The therapeutic relationship in e-therapy for mental health: a systematic review

Madalina Sucala, Julie B Schnur, Michael J Constantino, Sarah J Miller, Emily H Brackman, Guy H Montgomery, Madalina Sucala, Julie B Schnur, Michael J Constantino, Sarah J Miller, Emily H Brackman, Guy H Montgomery

Abstract

Background: E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues.

Objective: Our objective in this study was to systematically review the therapeutic relationship in e-therapy.

Methods: We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form.

Results: From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance-a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome.

Conclusions: Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
PRISMA 2009 Flow Diagram.

References

    1. Miniwatts Marketing Group. 2012. [2012-02-15]. Internet World Stats
    1. Barak A, Hen L, Boniel-Nissim M, Shapira N. A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. J Technol Hum Serv. 2008;26(2):109–60. doi: 10.1080/15228830802094429.
    1. Manhal-Baugus M. E-therapy: practical, ethical, and legal issues. Cyberpsychol Behav. 2001 Oct;4(5):551–63.
    1. Reynolds DJ, Stiles WB, Grohol JM. An investigation of session impact and alliance in internet based psychotherapy: preliminary results. Couns Psychother Res. 2006;6(3):164–8. doi: 10.1080/14733140600853617.
    1. Mallen MJ, Vogel DL, Rochlen AB, Day SX. Online counseling: reviewing the literature from a counseling psychology framework. Couns Psychol. 2005;33:819–71. doi: 10.1177/0011000005278624.
    1. Cook JE, Doyle C. Working alliance in online therapy as compared to face-to-face therapy: preliminary results. Cyberpsychol Behav. 2002 Apr;5(2):95–105.
    1. Rochlen AB, Zack JS, Speyer C. Online therapy: review of relevant definitions, debates, and current empirical support. J Clin Psychol. 2004 Mar;60(3):269–83. doi: 10.1002/jclp.10263.
    1. Wells M, Mitchell KJ, Finkelhor D, Becker-Blease KA. Online mental health treatment: concerns and considerations. Cyberpsychol Behav. 2007 Jun;10(3):453–9. doi: 10.1089/cpb.2006.9933.
    1. Lambert MJ, Barley DE. Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy. 2001;38(4):357–61. doi: 10.1037/0033-3204.38.4.357.
    1. Norcross JC. Norcross JC, editor. Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients. New York, NY: Oxford University Press; 2002. Empirically supported therapy relationships; pp. 3–16.
    1. Wampold BE. The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: L Erlbaum Associates; 2001.
    1. Ackerman SJ, Benjamin LS, Beutler LE, Gelso CJ, Goldfried MR, Hill C, Lambert MJ, Norcross JC, Orlinsky DE, Rainer J. Empirically supported therapy relationships: conclusions and recommendations of the Division 29 Task Force. Psychotherapy. 2001;38(4):495–7. doi: 10.1037/0033-3204.38.4.495.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009 Aug 18;151(4):264–9, W64.0000605-200908180-00135
    1. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gøtzsche PC, Lang T, CONSORT GROUP (Consolidated Standards of Reporting Trials) The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001 Apr 17;134(8):663–94.200104170-00012
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001 Apr 14;357(9263):1191–4.S0140673600043373
    1. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998 Dec;51(12):1235–41.S0895435698001310
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–74.
    1. King R, Bambling M, Reid W, Thomas I. Telephone and online counselling for young people: a naturalistic comparison of session outcome, session impact and therapeutic alliance. Couns Psychother Res. 2006;6(3):175–81. doi: 10.1080/14733140600874084.
    1. Knaevelsrud C, Maercker A. Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry. 2007;7:13. doi: 10.1186/1471-244X-7-13. 1471-244X-7-13
    1. Knaevelsrud C, Maercker A. Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients? J Med Internet Res. 2006;8(4):e31. doi: 10.2196/jmir.8.4.e31. v8i4e31
    1. Trautmann E, Kroner-Herwig B. Internet-based self-help training for children and adolescents with recurrent headache: a pilot study. Behav Cogn Psychother. 2008;36:241–5. doi: 10.1017/S135246580800421.
    1. Klein B, Mitchell J, Gilson K, Shandley K, Austin D, Kiropoulos L, Abbott J, Cannard G. A therapist-assisted Internet-based CBT intervention for posttraumatic stress disorder: preliminary results. Cogn Behav Ther. 2009 Jun;38(2):121–31. doi: 10.1080/16506070902803483.912392848
    1. Klein B, Mitchell J, Abbott J, Shandley K, Austin D, Gilson K, Kiropoulos L, Cannard G, Redman T. A therapist-assisted cognitive behavior therapy internet intervention for posttraumatic stress disorder: pre-, post- and 3-month follow-up results from an open trial. J Anxiety Disord. 2010 Aug;24(6):635–44. doi: 10.1016/j.janxdis.2010.04.005.S0887-6185(10)00086-1
    1. Kiropoulos LA, Klein B, Austin DW, Gilson K, Pier C, Mitchell J, Ciechomski L. Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? J Anxiety Disord. 2008 Dec;22(8):1273–84. doi: 10.1016/j.janxdis.2008.01.008.S0887-6185(08)00017-0
    1. Ruwaard J, Lange A, Bouwman M, Broeksteeg J, Schrieken B. E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial. Cogn Behav Ther. 2007;36(3):179–92. doi: 10.1080/16506070701381863.779266704
    1. Ruwaard J, Schrieken B, Schrijver M, Broeksteeg J, Dekker J, Vermeulen H, Lange A. Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cogn Behav Ther. 2009 Dec;38(4):206–21. doi: 10.1080/16506070802408086.908748225
    1. Horvath AO, Greenberg LS. Greenberg LS, Pinsoff WM, editors. The Psychotherapeutic Process: A Research Handbook. New York, NY: Guilford Press; 1986. Development of the Working Alliance Inventory; pp. 529–56.
    1. Bickman L, Vides de Andrade AR, Lambert EW, Doucette A, Sapyta J, Boyd AS, Rumberger DT, Moore-Kurnot J, McDonough LC, Rauktis MB. Youth therapeutic alliance in intensive treatment settings. J Behav Health Serv Res. 2004;31(2):134–48.
    1. Luborsky L, McLellan AT, Woody GE, O'Brien CP, Auerbach A. Therapist success and its determinants. Arch Gen Psychiatry. 1985 Jun;42(6):602–11.
    1. Tracey TJ, Kokotovic AM. Factor structure of the working alliance inventory. Psychol Assess. 1989;1(3):207–10. doi: 10.1037/1040-3590.1.3.207.
    1. Stiles WB, Hardy GE, Cahill J. The short ARM (a short form of the Agnew Relationship Measure). Annual meeting of the North American Society for Psychotherapy Research; 2003; Newport, RI, USA. 2003.
    1. Cahill J, Stiles WB, Barkham M, Hardy GE, Stone G, Agnew-Davies R, Unsworth G. Two short forms of the Agnew Relationship Measure: the ARM-5 and ARM-12. Psychother Res. 2012;22(3):241–55. doi: 10.1080/10503307.2011.643253.
    1. Krampen G, Wald B. Kurzinstrumente fur die Prozessevaluation und adaptive Indikation in der Allgemeinen und Differentiellen Psychotherapie und Beratung. Diagnostica. 2001;47:43–50. doi: 10.1026//0012-1924.47.1.43.
    1. Norcross JC. In: Psychotherapy Relationships That Work: Evidence-Based Responsiveness. 2nd edition. Norcross JC, editor. New York, NY: Oxford University Press; 2011.
    1. Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy. 1976;16(3):252–60. doi: 10.1037/h0085885.
    1. Bordin ES. Horvath AO, Greenberg LS, editors. The Working Alliance: Therory, Research, and Practice. New York, NY: Wiley; 1994. Theoryresearch on the therapeutic working alliance: new directions; pp. 13–37.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd edition. Hillsdale, NJ: L Erlbaum Associates; 1988.
    1. Castonguay LG, Constantino MJ, Holtforth MG. The working alliance: Where are we and where should we go? Psychotherapy (Chic) 2006;43(3):271–9. doi: 10.1037/0033-3204.43.3.271.2006-12148-004
    1. Mallen MJ, Day SX, Green MA. Online versus face-to-face conversations: an examination of relational and discourse variables. Psychotherapy. 2003;40(1/2):155–63. doi: 10.1037/0033-3204.40.1/2.15.
    1. Powell J, Clarke A. Internet information-seeking in mental health: population survey. Br J Psychiatry. 2006 Sep;189:273–7. doi: 10.1192/bjp.bp.105.017319. 189/3/273
    1. Hatcher RL, Barends A, Hansell J, Gutfreund MJ. Patients' and therapists' shared and unique views of the therapeutic alliance: an investigation using confirmatory factor analysis in a nested design. J Consult Clin Psychol. 1995 Aug;63(4):636–43.
    1. Eaton TT, Abeles N, Gutfreund MJ. Therapeutic alliance and outcome: impact of treatment length and pretreatment symptomatology. Psychotherapy. 1988;25(4):536–42. doi: 10.1037/h0085379.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir