The association between therapeutic alliance and outcome in internet-based psychological interventions: A meta-analysis

Kaiser, Jocelyn; Hanschmidt, Franz; Kersting, Anette

doi:10.1016/j.chb.2020.106512

Cited by 67 publications

(64 citation statements)

References 60 publications

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“…The positive relationship between the therapeutic alliance and treatment outcomes indicates that the type of alliance that emerges in text-based digital psychotherapy is indeed beneficial to the therapeutic work. The finding that many studies found a significant and moderate relationship between the alliance and treatment outcomes is also in accordance with a previous meta-analysis on the alliance-outcome association in digital psychotherapy that found a significant overall correlation of r = 0.28 (15), as well as a more recent meta-analysis on the same topic that found a significant overall correlation of r = 0.20 (19). Since the research on this topic was until recently very limited (10), our review provides the necessary update on the working alliance in this evolving and growing field.…”

Section: Quality Of the Therapeutic Alliance And Alliance-outcome Relationshipsupporting

confidence: 90%

“…Furthermore, therapists report less confidence in their abilities to develop a functional therapeutic alliance in internet-based psychotherapy (17). In contrast with this, research on internet-based cognitive behavior therapy suggests the quality of the therapeutic alliance, most commonly rated by the client, to be at least as strong as in face-to-face therapy and also highlights the association of the alliance with online treatment outcome (15,18,19).…”

Section: The (Digital) Therapeutic Alliancementioning

confidence: 99%

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Responsible Relations: A Systematic Scoping Review of the Therapeutic Alliance in Text-Based Digital Psychotherapy

Lotringen

Jeken

Westerhof

et al. 2021

Front. Digit. Health

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Introduction: Developing a good therapeutic alliance is considered essential for the responsible delivery of psychotherapy. Text-based digital psychotherapy has become increasingly common, yet much remains unclear about the alliance and its importance for delivering mental health care via a digital format. To employ text-based digital therapies responsibly, more insight is needed into the type and strength of the therapeutic alliance online.Methods: A systematic scoping review was performed searching four databases: Scopus, PsycINFO, Web of Science, and Wiley Online Library. A total of 23 studies were selected and data was extracted and tabulated to explore the characteristics of studies on text-based psychotherapy, measurements of the therapeutic alliance and associations of the alliance with treatment outcome.Results: The therapeutic alliance in text-based digital interventions was studied with a variety of client groups, though mostly for clients diagnosed with anxiety and/or depression issues. Treatment modalities were predominantly internet-based cognitive behavioral therapy (ICBT) and tailored platforms for distinct client groups (e.g., PTSD). Almost all treatments used asynchronous text-based communication, such as e-mails and integrated messaging functions, which were mainly used to give feedback on tasks. For measurements, a version of the Working Alliance Inventory (WAI) was used in most studies. Measurements with the WAI or WAI- short form indicated a good therapeutic alliance with a weighted mean score of 5.66 (on a scale of 1 to 7) and a weighted standard deviation of 0.84. Relations between the therapeutic alliance and treatment outcomes were mostly positive, with many studies reporting significant associations (n = 8 out of 10) or significant effects of the therapeutic alliance on treatment outcomes (n = 5 out of 6).Discussion: Our scoping review suggests that a good therapeutic alliance can be established in digital psychotherapy through text-based communication, and shows support for a positive relationship between the alliance and treatment outcomes. These findings illustrate that text-based online psychotherapy can be a responsible treatment option as far as the establishment of the therapeutic alliance is concerned. However, current measures of the therapeutic alliance might miss important aspects of the alliance in digital treatment, such as the presence of empathy or compassion.

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Section: Quality Of the Therapeutic Alliance And Alliance-outcome Relationshipsupporting

confidence: 90%

Section: The (Digital) Therapeutic Alliancementioning

confidence: 99%

Responsible Relations: A Systematic Scoping Review of the Therapeutic Alliance in Text-Based Digital Psychotherapy

Lotringen

Jeken

Westerhof

et al. 2021

Front. Digit. Health

View full text Add to dashboard Cite

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“…Mental health professionals still share concerns about whether online consultations are useful for their work, for example, concerning relational aspects, working with non-verbal behavior and emotions, performing certain assessments or interventions, or working with certain populations. Such concerns are not new (e.g., Stallard et al, 2010 ), but accumulating evidence shows the relevance of the therapeutic relationship in e-mental health ( Kaiser et al, 2021 ) and suggests the equivalence of relational aspects in different modes of delivery ( Irvine et al, 2020 ). Online consultations also appear feasible across different diagnostic groups and capable of reaching similar clinical outcomes as compared to conventional treatment ( Chiauzzi et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers

Witte¹,

Carlbring

Etzelmueller

et al. 2021

Internet Interventions

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Introduction While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. Objective This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations. Methods An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results. Results In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation. Conclusions This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

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“…Positive e-therapy therapeutic alliances were significantly associated with positive treatment outcomes. Building on the acceptance of the ability to form virtual therapeutic alliances, calls to pay specific attention to the selection and utilization of ICTs in e-therapy establishing this relationship have emerged (Kaiser et al 2021 ).…”

Section: Literature Reviewmentioning

confidence: 99%

Meeting the Practice Challenges of COVID-19: MSW Students’ Perceptions of E-Therapy and the Therapeutic Alliance

Earle

Freddolino

2021

Clin Soc Work J

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The COVID-19 pandemic prompted a radical shift in social work practice. Overnight, social work intervention models provided in-person gave way to the utilization of Information and Communication Technologies to facilitate direct practice in virtual environments (e-therapy). Social work’s slow acceptance of e-therapy prior to the pandemic resulted in a lack of training for many social work practitioners and MSW student interns, who were required to make rapid transitions to using and operating in online environments. It appears likely that e-therapy will continue after the COVID-19 pandemic subsides, so integrating education about effective e-therapy techniques into social work curricula seems like a logical next step. A social worker’s ability to establish the therapeutic alliance, which is at the heart of all helping relationships, will be central to this curricula. Understanding social work students’ perceptions of e-therapy and the therapeutic alliance can help shape the development of this new curriculum. Using internal student email, students at two Research I universities were invited to participate in a fully online anonymous survey dealing with attitudes towards e-therapy and the therapeutic alliance. Surveys were conducted in 2018 and April–May 2020. Survey questions were based on the only prior comprehensive study of student attitudes towards e-therapy (Finn in J Soc Work Educ 38(3), 403–419. 10.1080/10437797.2002.10779107, 2002 ). Study results indicate that students have e-therapy experience, believe that a practitioner can build a good therapeutic alliance, and think that some form of e-therapy will continue after the pandemic. These results confirm that further exploration about the inclusion of e-therapy education and its efficacy in social work curricula requires urgent attention.

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The association between therapeutic alliance and outcome in internet-based psychological interventions: A meta-analysis

Cited by 67 publications

References 60 publications

Responsible Relations: A Systematic Scoping Review of the Therapeutic Alliance in Text-Based Digital Psychotherapy

Responsible Relations: A Systematic Scoping Review of the Therapeutic Alliance in Text-Based Digital Psychotherapy

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers

Meeting the Practice Challenges of COVID-19: MSW Students’ Perceptions of E-Therapy and the Therapeutic Alliance

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