Therapeutic alliance (TA) is a term that concerns the establishment of certain qualities in the relationship that develops between a client and a mental health professional, qualities such as affective bond and shared goals/tasks which have proven to be essential ingredients in successful face-to-face therapy clinical outcomes. With the growth of unguided mental health apps (apps without human support) in recent times, either as standalone sources of mental health support or supplementations to traditional care, the question arises as to whether there is an analogous notion of a digital therapeutic alliance (DTA), and whether and how it plays a role in usage and efficacy of mental health apps. Recent work in constructing a DTA conceptual model has determined that the DTA has five dimensions: flexibility, self-initiative, emotional experiences, openness, and goals. Based on this conceptualization of DTA, we have built a preliminary scale that quantitatively captures this DTA conceptualization. In our current work, this DTA scale has been tested in a cross-sectional study of mindfulness apps and we are examining the associations between DTA and User Version of the Mobile Application Rating Scale (uMARS). The results will provide insights on how app design can help enhance user-app alliance and ultimately bring about better outcomes for users of unguided mental health apps.
Digital therapeutic alliance in the context of unguided mental health apps
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