期刊
BJPSYCH OPEN
卷 8, 期 4, 页码 -出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1192/bjo.2022.546
关键词
Working alliance; mental health practitioner; blended cognitive-behavioural therapy; qualitative research; e-mental health
类别
资金
- E-COMPARED trial - European Commission [603098]
This study is the first to investigate practitioners' perceived facilitators and barriers to forming a working alliance in blended cognitive-behavioural therapy (b-CBT) for depression. Findings suggest that the experiences of practitioners can be improved by considering time pressures, offering tailored digital programs, and providing training and technical support.
Background Digital technologies have been widely acknowledged as a potentially useful resource for increasing mental healthcare access. The working alliance is a key influence on outcomes in conventional psychotherapy, but little is known about therapists' experiences of forming an effective working alliance in blended interventions that involve in-person psychotherapy and a digital programme. Aims To investigate psychological well-being practitioners' (PWPs') experiences of the working alliance in a trial of blended cognitive-behavioural therapy (b-CBT) for depression. Trial registration ISRCTN12388725. Method Semi-structured qualitative interviews were conducted with 13 PWPs who delivered b-CBT in a two-arm, non-inferiority randomised controlled trial investigating the effectiveness of b-CBT compared with face-to-face CBT. Thematic analysis was used to analyse the data. Results Participants reported four facilitating factors when building and maintaining a working alliance in b-CBT: having more time to deliver treatment, access to a wider toolkit, capacity to tailor components of b-CBT and receiving appropriate training and support. Participants also identified four barriers to building and maintaining a working alliance: time and resource constraints, usability challenges, limited flexibility to tailor the digital programme to patients' needs and lack of confidence in delivering b-CBT. Conclusions Our study is the first specifically to investigate practitioners' perceived facilitators and barriers to forming a working alliance in b-CBT for depression. Findings suggest that PWPs' experiences of the working alliance can be improved by: accounting for the time required to deliver b-CBT in service workflows to reduce time pressures; increasing opportunities to tailor the digital programme through offering transdiagnostic tools and adaptable features; and providing appropriate b-CBT training and technical support.
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