Skip to main content

Advertisement

SpringerLink
Log in

Technology-Based Mental Health Treatment and the Impact on the Therapeutic Alliance

  • Psychiatry in the Digital Age (J Shore, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Telemental health, which is treatment mediated by technology, is an increasingly common method of delivering mental health care. However, its impact on the therapeutic alliance is unclear. This review examines studies of telemental health and its impact on therapeutic alliance.

Recent Findings

Findings indicate that a therapeutic alliance can be maintained through a variety of communication technologies, with some caveats. Considerations on maintaining a successful therapeutic alliance include using technology as an adjunct to treatment and ensuring patients and providers have back-up plans for continuing communication in the event of technical difficulties.

Summary

Overall, the studies found that clinicians often have more concerns about alliance than patients do, suggesting that clinicians could make some changes to feel more comfortable. Recommendations are offered for implementing techniques into practice that will help clinicians increase their awareness of ways to support the therapeutic alliance when using telemental health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Andrews G, Basu A, Cuijpers P, Craske MG, McEvoy P, English CL, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J Anxiety Disord. 2018;55:70–8. https://doi.org/10.1016/2Fj.janxdis.2018.01.001.

    Article  CAS  PubMed  Google Scholar 

  2. •• Richards P, Simpson S, Bastiampillai T, Pietrabissa G, Castelnuovo G. The impact of technology on therapeutic alliance and engagement in psychotherapy: The therapist’s perspective. Clinical Psychologist. 2018;22(2):171–81. https://doi.org/10.1111/2Fcp.12102 This study highlights the differences between therapists’ and patients’ experiences of the therapeutic alliance via telemental health. Patients reported higher levels of therapeutic alliance than the therapists, with personal comfort level with the technology a primary factor in how easily the therapists were able to form alliance via technology.

    Article  Google Scholar 

  3. Horvath AO, Del Re AC, Flückiger C, Symonds D. Alliance in individual psychotherapy. Psychotherapy. 2011;48(1):9–16. https://doi.org/10.1037/2Fa0022186.

    Article  PubMed  Google Scholar 

  4. Wampold BE. How important are the common factors in psychotherapy? An update. World Psychiatry. 2015;14(3):270–7. https://doi.org/10.1002/wps.20238.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Totura CMW, Fields SA, Karver MS. The role of the therapeutic relationship in psychopharmacological treatment outcomes: a meta-analytic review. Psychiatr Serv. 2018;69(1):41–7. https://doi.org/10.1176/2Fappi.ps.201700114.

    Article  PubMed  Google Scholar 

  6. Zeber JE, Copeland LA, Good CB, Fine MJ, Bauer MS, Kilbourne AM. Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder. J Affect Disord. 2008;107(1–3):53–62. https://doi.org/10.1016/2Fj.jad.2007.07.026.

    Article  PubMed  Google Scholar 

  7. Cook JE, Doyle C. Working alliance in online therapy as compared to face-to-face therapy: preliminary results. Cyber Psychol Behav. 2002;5(2):95–105. https://doi.org/10.1089/109493102753770480.

    Article  Google Scholar 

  8. Rettie R. Mobile phone communication: extending Goffman to mediated interaction. Sociology. 2009;43(3):421–38. https://doi.org/10.1177/2F0038038509103197.

    Article  Google Scholar 

  9. Pettegrew LS, Day C. Smart phones and mediated relationships: the changing face of relational communication. Rev Commun. 2015;15(2):122–39. https://doi.org/10.1080/2F15358593.2015.1044018.

    Article  Google Scholar 

  10. Yellowlees P, Richard Chan S, Burke Parish M. The hybrid doctor–patient relationship in the age of technology. Telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry. 2015;27(6):476–89. https://doi.org/10.3109/2F09540261.2015.1082987.

    Article  PubMed  Google Scholar 

  11. Berger T. The therapeutic alliance in internet interventions: a narrative review and suggestions for future research. Psychother Res. 2017;27(5):511–24. https://doi.org/10.1080/2F10503307.2015.1119908.

    Article  PubMed  Google Scholar 

  12. • Farabee D, Calhoun S, Veliz R. An experimental comparison of telepsychiatry and conventional psychiatry for parolees. Psychiatr Serv. 2016;67(5. This study highlights the challenges of telemental health when there are technical problems.):562–5.

    Article  Google Scholar 

  13. Lopez A. An investigation of the use of Internet based resources in support of the therapeutic alliance. Clin J Soc Work. 2014;42(3):189–200.

    Google Scholar 

  14. Ertelt TW, Crosby RD, Marino JM, Mitchell JE, Lancaster K, Crow SJ. Therapeutic factors affecting the cognitive behavioral treatment of bulimia nervosa via telemedicine versus face-to-face delivery. Int J Eat Disord. 2011;44(8):687–91. https://doi.org/10.1002/eat.20874.

    Article  PubMed  Google Scholar 

  15. • Banbury A, Nancarrow S, Dart J, Gray L, Parkinson L. Telehealth interventions delivering home-based support group videoconferencing: systematic review. J Med Internet Res. 2018;20(2):e25. https://doi.org/10.2196/jmir.8090 This study explored group therapy rather than individual treatment and found that online groups were able to replicate the same group processes as face to face groups. This study also explored variations in social cues (seeing and hearing each other versus reading posts) and how these differences influenced therapeutic alliance.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Parish MB, Fazio S, Chan S, Yellowlees PM. Managing psychiatrist-patient relationships in the digital age: a summary review of the impact of technology-enabled care on clinical processes and rapport. Curr Psychiatry Rep. 2017;19(11):90. https://doi.org/10.1007/s11920-017-0839-x.

    Article  PubMed  Google Scholar 

  17. Simpson SG, Reid CL. Therapeutic alliance in videoconferencing psychotherapy: a review. Aust J Rural Health. 2014;22(6):280–99.

    Article  Google Scholar 

  18. Steel K, Cox D, Garry H. Therapeutic videoconferencing interventions for the treatment of long-term conditions. J Telemed Telecare. 2011;17(3):109–17. https://doi.org/10.1258/2Fjtt.2010.100318.

    Article  PubMed  Google Scholar 

  19. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):329–42. https://doi.org/10.1016/2Fj.cpr.2012.02.004.

    Article  PubMed  Google Scholar 

  20. Berry K, Salter A, Morris R, James S, Bucci S. Assessing therapeutic alliance in the context of mHealth interventions for mental health problems: development of the mobile Agnew Relationship Measure (mARM) questionnaire. J Med Internet Res. 2018;20(4):e90. https://doi.org/10.2196/jmir.8252.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Renn BN, Hoeft TJ, Lee HS, Bauer AM, Areán PA. Preference for in-person psychotherapy versus digital psychotherapy options for depression: survey of adults in the U.S. Digital Med. 2019;2(1):s41746-019-0077-1.

    Google Scholar 

  22. Waller R, Gilbody S. Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychol Med. 2009;39(05):705–12. https://doi.org/10.1017/2FS0033291708004224.

    Article  CAS  PubMed  Google Scholar 

  23. Thase ME, Wright JH, Eells TD, Barrett MS, Wisniewski SR, Balasubramani GK, et al. Improving the efficiency of psychotherapy for depression: computer-assisted versus standard CBT. Am J Psychiatr. 2018 Mar;175(3):242–50. https://doi.org/10.1176/2Fappi.ajp.2017.17010089.

    Article  PubMed  Google Scholar 

  24. Hubley S, Schneck C, Thomas M, Shore J. Review of key Telepsychiatry outcomes. World J Psychiatry. 2016;6(2):269–82.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Helen and Arthur E. Johnson Depression Center, University of Colorado School of Medicine, 13199 E. Montview Ave, Aurora, CO, 80045, USA

    Amy Lopez, Sarah Schwenk & Rachel J. Griffin

  2. Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, University of Colorado School of Medicine, 3199 E. Montview Ave, Aurora, CO, 80045, USA

    Christopher D. Schneck

  3. Department of Family Medicine, Helen and Arthur E. Johnson Depression Center, University of Colorado School of Medicine, 13199 E. Montview Ave, Aurora, CO, 80045, USA

    Matthew C. Mishkind

Authors
  1. Amy Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Schwenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher D. Schneck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachel J. Griffin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew C. Mishkind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy Lopez.

Ethics declarations

Conflict of Interest

Amy Lopez, Sarah Schwenk, and Rachel J. Griffin declare that they have no conflict of interest.

Christopher D. Schneck has received grants from the NIMH and the Ryan White Foundation.

Matthew C. Mishkind has received personal fees from Meta Pro.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Psychiatry in the Digital Age

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lopez, A., Schwenk, S., Schneck, C.D. et al. Technology-Based Mental Health Treatment and the Impact on the Therapeutic Alliance. Curr Psychiatry Rep 21, 76 (2019). https://doi.org/10.1007/s11920-019-1055-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-019-1055-7

Keywords

Search

Navigation