{"id":{"repo_id":"lancaster","oai_identifier":"oai:eprints.lancs.ac.uk:127663"},"canonical_url":"https://search.dev.ndltd.org/etd/lancaster/oai:eprints.lancs.ac.uk:127663","repository":{"repo_id":"lancaster","name":"Lancaster University","base_url":"https://eprints.lancs.ac.uk/cgi/oai2"},"display":{"title":"Exploring the nature of the therapeutic alliance in technology-based interventions for mental health problems","abstract":"Background: Digital technology is increasingly being used in healthcare delivery, and can potentially improve access to psychological services. “Technology-based interventions” (TBIs) are a form of self-guided psychological treatment delivered by digital technology, such as computer programs, websites, or smartphones. Little is known about how these work, and high drop-out rates raise a pressing need to understand user engagement. The therapeutic alliance concerns the level of collaboration in therapy, and is strongly linked to face-to-face treatment’s effectiveness. The validity of therapeutic alliance is uncertain in TBIs, but it may contribute towards an understanding of user engagement. Objective: To explore the nature of the therapeutic alliance in the context of technology-based interventions (TBIs) for mental health problems. Methods: A systematic review was undertaken, which included qualitative, quantitative and mixed methods research. 13 papers were analysed using a best-fit framework synthesis approach. A qualitative study was also conducted, using topic-guided interviews to explore 13 participants’ experiences regarding their interaction and engagement with TBIs. Thematic analysis was used to analyse the data. Results: The user-TBI alliance is largely comprised of similar dimensions to the alliance in face-to-face therapy. There are also some new dimensions which specifically apply to TBIs: interactivity (personalising a TBI), and availability (flexible access to treatment). The user-TBI alliance may not be directly associated with outcomes, but it does appear to be related to user engagement. Conclusions: TBI users can experience a therapeutic alliance with the digital technology, especially if the TBI is sufficiently personalised. The terminology of a “relationship” with digital technology is generally unacceptable to TBI users, which will pose challenges when attempting to adapt or design alliance measures that take account of the unique TBI context.","abstract_html":"Background: Digital technology is increasingly being used in healthcare delivery, and can potentially improve access to psychological services. “Technology-based interventions” (TBIs) are a form of self-guided psychological treatment delivered by digital technology, such as computer programs, websites, or smartphones. Little is known about how these work, and high drop-out rates raise a pressing need to understand user engagement. The therapeutic alliance concerns the level of collaboration in therapy, and is strongly linked to face-to-face treatment’s effectiveness. The validity of therapeutic alliance is uncertain in TBIs, but it may contribute towards an understanding of user engagement. Objective: To explore the nature of the therapeutic alliance in the context of technology-based interventions (TBIs) for mental health problems. Methods: A systematic review was undertaken, which included qualitative, quantitative and mixed methods research. 13 papers were analysed using a best-fit framework synthesis approach. A qualitative study was also conducted, using topic-guided interviews to explore 13 participants’ experiences regarding their interaction and engagement with TBIs. Thematic analysis was used to analyse the data. Results: The user-TBI alliance is largely comprised of similar dimensions to the alliance in face-to-face therapy. There are also some new dimensions which specifically apply to TBIs: interactivity (personalising a TBI), and availability (flexible access to treatment). The user-TBI alliance may not be directly associated with outcomes, but it does appear to be related to user engagement. Conclusions: TBI users can experience a therapeutic alliance with the digital technology, especially if the TBI is sufficiently personalised. The terminology of a “relationship” with digital technology is generally unacceptable to TBI users, which will pose challenges when attempting to adapt or design alliance measures that take account of the unique TBI context.","abstract_has_math":false,"creators":["Hillier, Laura","Lobban, Fiona","Jones, Steven","Dagnan, Dave"],"institution":"Lancaster University","degree_name":"masters","degree_level":"masters","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018","date_published":"2018","updated_at":"2026-07-24T02:48:45Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":null,"outbound_label":null,"outbound_source":null},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Hillier, Laura","Lobban, Fiona","Jones, Steven","Dagnan, Dave"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2018"]},{"key":"dc:date.issued","label":"Date","values":["2018"]},{"key":"dc:publisher.commercial","label":"Dc Publisher Commercial","values":["Lancaster University"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Health Research"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["Lancaster University"]},{"key":"dc:relation.isreferencedby","label":"Dc Relation Isreferencedby","values":["https://eprints.lancs.ac.uk/id/eprint/127663/"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["masters"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["masters"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://eprints.lancs.ac.uk/id/eprint/127663/1/2018hilliermphil.pdf"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background: Digital technology is increasingly being used in healthcare delivery, and can potentially improve access to psychological services. “Technology-based interventions” (TBIs) are a form of self-guided psychological treatment delivered by digital technology, such as computer programs, websites, or smartphones. Little is known about how these work, and high drop-out rates raise a pressing need to understand user engagement. The therapeutic alliance concerns the level of collaboration in therapy, and is strongly linked to face-to-face treatment’s effectiveness. The validity of therapeutic alliance is uncertain in TBIs, but it may contribute towards an understanding of user engagement. Objective: To explore the nature of the therapeutic alliance in the context of technology-based interventions (TBIs) for mental health problems. Methods: A systematic review was undertaken, which included qualitative, quantitative and mixed methods research. 13 papers were analysed using a best-fit framework synthesis approach. A qualitative study was also conducted, using topic-guided interviews to explore 13 participants’ experiences regarding their interaction and engagement with TBIs. Thematic analysis was used to analyse the data. Results: The user-TBI alliance is largely comprised of similar dimensions to the alliance in face-to-face therapy. There are also some new dimensions which specifically apply to TBIs: interactivity (personalising a TBI), and availability (flexible access to treatment). The user-TBI alliance may not be directly associated with outcomes, but it does appear to be related to user engagement. Conclusions: TBI users can experience a therapeutic alliance with the digital technology, especially if the TBI is sufficiently personalised. The terminology of a “relationship” with digital technology is generally unacceptable to TBI users, which will pose challenges when attempting to adapt or design alliance measures that take account of the unique TBI context."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Exploring the nature of the therapeutic alliance in technology-based interventions for mental health problems"]}]}],"canonical_facts":{"dc:creator":["Hillier, Laura","Lobban, Fiona","Jones, Steven","Dagnan, Dave"],"dc:date":["2018"],"dc:date.issued":["2018"],"dc:description.abstract":["Background: Digital technology is increasingly being used in healthcare delivery, and can potentially improve access to psychological services. “Technology-based interventions” (TBIs) are a form of self-guided psychological treatment delivered by digital technology, such as computer programs, websites, or smartphones. Little is known about how these work, and high drop-out rates raise a pressing need to understand user engagement. The therapeutic alliance concerns the level of collaboration in therapy, and is strongly linked to face-to-face treatment’s effectiveness. The validity of therapeutic alliance is uncertain in TBIs, but it may contribute towards an understanding of user engagement. Objective: To explore the nature of the therapeutic alliance in the context of technology-based interventions (TBIs) for mental health problems. Methods: A systematic review was undertaken, which included qualitative, quantitative and mixed methods research. 13 papers were analysed using a best-fit framework synthesis approach. A qualitative study was also conducted, using topic-guided interviews to explore 13 participants’ experiences regarding their interaction and engagement with TBIs. Thematic analysis was used to analyse the data. Results: The user-TBI alliance is largely comprised of similar dimensions to the alliance in face-to-face therapy. There are also some new dimensions which specifically apply to TBIs: interactivity (personalising a TBI), and availability (flexible access to treatment). The user-TBI alliance may not be directly associated with outcomes, but it does appear to be related to user engagement. Conclusions: TBI users can experience a therapeutic alliance with the digital technology, especially if the TBI is sufficiently personalised. The terminology of a “relationship” with digital technology is generally unacceptable to TBI users, which will pose challenges when attempting to adapt or design alliance measures that take account of the unique TBI context."],"dc:format":["application/pdf"],"dc:identifier.uri":["https://eprints.lancs.ac.uk/id/eprint/127663/1/2018hilliermphil.pdf"],"dc:publisher.commercial":["Lancaster University"],"dc:publisher.department":["Health Research"],"dc:publisher.institution":["Lancaster University"],"dc:relation.isreferencedby":["https://eprints.lancs.ac.uk/id/eprint/127663/"],"dc:title":["Exploring the nature of the therapeutic alliance in technology-based interventions for mental health problems"],"dc:type":["Thesis"],"dc:type.qualificationlevel":["masters"],"dc:type.qualificationname":["masters"]},"updated_at":"2026-07-24T02:48:45Z"}