The Digital Therapeutic Alliance and Human-Computer Interaction
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Abstract
The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.
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In the digital health literature, the therapeutic alliance construct has been extended to the notion of the DTA, describing the perceived empathy, responsiveness, and relational quality between users and digital applications.
“In the digital health literature, this construct has been extended to the notion of the DTA, describing the perceived empathy, responsiveness, and relational quality between users and digital applications [31,32].”
From Delusional Experiences Emerging From AI Chatbot Interactions or “AI Psychosis” (2025) · cites this paper as [32]
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- Authors
- D'Alfonso, S., Lederman, R., Bucci, S., & Berry, K.
- Affiliations
- The University of Melbourne (AU)
- University of Manchester (GB)
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2020-12-29
- Volume
- 7
- Issue
- 12
- Pages
- e21895
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC7803473
- OpenAlex
- W3113891030
- Cited by
- 90
- References
- 71
- Citations by year
- 2026: 18 · 2025: 24 · 2024: 17 · 2023: 17 · 2022: 11 · 2021: 3
- FWCI
- 7.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Manchester
- University of Melbourne
- Medical Research Council (MR/P026664/1)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Keywords
- therapeutic relationship, human-computer interaction, mental health apps, digital mental health, relationship measurement
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