JMIR Publications

ABSTRACT

Background:

Loneliness is a prevalent and growing concern across the United Kingdom. While numerous validated scales exist to quantify the severity and prevalence of loneliness experiences across populations (the University of California, Los Angeles Loneliness Scale and the DeJong Gierveld Loneliness Scale) (de Jong-Gierveld, 1987; Russell, 1996), there remains a gap in understanding how loneliness manifests and is addressed within therapeutic practice. Given the associated stigma and shame surrounding loneliness self-disclosure, practitioner perspectives offer crucial insights into how clients express loneliness concerns within digital therapeutic environments.

Objective:

The objectives of this study are to gather the practitioners' perspective of loneliness within a digital therapeutic context, and are defined as follows: 1. To understand how practitioners identify loneliness concerns 2. To identify how loneliness is elicited in digital mental health interventions 3. To identify co-occurring themes (such as grief, shame, and social disconnection) that signal loneliness concerns in client communications within digital therapeutic environments

Methods:

Semi-structured interviews were conducted with nine experienced practitioners (minimum one year of practice). Participants included specialists in grief counselling, LGBTQ+ support and digital mental health platform therapists. Interview transcripts were analysed using Braun and Clarke's six-phase thematic analysis approach, employing an inductive, data-driven methodology to allow themes to emerge from participant accounts rather than fitting data to pre-existing theoretical frameworks.

Results:

Four interconnected themes were identified: 1. Conceptualising Loneliness: practitioners distinguished between social contact and meaningful connection, identifying the experience of being “lonely in the crowd” where clients feel disconnected despite having social networks; 2. Contextual Causes: loneliness emerges from life transitions (university, grief, relationships change), stigmatised identities and cultural minorities (LGBTQ+, neurodiversity), and resource reduction (youth services closures and social support); 3. Expressions and Language: specifically that clients rarely expressed loneliness directly, instead using terms like “depressed” or “misunderstood”, with disclosure patterns varying by age and stigma experience; 4. Mental Health Co-occurrence: severe mental health conditions created bidirectional cycles where loneliness exacerbated symptoms, while mental health difficulties increased social isolation. Practitioners reported that 80-90% of their clients experienced loneliness concerns, yet direct disclosure was virtually absent across all participants' experiences.

Conclusions:

Practitioners identified multiple stigmatising experiences as contextual drivers of loneliness, highlighting how loneliness emerges not only from individual factors but from broader patterns of social exclusion and marginalisation. For therapeutic practice, these insights suggest that practitioners can use awareness of stigmatising experiences as potential indicators when assessing loneliness risk. The presence of these contextual patterns were consistent across digital practitioners’ experiences, providing a foundation to develop more targeted interventions that address both the emotional experience of loneliness and its underlying social drivers across therapeutic environments.