Accepted for/Published in: JMIR Mental Health
Date Submitted: Jun 13, 2024
Date Accepted: Oct 8, 2024
The Effectiveness of a Novel Web-Based Intervention for Enhancing Therapeutic Relationship and Treatment Outcome in Adult Individual Psychotherapy: Randomized Controlled Trial and Analysis of Predictors of Drop-Out
ABSTRACT
Background:
Routine process/outcome monitoring interventions added to psychotherapy are known to improve treatment outcomes, although they vary in format and effectiveness.
Objective:
This study aimed to evaluate whether a therapist-independent, internet-based routine process monitoring and feedback system could significantly reduce psychological distress and enhance the quality of the therapeutic relationship compared to a treatment-as-usual control group among individuals already engaged in individual psychotherapy.
Methods:
We randomized 475 participants into either the intervention group, which received access to an internet-based routine process monitoring and feedback system in addition to psychotherapy, or the control group, which received only psychotherapy. The trial lasted for 10 weeks. Follow-up assessments at five and ten weeks used the Clinical Outcomes in Routine Evaluation–Outcome Measure as the primary outcome, with the Working Alliance Inventory–Short Revised and the Real Relationship Inventory–Client form as secondary outcomes.
Results:
Per-protocol analyses (n = 166) showed that psychological distress decreased in both groups, but there was no significant advantage for the intervention group. The intervention group experienced a decline in the genuineness dimension score of the real relationship, with an effect size of d = –0.27, compared to d = 0.01 in the control group.
Conclusions:
The findings do not provide conclusive evidence for the efficacy of the new internet-based intervention in enhancing self-monitoring and prompting reflection on patients’ emotional responses to their therapists. However, the intervention appears to influence patients’ perceptions of the genuineness dimension in the therapeutic relationship, warranting further investigation. We hypothesize that this alteration in the genuineness dimension could be attributed to the intervention facilitating a more realistic and accurate perception of the therapeutic relationship among participants. Clinical Trial: ClinicalTrials.gov NCT06038747. Funding: European Union’s Horizon 2020.
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