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

Hillier, Laura and Lobban, Fiona and Jones, Steven and Dagnan, Dave (2018) Exploring the nature of the therapeutic alliance in technology-based interventions for mental health problems. Masters thesis, Lancaster University.

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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.

Item Type:
Thesis (Masters)
?? therapeutic alliancetherapeutic relationship working alliancetechnology-based interventionsmental healthself-helpdigital healthe-healthonline interventionsm-healthself-guided ??
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Deposited On:
21 Sep 2018 09:40
Last Modified:
05 Jun 2024 23:41