JMIR Publications

ABSTRACT

Background:

Therapeutic alliance, or the working relationship between patient and clinician, is one of the foremost predictors of patient outcomes among adolescents participating in mental health interventions. However, few studies have investigated the quality and potential predictors of therapeutic alliance among youth participating in internet-based behavioral care.

Objective:

Using reported therapeutic alliance from caregivers of children and adolescents engaged in care with a digital mental health intervention (DMHI), the current study investigates (1) the quality of therapeutic alliance, satisfaction with services, and perceived improvement, and (2) whether duration in care may predict these outcomes.

Methods:

Adolescents (n = 22) and caregivers of children/adolescents (n = 43) involved in care with Bend Health Inc., a collaborative care DMHI, completed a survey to measure level of therapeutic alliance with their practitioner (e.g., coach or therapist), satisfaction with care, and perceived symptom improvements.

Results:

With ratings out of five, average therapeutic alliance (4.21 ± 0.83), overall satisfaction (4.13 ± 0.88), and perceived improvement (3.69 ± 0.88) were high in our study. Survey scores differed by survey domain (F2,122 = 39.58; P < .001), as perceived improvement scores were lower than the other domains. Survey scores tended to be higher with greater months in care (F1,62 = 6.67; P = .012), and this was most pronounced for the perceived improvement domain (months in care X domain: F2,122 = 3.35; P = .038).

Conclusions:

Our findings indicate that strong therapeutic alliance, satisfaction with care, and perceived improvement in symptoms can be achieved in the context of a pediatric DMHI. Further, these outcomes are higher in those with longer durations in care, suggesting that therapeutic alliance in digital contexts is strengthened by interaction and time spent with a care provider. Future studies should assess whether child and adolescent therapeutic alliances with DMHI care providers relate to symptom outcomes.