A qualitative study of the therapeutic alliance during telephone cognitive behavioural therapy: Clinicians’ perspectives
Background: Telephone interventions represent a rapidly-growing method of treatment delivery, particularly in primary care. The evidence base for telephone delivery is accumulating, and studies have demonstrated high levels of client satisfaction. However, some clinicians have expressed scepticism and concerns regarding the quality of a therapeutic alliance developed via telephone. Qualitative studies have also highlighted the emergence of potentially new elements of the therapeutic alliance when treatments are delivered remotely.There is a paucity of research regarding clinicians’ perspectives on these issues, which underlie the effective implementation of service delivery. Therefore, the current study investigates clinicians’ perspectives and experiences of the therapeutic alliance during CBT-based telephone interventions with a view to furthering our understanding of the therapeutic alliance as a theoretical construct, and informing the development and implementation of telephone-delivered interventions. Methods: Qualitative semi-structured interviews were conducted with 14 clinicians from Improving Access to Psychological Therapies (IAPT) services. Interviews were transcribed, coded and analysed using an inductive thematic analysis from a critical realist perspective. Results: The thematic analysis identified four major themes: 1) increased treatment focus, 2) shift in power, 3) reduced sense of personhood, and 4) adapting to the telephone. It was also noted that participants demonstrated difficulties in discussing the therapeutic alliance per se. iii Conclusions: Results suggest that the therapeutic alliance via the telephone may be qualitatively different from current conceptualisations and from the alliance which exists face-to-face. It is suggested that new theoretical models of distance alliance are necessary, along with corresponding clinical measures and adaptations to support clinicians.
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