An exploration of digital therapy: the therapeutic alliance online and psychologists’ experiences and reflections on offering online therapy

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Date
2022-05-13
Authors
Geary, Christina
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University College Cork
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Abstract
Systematic Review: Remotely delivered therapy for mental health disorders is increasingly adopted in health services worldwide. However, evidence of how the implementation of remote therapy affects the therapeutic relationship is disjointed. To synthesise international evidence exploring the sociotechnical features that may play a role in determining a strong therapeutic relationship in remotely delivered therapy for mental health disorders. A qualitative systematic review. A systematic review was conducted up until May 2022, including qualitative studies from EBSCO CINAHL, Medline - PubMed, Embase, PsychInfo and SCOPUS, which explored the therapeutic relationship and alliance of remotely delivered therapies. Twenty-three studies were included. The data were categorised into four themes: 1. Therapists’ enthusiasm for remote therapy facilitates service user buy-in, 2. It is possible to establish a therapeutic relationship in remotely delivered therapy 3. Remote therapy should be implemented as an adjunct to face-to-face therapy, and 4. Technical issues have the potential to disrupt the creation of a safe and trusting atmosphere in remote therapy. Sociotechnical components play a role in determining a strong therapeutic alliance in remotely delivered therapy, such as the characteristics of the therapist and the centrality of technology. Augmenting rather than replacing face-to-face, can assist in identifying areas for the improvement of remote therapy. Empirical Research: Digital technologies can transform healthcare services and may contribute to health system goals of accessibility, quality and equality of healthcare. However, this requires careful consideration of both the technical requirements needed to make online therapy work and sensitivity towards the relational factors required to build a therapeutic alliance. The current study uses Psychologists’ experiences during the Covid-19 pandemic and the associated move to online therapy as a critical incident to reflect on the future of digitisation. The socio-technical systems (STS) theory has been adopted as a lens that allows us to interrogate participants' social, technical, interpersonal and organisation experiences of the digitilisation of mental health services. Participants (N=10) were psychologists from Health Service Executive (HSE) Mental Health and Primary Care Services in Ireland who had provided therapeutic intervention online during the Covid-19 pandemic (F= 6, M=4) (age 25- 44). An inductive reflexive thematic analysis generated four themes: 1. Optimizing outreach and engagement through digital therapy; 2. Digital therapeutic disruptions; 3. Understanding what makes online therapy feel like a suboptimal offering; 4. Identifying the enablers to offering effective online therapy. Some psychologists indicated that engaging the online platform could convey a degree of protection and anonymity due to physical distance that was sometimes beneficial to establishing a more intimate connection.
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Therapeutic relationship , Therapeutic alliance , Mental health , eMental health , Technology , Remote therapy , Systematic review , Thematic synthesis , Qualitative research , The socio-technical systems (STS) theory , Digitilisation , Mental health services , Health Service Executive
Citation
Geary, C. 2022. An exploration of digital therapy: the therapeutic alliance online and psychologists’ experiences and reflections on offering online therapy. DClinPsych Thesis, University College Cork.