Accepted for/Published in: JMIR Mental Health
Date Submitted: Nov 29, 2019
Date Accepted: Jun 7, 2020
The therapeutic alliance in digital mental health interventions for serious mental illnesses: Narrative review
ABSTRACT
Background:
Background:
Digital mental health interventions offer unique advantages, and research indicates that these are effective for a range of mental health concerns. While less established for individuals with serious mental illnesses these demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, while less emphasis has been placed on its role in digital interventions. The nature of the digital therapeutic alliance and its relationship with outcomes requires further attention, in particular for individuals with serious mental illnesses.
Objective:
Objective:
The objective of this narrative review was to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses.
Methods:
Methods:
A narrative review was conducted combining three main bodies of literature; the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions and the third surrounding practical considerations to enhance the digital therapeutic alliance.
Results:
Results:
Results indicated that the therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet to be confirmed characteristics in digital contexts. Additionally, the therapeutic alliance appears less directly associated with outcomes in digital interventions than in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, via which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features.
Conclusions:
Conclusions:
More research is required to further understanding of the nature and specific role of the therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed a number of key research priorities to advance the therapeutic alliance in digital interventions.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.