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Cited by 5Digital Mental Health InterventionsPsychotherapy Techniques and ApplicationsTelemedicine and Telehealth Implementation

Exploring the nature of the therapeutic alliance in technology-based interventions for mental health problems

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Hillier, Laura·2018·Lancaster University
DOI 10.17635/lancaster/thesis/406
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Abstract

Background: Digital technology is increasingly being used in healthcare delivery, and can potentially improve access to psychological services. “Technology-based interventions” (TBIs) are a form of self-guided psychological treatment delivered by digital technology, such as computer programs, websites, or smartphones. Little is known about how these work, and high drop-out rates raise a pressing need to understand user engagement. The therapeutic alliance concerns the level of collaboration in therapy, and is strongly linked to face-to-face treatment’s effectiveness. The validity of therapeutic alliance is uncertain in TBIs, but it may contribute towards an understanding of user engagement. Objective: To explore the nature of the therapeutic alliance in the context of technology-based interventions (TBIs) for mental health problems. Methods: A systematic review was undertaken, which included qualitative, quantitative and mixed methods research. 13 papers were analysed using a best-fit framework synthesis approach. A qualitative study was also conducted, using topic-guided interviews to explore 13 participants’ experiences regarding their interaction and engagement with TBIs. Thematic analysis was used to analyse the data. Results: The user-TBI alliance is largely comprised of similar dimensions to the alliance in face-to-face therapy. There are also some new dimensions which specifically apply to TBIs: interactivity (personalising a TBI), and availability (flexible access to treatment). The user-TBI alliance may not be directly associated with outcomes, but it does appear to be related to user engagement. Conclusions: TBI users can experience a therapeutic alliance with the digital technology, especially if the TBI is sufficiently personalised. The terminology of a “relationship” with digital technology is generally unacceptable to TBI users, which will pose challenges when attempting to adapt or design alliance measures that take account of the unique TBI context.

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  • Three studies which used qualitative research methods found that users felt more comfortable interacting with technology than healthcare professionals because participants were less fearful about being judged and consequently felt less stigmatized.

    “Three studies which used qualitative research methods found that users felt more comfortable interacting with technology than healthcare professionals because participants were less fearful about being judged and consequently felt less stigmatized (14, 48, 52).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [52]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • One qualitative study found that users generally rejected the ideas of having a connection or a bond with fully automated digital mental health interventions.

    “One qualitative study found that users generally rejected the ideas of having a connection or a bond with fully automated digital mental health interventions (52).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [52]

    In §4.4.4.1 (page not provided), the qualitative study reports that around two-thirds of participants rejected the idea of a relationship with the technology. But §4.3.2 says participants could have received some human support, up to 1.5 hours, so describing the interventions as fully automated is not supported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Two studies which used qualitative interview methods found that although apps can mimic human support in some ways, users felt that apps were less understanding.

    “Two studies which used qualitative interview methods found that although apps can mimic human support in some ways, users felt that apps were less understanding (14, 52).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [52]

    Hillier’s qualitative interview findings (sections 4.4.1.1 and 5.3; page unavailable) describe users wanting technology-based interventions to respond to personal needs and show empathy, while several participants saw limits to their understanding of deeper issues. The source supports that contrast, but studies technology-based interventions more broadly than apps and does not say users uniformly found them less understanding than people. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • By interviewing users, two studies found that interactivity might be an important component of DTA which was not a TA subscale.

    “In addition, by interviewing users, two studies found that interactivity might be an important component of DTA which was not a TA subscale (14, 52).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [52]

  • Whether and how users can build a bond with apps remains unclear, as some users rejected the idea that they could form a relationship with digital mental health interventions.

    “However, whether and how users can build a bond with apps remains unclear as some users rejected the idea that they could form a relationship with digital mental health interventions (52).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [52]

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Authors
Hillier, L.
Corresponding author
Hillier, Laura
Venue
Lancaster University
Publisher
Lancaster University
Published
2018
DOI
10.17635/lancaster/thesis/406
OpenAlex
W2901871951
Cited by
5
References
0
Citations by year
2024: 1 · 2023: 1 · 2022: 2 · 2020: 1
Type
dissertation
Language
en
Open access
Locations
  • Lancaster EPrints (Lancaster University) (submittedVersion)
  • Lancaster EPrints (Lancaster University)
Funders
Economic and Social Research Council
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
therapeutic relationship, technology-based interventions, digital mental health, user engagement, dropout rates, personalization, interactivity, user experience

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