were revealed by the participants about challenges caused by the blending of the home environment and the digital therapeutic space, which include disruptions from family members during therapy sessions, other technological interruptions , lack of private space, and client behaviours that would not ordinarily occur during physical (face-to-face) sessions (T2-3: Disruptive environment).Participant 8: With my teenage clients, I think that they don’t have as much respect for the therapy… [It’s] not the kids, but the parents will come into the room and say, “are you talking to [participant name]?”, and they’re like “yeah”, and then the [parents] will say something like, “ok, well, when you’re done, I’ll need you to do the laundry”, you know. … there’s more interruptions not only from their environment, their phones and whatever, or their cat or their baby, but also from other people living in the household who are reminding them of chores or whatever, so it’s harder to maintain focus.Participant 3: I have noticed that clients from lower socioeconomic backgrounds tend to experience more distraction. I can give you some examples of what I mean: people who often do therapy in their cars are usually from poorer socioeconomics, which means less time, and they often quite literally don’t have the private space.Participant 7: I had a client who… She will drink alcohol, she will have a cocktail or whatever, during the session… And that would just very rarely happen in your office. But if they’re home, and their fridge is right there, and it’s a time where they would kick back anyway, then this seems more natural to have a drink when you’re talking with a therapist. That was definitely surprising to me, to see that there’s a blending between someone’s home life and their therapy appointment. […] In that sense, the container-ontained relationship is out of control.Several participants noted that online therapy is not suitable for clients who suffer from severe psychopathology or mental health distress  (T2-4: Severe psychopathology), because they require greater contact and containment that cannot be facilitated via online mediums:Participant 8: I feel like right now I have a client who wants to transition to [face-to-face] psychotherapy because they are too severe, but because there’s this force to be online, I feel like one of the issues is that not everyone is well-suited for this mode of therapy.In sum, the participants reported that technological issues (T2-1) could negatively impact the containment of the therapy (T2-2). Moreover, they noted that some clients were not in an ideal environment to engage in therapy (T2-3). Because of these challenges, they perceived online therapy not suitable to treat severe psychopathology (T2-4).All participants reported having only had minimal or no training for online therapy prior to the pandemic (T3-1: Lack of training).Participant 2: I received zero training, even though I would have liked to receive education on online therapy. For example, what about privacy? Containment in the room?Some of the issues identified in training for online therapy include a) lack of documents, surveys and scales for online sessions; b) lack of technological guidance (for both clients and therapists); and c) lack of guidance on how therapeutic relationships and outcomes can be addressed in online therapy (T3-2: Lack of guidance).Participant 8: I’ve had to make certain documents online because they previously [didn’t exist] […] for example, certain anxiety, depression, relationship, satisfaction, mood surveys that I would typically do as a check-in just before the session with the clients to get the baseline of their functioning. The first two weeks of being online I couldn’t get them because there was no way to administer them. So, tools had to be developed specifically for online therapy.Participant 5: I think that it would be really helpful just to understand what is exactly being expected from you and what are the differences between [online and face-to-face] therapy.Participant 3: I still feel like there is a lack of more nuanced aspects that I was trained about in-person, for example, observing the space, the container of where you are with the client, the quality of the presence. We didn’t get too much into that when we did the training, and I think that’s generally very important. […] Similarly, I wish I have been taught the ground rules more from the beginning to asking about the address, you know, those tips like: make sure you check with the clients that they’re in a private space, that they do not have any distractions, even other screens, phones, things like that. It’s just not natural for people to do and I think they make a big difference, if you know this from the beginning and set it up. You avoid disruptions and the general loss of the quality.In order to mitigate the lack of training and experience in online therapy, some participants joined an online community of therapists; however, more support is needed (T3-3: Need for a helpful online community).Participant 8: When working online, I found it more difficult to do consults with other therapists because in real life you’re in an office and you can say, “hey, can I ask you a question about something?” or “do you have this resource?”. Fortunately, there are online consult groups that I am a part of, but there is that missing component of peer support. It’s more difficult online.Lastly, some participants highlighted a need for a careful evaluation of online therapy while recognising the potential of this form of therapy .Participant 3: Online therapy is shaking up the field. Because a lot of people that could not access therapy can now access it. The rules of the language of therapy are changing, and it opens up the field for new interpretations. I do not think we know yet how digital technologies will change our consciousness, and how we manipulate it for therapeutic benefits. Much like we do not see how complexity of narrative is changed over digital technologies.Taken together, the participants did not feel that they had had enough training (T3-1), nor that helpful guidance was available (T3-2). Though some of them accessed an online community of therapists, more support was needed (T3-3). Additionally, a need for empirical evaluation of online therapy was suggested (T3-4).Since the beginning of the COVID-19 pandemic, the use of online therapy has increased rapidly, and working populations have utilised this form of therapy and received its benefits. However, the existing research primarily focused on clients’ perspectives, missing an understanding of how therapists perceive and experience online therapy. Accordingly, we aimed to (i) examine the perception towards online therapy, (ii) offer suggestions for future practice, and (iii) discuss how employees can benefit from online therapy. Our analysis identified positive experiences (T1), challenges (T2), and preparation and training (T3) relating to online therapy (Aims 1 and 2). The participating therapists perceived online therapy positively, reporting more utility than expected (T1-1) relating to factors such as quality assurance (T1-2), accessibility (T1-3), and control over therapy (T1-4), while noting some challenges, including the technological disruption (T2-1), a lack of containment (T2-2), disruptive environment (T2-3), and unsuitability for severe mental illnesses (T2-4). A lack of training and guidance  was noted by the participants, indicating a need for a more helpful online community and the evaluation of online therapy  in the future. These findings are discussed below, regarding clients in employment (Aim 3).One notable finding of our study is that, although the participating therapists felt that they had not been trained enough in online therapy (see T3), overall, they found it helpful and were willing to continue using it (see T1). In addition to their positive experience, they also reported the advantages of online therapy from the client’s perspective relating to time, location, and costs. These components contribute to the accessibility of online therapy, which may be particularly helpful to busy clients. During the pandemic, many employees were forced to work from home, yet online therapy offered access to treatment for these clients. Considering the increased rates of mental health problems in the workforce during the COVID-19 pandemic ,37, the Moreover, many therapists showed an intention to continue using online therapy, which can have implications for clients, including employed clients. For example, shame regarding mental health problems tends to be high in many occupational groups, reducing help-seeking in this population ,8,39,40.While highlighting the positives of online therapy, challenges were also reported (see T2). Technological problems, including a lack of digital skills in therapists and/or clients, are among them. An unstable internet connection can disrupt the flow in a therapy session, negatively impacting the therapeutic relationship and outcomes. Moreover, while many clients can benefit from the flexibility of online therapy, some clients are not equipped with a good environment at home to focus on therapy . Alternative approaches for this population need to be considered. Therapeutically, the participating therapists noted the limited view of the client as a challenge; much information can be received from the physiology , which is often excluded in online therapy. This type of information is particularly important when treating a client with severe mental health problems ,44, and There are several limitations arising from this research project, which are important to note. First, as with all small-scale qualitative projects, the data and findings contained within this project cannot be assumed to be representative of larger therapist groups. Indeed, this study was conducted in California, US, with a particular social and cultural representation of what online therapy is (or is not). More diverse and larger samples are needed in the future studies. Nevertheless, the themes arising from this study will be of interest to therapists and clients from a broad range of backgrounds and will give insight into ways of working therapeutically online. Second, as the therapists have been drawn from a wide and eclectic mix of therapeutic orientations, each with sometimes diverging conceptualisations of therapy, there is limited sample homogeneity, which has prevented the in-depth exploration of therapies in depth. Third, due to the nature of study recruitment, the sample was self-selecting: participants who took part likely had stronger views of online therapy. This has likely impacted the study results. To counter this, further studies which use a quantitative and larger-scale study design will be useful in exploring in further depth some of the initial themes generated from this study.The demand for online therapy due to the COVID-19 pandemic is expected to continue to increase in the coming years. This study reported the first-hand experience of online therapy from the professional therapist’s perspective, regarding the advantages, challenges and workplace implications. While noting the small sample size, the findings will help (i) therapists refine their future practice, and (ii) working clients and workplace leaders to consider helpful applications of online therapy to improve individual and organisational mental health outcomes.


Bonsai art refers to the cultivation of a miniature tree. This study was motivated by the hypothesis that bonsai art may also be an ecopsychological, therapeutic practice that can have meaningful healing qualities. An international online survey elicited the meaning of bonsai art for 255 skilled bonsai practitioners. Questionnaires and interviews were used to elicit the experiences of participants. The findings supported the hypothesis that, for skilled practitioners, bonsai art was associated with meaningful healing experiences. In particular, the evidence suggests that bonsai art facilitates improved ecological, spiritual and emotional awareness, as well as various healing dimensions, including aesthetic creativity, resilience, adaptability, and social, physical, and personal health. It is viewed as an intervention technique that requires few resources, is easy to apply, and has a minimal impact on any environmental setting. The conclusions drawn point to the ethically sound health promotion value of bonsai art in various settings, such as psychiatric hospitals, retirement homes, rehabilitation centres and prisons. Recently, practitioners have endeavoured to combine psychotherapy with ecotherapy  using noEarly ecopsychologists believed that people need to reconnect with nature, and ecopsychology has gained popularity because it reconnects people with the wider natural environment, thus enabling them to lead more meaningful and fulfilling lives ,4. EcothTo heal is to make a person whole, to transform them from illness to wholeness, from disintegration to integrity. There are various forms of health: physical, personal, interpersonal, social, ecological, and spiritual. There are also different types of energy, which not only correspond to dynamic, human, social, and behavioural patterns, but also respond to correlated environmental resonant frequencies . This stIntegral health depends on the harmony of nature, consciousness, body and soul. The purpose of bonsai is to create a miniature version of a full-size tree in nature. The art of bonsai requires specific skills related to explicit philosophical, horticultural and artistic styles and rules. The skill, effort and creativity of practitioners are rewarded with renewed growth, flowering and fruiting . Very feBonsai means a “tree in a pot” or “tray”. The origins of bonsai are vague, possibly dating back to the Hanging Gardens of Babylon, allegedly built by King Nebuchadnezzar II around 600 B.C. ,12. BonsEcopsychology studies the unique connection that exists between human beings and the natural world. Robinson  refers tA person experiences numerous benefits from being connected to nature at the time of interaction . It is iContact with the natural environment helps children develop relationships based on cognition, emotional, behavioural, social and biophysical levels. Children’s experiences of nature are important for encouraging imagination and creativity, building cognitive and intellectual development, and social relationships . Art theBuzzell and Chalquest  refer toSeveral studies have reported on the restorative health benefits of nature. For example, in one study at a large medium-security  UK prisoTwo studies reviewed the physiological effect of “viewing” bonsai trees on patients. Ochiai  presenteVarious data collection methods were used. A mixed methods approach, using both qualitative and quantitative techniques, was used. Data were collected through purposeful convenience sampling and global peer recognition of bonsai practitioners. The questionnaires were sent to 300 bonsai practitioners and 255 global bonsai practitioners responded. n = 255) to the questionnaire. Bonsai practice was assessed in terms of the level of the participants’ commitment to practising the art of bonsai, as well as the effect bonsai had on their health and well-being.Questionnaire: Well-known and respected bonsai artists (300) were invited to complete an open-ended questionnaire, designed to establish demographics regarding age, gender and bonsai practice. The majority of invitees responded : This instrument is used to identify anxiety , with scPhysical Health Questionnaire (PHQ-9): This instrument measures depression with subscales of 5 for “mild”, 10 indicating “moderate”; 15 for “moderately severe” and 20 for “severe” depression .InstrumentsThe focus of the study is qualitative health, as perceived by the bonsai practitioners themselves. A quantitative objective health assessment of the sample is beyond the scope of the present study. However, to provide some indication of the objective health of the sample, a brief objective report appeared to be warranted.All ethical principles regulating research were observed during the initial doctoral study. Participants were informed of the research protocols, informed consent was obtained during the initial questionnaire and participants were allowed to withdraw at any stage, with their records removed from the study and destroyed. Permission was obtained for the instruments used where necessary. No financial reward was offered to participants. The research proposal was registered with the Research Ethics Committee of the University of Zululand and received approval number C892/14 (UZREG171110-030-RA Dept. 2015/85)Data were recorded using the transcription of interviews, and email conversations. Completed questionnaires were transcribed, and saved in an easily coded Microsoft Word document format. Segments of text with related content were sorted into distinct categories. Refined final concepts were categorised into major themes . Themes The simple demographical analysis was based on age and gender, total bonsais owned by participants and, finally, how much time participants spent with their bonsai. Of the 255 participants, 201 were male and 54 were female. This is in line with observations at the club level, where men are traditionally more drawn to the art. Two of the participants were younger than 25, 95 were between 26 years and 40 years of age, the majority (135) were between the ages of 41 and 60 and 23 were older than 61. Bonsai art seems to be attractive to older generations and this trend is also observed at the club level. Three participants owned between one and five bonsais, five owned between six and 20; 67 owned between 21 and 50; 80 owned between 51 and 100 and 100 participants owned more than 100 trees. Forty participants spent between 1 and 2 h per week working on their bonsais, 117 between 3 and 4 h per week, 71 between 5 and 10 h per week and 27 spent more than 11 hours per week on their trees.Theme 1—ecological awareness: Bonsai appears irrefutably connected to profound awareness and love of all things in nature. Participants reported feelings of empowerment, harmony and respect for nature and conservation. When living close to or in harmony with nature, their behaviour changed. These behavioural changes became an integral part of the artist. The following subthemes were identified:Respect for nature: A genuine indebtedness to nature is experienced in conjunction with the appreciation of the art of bonsai. Participants felt that, through the art, they were making valuable contributions towards conservation and, in doing so, that they might decrease their negative effect on the Earth.“With regard to ecological wellbeing, growing Bonsai has made me more aware of the necessity to maintain the growth of trees, jungles and our surroundings.…Growing Bonsai has made me love nature more” .“Working with Bonsai makes us aware of nature and I think that all bonsai growers are extremely aware of the ecological well-being of nature as a whole. One looks at nature with new eyes and tries to protect our natural heritage” .Ecological health balance: There is a balance between the emotions that the bonsai artist feels toward the tree and the innate need to create . This ne“Having to concentrate when shaping or styling a tree, or keep your mind active when handling a problem tree helps one to stay mentally alert and sharp” .“A connection to the real world, to changing seasons, to life, to death, and to natural processes” .“I rate it as my highest priority and place it before my collection. I would rather have the world enjoy nature as it ought to be, regardless of my personal interests” .Empowerment: Feelings of empowerment relate to the objectives of art therapy, namely “engagement, empowerment and recovery”  or “hope“To make a bonsai trunk taper and the lower branch thicker, while the tendency of a plant is to give most of the nutrient to the top, means that control of the tendency is really necessary in order to achieve a good result (sic)” .“We have to prune the top section of the tree regularly so as to force the nutrient to the lower part. It is an example of controlling the natural tendency in order to achieve a good result. It works both ways, too ” .Theme 2—spiritual awareness: This theme manifested in the subthemes of harmony and order, transcendence and pleasure, contentment, respect, inner spaces and silence and the spirit guide of bonsai. Each subtheme is explicated in its respective order. Spirituality is an integral part of life, and manifests in hopes and connections . SpirituHarmony and order: Giri  claims t“I have a certain routine… To begin working without the cleaning ritual makes me feel uncomfortable because I could possibly overlook any number of important things” .“I just concentrated on my tree of choice for a long time. I channeled my imagination toward attempting to design it. When the idea came to me, I started to work” .“Some of my trees make me think of my mother (Those I don’t like that much) so I carve or change them until I can see myself again” .Transcendence and pleasure: Participants conveyed feelings of great joy when they were able to spend time in their bonsai gardens with their trees. Subjective emotional states of pleasure were expressed as “happy” and “peaceful moments”. Ballantine  labelled“Bonsai gives me a creative outlet, helps me relax, helps me focus, and sometimes gives a temporary refuge from conflict” .“A tree also has a soul. A well styled, healthy bonsai gets a higher degree in the next reincarnation. It is already a civilized creature, not a wild one” .“I make trees of my memories… and people. I remember my Gran, my father and brother who have all passed” .Respect: The theme of respect, in relation to God and the natural spirit, guides and shapes a bonsai tree. Kandinsky  stated t“But now I surrender more to God” .“I let the tree tell me what the best shape is” .“I like to be quiet and listen for the voice of God” .“I respect nature as it reflects God’s face” .Contentment: Participants expressed a feeling of contentment when they admired their handiwork. It did not matter if the final product was highly regarded by other viewers or not. The participants did not feel that it was important to be admired by other bonsai practitioners. The private viewing of their own trees brought much happiness, and much pleasure was derived from the object (tree) itself.“Enjoying the bonsai experience … will help us to better ourselves in many ways” .“…the artistic significance of bonsai creation makes me delighted to have this opportunity to display a small number of our better examples…” .“Many feel that being able to spend time with your bonsai, is a divine experience in which every decision to cut back, nip or leave to develop is a reflection of the artist’s spirit and personality” .Inner spaces and silence: Bonsai practitioners, just like any other artists, also make use of space in between the branches and shadows cast by their tree. It is often said that one should leave a space for birds to fly through the tree. It is believed that some artists may also leave a space for Buddha to sit under their tree . The .“Negative spaces, which can also be the ‘empty space’ between branches or foliage, are also shaped and proportioned to appear in balance….see completely through the tree’s negative spaces to the background” .“Negative space resonates within my soul to a certain degree but I focus more on the general ‘feel’ of the tree than on the individual components (as with life)” . “I find this to be key, as I need silence in which to ‘lose myself’ when working on my trees” .“Negative space is very important for correct balance. As in life, you need the bad to place the good in perspective” .As an artist works on a tree, be it a personal tree or a tree used during a demonstration, silence is of the utmost importance. Milner  found th“Silence is very important, I even chase my seven-year-old away” . “Silence allows communion with my trees and results in better concentration” . “Yes, I valued the silence, especially when I was still working. It was wonderful to return from work and concentrate on my trees with no interruptions or other people who needed attention. Very relaxing” .Theme Three–Emotional awareness: Nature is considered to be sacred, facilitating the ability to interact with nature’s rhythms, both intellectually and emotionally . Giri 3 also cla“Yes, a desire to reduce our pain or to direct our concentration away from a painful thing is normal” .“Bonsai is like a faithful second wife to me. I can share my love with it. It keeps me busy. I would be sad if anything happened to it. It is really loyal and would never betray me. In the ‘Whole life’ it accompanies me. What is more the first wife will never be jealous of the second one” .“I have developed coping mechanisms for when a tree dies…When a major tree dies it really hurts me deeply” .“Part of my personality is inevitably reflected in my trees” .Theme 4—aesthetic health and creativity: This theme portrays a unique aesthetic and creative health link, specifically art appreciation and creation for its own sake, rather than for fame and fortune. Hagman  equates “It gave me fame, a lot of friends and richness in art appreciation, but I don’t need clubs” .“It was a big breakthrough, artistically and also financially, to be accepted to exhibit at XXX” .“Growing bonsai engenders a certain degree of love for the tree and pride in the result of our creations” .Theme 5—social health: Bonsai art is, inevitably, a communal and social activity, ranging from meeting with friends, to small clubs, and beyond. Every person primarily needs to discover their social function within a group or community ,45. Bons“Bonsai brings one together with many people all over the world and so broadens one’s social spectrum. Once they have met, bonsai growers become friends forever” .“Growing bonsai has made me a member of a large society. I have many friends all over the world. It made me famous as well” .“I think it provides a sense of being part of a community …whom I’ve never met in the flesh but have come to regard as friends” .Theme 6—physical health: The gardening of bonsai trees is a natural physical form of exercise that can also assist in other physically traumatic situations. Bonsai is a physical and sensory experience, which can improve one’s mental and physical health and well-being . Ecopsyc“People who grow bonsai don’t really need to go to the gym on a daily basis. They get enough exercise by moving their trees around, digging up those growing in the ground, going on digs, mixing soil and re-potting their trees regularly. So one can have enough exercise while working with bonsai” .“It helped me to overcome major  trauma in a positive way” .Theme 7—resilience and adaptive health: Bonsai implies durability, patience, and a realistic, nature-orientated outlook. Through being conscious of one’s relationship with nature, one becomes aware of an interdependence and connectedness to the world, nature and others. This awareness leads to stability and the capacity to adapt . “…Bonsai has helped me to evolve into a tougher person, more durable in changing situations. I have acquired enough patience to accept the fact that it takes years to create a fine Bonsai” .“A connection to the real world, to changing seasons, to life, to death, and to natural processes” .Theme 8—personal health: The art of bonsai offers gentle physical exercises to hard labour when repotting or digging trees from nature.“Growing Bonsai makes me aware of the need to care about my personal health and wellbeing” .“Bonsai is giving me a little more confidence in dealing with people. That’s especially significant because I had a life-long speech impediment” .Practising the art of bonsai allows the practitioner to create, on a reduced scale, what has been seen in nature . The creEcological health balance emerged as the first theme. The need for a balance between public health and ecology is compared to the idealisation of non-industrialised communities’ ability to live in balance with nature . This coThe second theme refers to spiritual awareness. Giri  claims tFor the lay artist, many stories are told through their creations, and they do not need to conform to the rules and “likes” of other people. Following the horticultural and artistic rules of bonsai also brings harmony and order to the practitioner’s life: “when the idea came to me, I started to work”  and “some of my trees remind me of my mother…” , “so I carve and change them until I can see myself again”.Working with bonsai facilitates emotional awareness and the recognition of feelings. In their theory of transformative coping, Corry, Tracey and Lewis  note thaConcerning the third theme of emotional awareness, Giri  claims tThemes four to eight explicate further differential influences of bonsai art on health. These inclusively extend subjective experiences such as awareness, aesthetic creativity and resilience into relatively more objective social, physical, adaptive and personal health dimensions. Thus, support was provided for the hypothesis that, as an ecopsychological, therapeutic practice, bonsai art provides meaningful healing qualities and promotes integral health. This is an important finding from the point of view of practice, and can be used in various areas of public health. For example, bonsai art has the potential to be of huge benefit as a therapy tool, specifically where the client/patient is separated from the family, primary care group or society. Long-term psychiatric institutions, correctional services, retirement homes, rehabilitation or step-down facilities or orphanages could adapt the intervention for their residents. The therapist should be able to meet with the client/patient in order to assess their therapeutic needs and implement interventions that are suitably graded and tailored to suit participants ,17.The results of this research suggested that being involved in bonsai art has both direct and indirect impacts on the well-being and health of individuals. Thus, support was provided for the hypothesis that, as an ecopsychological, therapeutic practice, bonsai art provides meaningful healing qualities and promotes integral health. This is an important finding from the point of view of practice that can be used in various areas of public health. It can be viewed as an intervention technique that requires few resources, is easy to apply, and has a minimal impact on any environmental setting. The conclusions drawn point to the ethically sound health promotion value of bonsai art in various settings, such as psychiatric hospitals, retirement homes, rehabilitation centres and prisons. Certain limitations associated with this study should also be noted, especially those that concern the generalisability and explanation of the findings. For example, the study focused only on experienced practitioners of the art and the results are based on subjective reports by these participants. This study also lacks a control group and pre- and post-test assessments. This, however, paves the way for future studies. On the other hand, the findings do repeatedly indicate, in great depth and detail, that bonsai art had healing qualities for practitioners.Bonsai art affords a deep and meaningful insight to be gained into the artist as a creator, the creative act and their continued creation. From a therapeutic perspective, the creation of a bonsai tree affords the artist or client a wonderful experience. The creative process gives meaning and value to what has been created. The practitioner enters into a relationship with the bonsai, creating something new. The constant, cadenced cycles of nature and in time are satisfied through the tending of the tree, providing a form of accomplishment that generates joy in the practitioner. The practitioners’ pain and pleasure with regard to lost or dead trees are overlooked and their exertion when styling and caring for the trees is quickly forgotten, as mothers forget the pain of childbirth. The bonsai becomes a representation that embodies the joy of finding and transcending the self through the creative experience. This study focused on established bonsai practitioners’ experiences of how bonsai made them feel. Bonsai art is an untapped source in the field of ecopsychology and ecotherapy. Further studies will focus on introducing the art of bonsai to non-practitioners in order to make meaningful contributions to emerging forms of psychotherapy.


In this paper I ground a brief account of the impact of COVID-19 on the United Kingdom in an understanding of a decade of austerity politics from 2010 to 2020, itself a product of the advent and consolidation of post-1970s financialised or rentier capitalism. I argue that such an analysis is essential if realistic plans are to be laid for a “better”—understood here as a more equitable or “fairer”—society. I go on to consider the contributions that sociology can, and arguably should, make to this end. This involves a range of engagements from scholarship at one end of the spectrum to action or muckraking sociology at the other. In addition to plotting a role for sociology, I suggest a set of criteria for recognizing a “fairer society”; postulate a series of institutional reforms that might characterize the attainment of such a society; and outline and confront social structural, cultural and agential obstacles to its realization. A theme running throughout the paper is that the delineation and promulgation of the “good society” remains central to any credible—that is, post-Enlightenment reconstruction of - the sociological project. There is an emerging picture on why this is which can be encapsulated in the following propositions:www.grahamscambler.com; see also I am aware that this series of assertions will be regarded by some as: 1) polemical rather than sociological; 2) in need of more by way of empirical corroboration; and/or 3) signaling a form of activism or engagement in the volatile contemporary politics of the UK. I will not defend them again as I have done so in some detail elsewhere  decreased by approximately £10bn, and house prices - which fell by an average of 22% over the previous four recessions—rose by 8%. Overall, total UK wealth increased by £900bn to £16.5tn during the pandemic, but the poorest households were more likely to have run down rather than increased their savings. Nor did they share in the house price boom because they were less likely to own a home. The richest 20% of households were four times as likely to have increased their savings during the crisis as the poorest 20% of households (47 vs. 12%), and 2.5 times as likely to have reduced their debts. According to the Resolution Foundation, this reflected pandemic-induced spending reductions being concentrated among those on higher incomes. The adults in the richest 10% of households currently have wealth of £1.4m each following a £50,000 increase during the crisis, while the poorest 30% gained an average of just £86 per adult in additional wealth.Sunday Times listing, an additional 24 billionaires were added to the UK’s list during 2020/21, making a total of 171, the highest number in the 33 years of the newspaper’s rich lists. The gains reaped by the super-rich came in a year that the UK government stepped in to pay the wages of millions of citizens  are proffered here see also . The firThe “stigma/deviance dynamic” is one of a number of companion mechanisms . It main• the relatively powerless position: in economic terms, but also in terms of access to social or formal facilities, services or institutions ;• the lack of protection and opportunities afforded by membership in powerful social networks;• limited internal cohesion between new migrants as a whole, rooted in the fact that they are all “new”;• representations and stereotypes of these groups as threatening, images based on the socially unacceptable characteristics of a small minority of group members .The third dynamic is that of the “insider/outsider”. Rentier capitalism’s cultural relativism is pertinent here. It has led to cultural disorientation, a “disconnected fatalism” and a tendency to fundamentalist thinking and populist engagement. The diminution of the role of structures like class as primary resources for identity formation, together with the emergence of identity politics, has prompted new levels of cultural disinhibition. Othering, or “outsidering”, has become easier. Adapting  what might a “good”—or better, fairer—society look like; 2) what are the major obstacles to its creation; and 3) how might these obstacles be overcome. Each will be commented on in turn.Beveridge was of course not a sociologist, but rather an evidence-based reformer, committed to improving the lot of the citizenry as a whole in the wake of WW2. He provided a policy blueprint and something of a narrative without drifting into utopianism. The notion of foresight sociology introduced earlier exhorts a sociological engagement with parameters for alternative futures, extending to detailed innovative institutional change. As The first point is to acknowledge that those philosophical principles of democracy, freedom, equality, justice and so on that commonly constitute criteria for identifying a good society are independent but not absolute: there is necessarily a trade off between them in any actually existing societal formation. The telling query thus becomes: are the trade offs optimal for the citizenry as a whole? In the UK, as in many other societies, there are conspicuous and troubling deficits. Consider democracy for example. The evidence is unambiguous. It is implicit in the concept of trade offs that subversions of democratic processes have echoes, and themselves echo, compromises in other principles. A democratic deficit, for example, will almost invariably be linked with deficits in freedom, equality and justice. To resurrect an old liberal distinction between formal and actual freedom, it is apparent that while all citizens are formally free to apply to send their offspring to Eton, still the breeding ground for multiple UK elites, very few are actually free to do so: they simply lack the requisite economic, cultural and social capital. The extent of wealth and income inequality in UK’s rentier capitalism was sketched earlier. Nor can there be any doubt that this family of deficits in democracy, freedom and equality add up to a substantial charge of injustice. It is not just that in the UK the trade offs between independent political principles has gone seriously awry, but also that no lasting remedy can be accomplished via pro-capitalist piecemeal social engineering, which is all that capitalist/parliamentary democracy can offer [and that only when confronted by a potential crisis of legimation ]. It wilFor all that a number of professional sociologists are on record as anticipating a likely crisis in rentier capitalism see , it is avia identity-neutral mechanisms) have certainly not  mechanisms, have long historical tap roots and are exceptionally resistant to (on-the-surface) agential efforts to revise, deconstruct or disassemble them.• Within the UK’s existing system of capitalist democracy, a parliamentary route to transformatory structural change is all but inconceivable, as was evidenced recently by the rapid and effective undermining of the Corbyn challenge.• Principal among the mechanisms causally responsible for wealth, income and health inequalities is a class/command dynamic, reinvigorated in the period of rentier capitalism, which asserts that these inequalities derive above all else from the transnational sway of a tiny minority of owners of capital assets who buy power from the nation state to implement policies to their advantage.• Given the ongoing “contamination” of the state’s power elite and the impotence of parliament, the only way to effect structural, transformatory change is by mobilizing the populace .• A precondition of the effectiveness of a people’s movement is that it is class-based, in other words underwritten by the working class, which as Wright maintained, unites the bulk of those who “work to live”.• Although the likelihood of this kind of working-class unity and class-based collective action—and hence of an effective people’s movement—remains slight, it can (perhaps only) occur in the event of a “trigger event” occasioning a crisis of state legitimation.• Such a people’s movement will necessarily involve a series of alliances across overlapping campaigns and group interests.• As Bambra and colleagues (2021) have suggested, COVID might carry the potential to precipitate a legitimation crisis see also : transfoattainable to the aspirational .• The optimal strategy in present circumstances could therefore be one of permanent reform, that is, a continuous and coordinated push for reform along a spectrum from the The strategy of “permanent reform” espoused elsewhere might perhaps be cast as “escaping capitalism” plus “resisting capitalism” through “dismantling capitalism” towards “smashing capitalism” see . The thiIt is one thing to prescribe a strategy and another to show what it might look like in practice. In this section, after a few words on culture, the focus is on attainable-to-aspirational economic change. Privilege and advantage are written into and underlined in UK culture. This is nowhere more apparent than in the survival of a monarchy that remains obscenely rich and clandestinely and extra-legally active in the political arena. Why is it important? Because its absence would expose to critique a series of institutions that are parasitic upon it, like hereditary titles, the House of Lords and the honours system. When the present monarch dies, attainable ends might include a trimming of “the firm”, the abolition of hereditary titles, the replacement of the House of Lords by a second chamber based on deliberative democracy and the end of the conspicuously corrupt honours system [a quarter of top Conservative Party donors have received honours or peerages]. Aspirational change might include the introduction of republican governance. The point to emphasise here is that culturally and economically attainable reforms en route to aspirational or transformatory change are related dialectically and, arguably, need to occur in tandem.Of overriding import are challenges to rentier capitalism itself. Towards the attainable end of the spectrum might be included such measures as restoring trade union rights, abolishing hire and rehire practices, ending zero hour contracts, increasing sick pay, replacing Universal Credit, raising the UK’s parsimonious state pension, restoring funding to the NHS, and expanding public housing. r) globally before tax has always been greater than the rate of economic growth (g); and for most of the history of capitalism, r after tax has also been greater than g, hence his claim that, ceteris paribus, wealth inequality increases under capitalism. Unusually during the period after WW2, g exceeded net (post-tax) r, in the process curbing inequality . In the present era of rentier capitalism Piketty commends higher taxes on assets to bring r back below g and thus counteract surging wealth inequality   : 393.Christophers also promotes the idea of a state investment bank, which would have the potential to contribute to seeding/funding a transition away from rentierism. Unarguably, this transition requires to be accompanied by another: to a low-carbon future. So what kind of salient non-asset intensive economic activities might the state invest in? Christophers’ shorthand answer is workers and their skills rather than non-human assets and their protection from competition. He appends to this investment in collective consumption of essential or “foundational” goods and services, including material services , and providential services . Another necessary and vital state investment, to reiterate, is in a green or carbon-neutral economy.Wrapping up this brief sketch of attainable-to-aspirational economic policy change, special reference needs to be made to ownership. For any meaningful transformation from rentier capitalism, the current direction of ownership transfers from the public to the private sector must be reversed. This means shrinking the portfolio of exclusive proprietary assets on which the rentier is able to “earn” private rents. This paper has covered a lot of ground, and necessarily in an abbreviated fashion. No apology is offered for this since the objective was to set out, with examples, a framework for a vibrant, relevant and engaged sociology of the UK as a fractured society facing something of a perfect storm of political austerity, Brexit, COVID and climate change in an era of largely unopposed post-industrial rentier capitalism. While there are the beginnings of a professional macro-sociological literature on these issues, there remain deficits in both a foresight sociology of alternate—utopian, dystopian or merely revised—futures and an action sociology of commitment to the pursuit of a good or better, fairer, post-fractured society. As Christophers concludes in his excellent analysis of rentier capitalism, the obstacles—structural, cultural, agential, causal offspring of the quartet of “dynamics” outlined earlier—remain daunting. He notes the strength of the “establishment backlash” against the proposals mooted by the Corbyn-led Labour Party during the course of 2017 and 2019. Witness for example the proposals for progressive land reform contained in the Labour-commissioned “Land for the Many”, published in mid-2019. Monbiot, one of its co-authors, was led to reflect on the readiness of the UK’s “billionaire press” to go into battle on behalf of the ‘ultra-rich’ and “oligarchic power” : 415.It is critically important that sociologists address these issues: doing so does not turn them into polemicists, although it may involve contesting institutional pressures, which can amount to a form of sociological taming . While i