Practitioners’ experience of the working alliance in a blended cognitive–behavioural therapy intervention for depression: qualitative study of barriers and facilitators

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...

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Bibliographic Details
Published in:BJPsych open 2022-07, Vol.8 (4), p.e142-e142, Article e142
Main Authors: Doukani, Asmae, Free, Caroline, Araya, Ricardo, Michelson, Daniel, Cerga-Pashoja, Arlinda, Kakuma, Ritsuko
Format: Article
Language:English
Subjects:
Behavior modification
Cognitive therapy
Collaboration
Data collection
Ethics
Focus groups
Intervention
Mental depression
Patients
Psychotherapy
Qualitative research
Therapists
Therapy
Usability
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Summary: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.
ISSN:2056-4724
2056-4724
DOI:10.1192/bjo.2022.546