The Digital Therapeutic Alliance: Prospects and Considerations

The increasing prevalence of digital mental health research and interventions has given rise to the term “digital therapeutic alliance” (DTA), which aims to conceptually capture and measure the therapeutic quality of online psychological therapy or digital mental health interventions.

alliance between client and therapist in the case of therapy sessions conducted via email, online chat, or videoconferencing.

Research suggests that the therapeutic alliance can also be achieved in online modes, such as described above, in the same way that it is in face-to-face therapy and that such digital interventions can have a similar effect as face-to-face therapy [3]. These interactions involve what is known as computer-mediated communication, which is a field of study concerning computing technology use that is relevant to online teletherapy [4].

At the other end of the spectrum of forms of digital mental health care is engagement between a human client and an artificial intelligence (AI)–driven therapy agent. This could range from an online chatbot for mental health [5,6] to robotic or virtual human therapists [7,8]. Such AI-driven therapy agents, from the relatively simple to the more complex, raise a plethora of interesting questions around the nature of the relationship between the human client and the AI therapist. In terms of input from a computing/technology field, human-robot interaction is pertinent [9,10], including questions concerning the psychology of an interaction between a human and an AI agent, particularly its anthropomorphic aspects.

Should app developers be trying to recreate face-to-face therapy online, or should the online model have completely different characteristics to traditional therapeutic models?

In the paper “The Therapeutic Alliance in Digital Mental Health Interventions for Serious Mental Illnesses: Narrative Review” [14], the authors indicate that digital mental health applications offer advantages not found in traditional therapies. These include increased accessibility and autonomy, which can enhance adherence and engagement. They suggest that opportunities for self-guided therapy can lead to unique characteristics for therapeutic alliance in digital contexts. They show that currently the greatest support exists for the effectiveness of digital interventions for anxiety and depression, as opposed to other mental health conditions. They also emphasize the complexity of reaching conclusions in this very diverse field.

Clients of psychotherapy were generally satisfied that it was possible to establish a therapeutic alliance through video conferencing. Conversely, therapists expressed concern about the quality of the alliance and the ability to establish a satisfying therapeutic relationship through digital channels.