Support for Carers of Young People with Mental Illness: Design and Trial of a Technology-Mediated Therapy

In this article, we show how a technology-mediated mental health therapy involving psycho-education, therapist moderators, and social networking can provide support for carers of young people with mental illness. This multi-faceted tool provides opportunities for users to adapt the system to their needs, leading us to refocus the goal of treatment adherence toward a relatively new phenomenon in HCl, concordance, which has not previously been examined in the HCl literature in relation to online mental-health tools. Concordance shares important links with the development of therapeutic alliance, which is centrally important to mental health therapy, and to Self-Determination Theory (SDT), which informed our approach to design. We present a three-month user study, which provides initial encouraging support for both the suitability of concordance as a lens for viewing user engagement and the idea that users can develop a therapeutic alliance with an online support system. This latter result is surprising as the phenomenon of therapeutic alliance generally describes a relationship between client and (human) clinician. Therapeutic alliance has previously been explored for face-to-face groups, and between individuals and online systems, but not for online groups. We show how even automated system behavior can encourage engagement from users and contribute to alliance formation, if the non-human parts of an online system are interactive. We argue that a design approach involving peer/moderator support as well as automated feedback, and which takes account of SDT, can provide support for therapeutic alliance.