scholarly journals The Digital Therapeutic Alliance and Human-Computer Interaction

10.2196/21895 ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. e21895
Author(s):  
Simon D'Alfonso ◽  
Reeva Lederman ◽  
Sandra Bucci ◽  
Katherine Berry

The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.

2020 ◽  
Author(s):  
Simon D'Alfonso ◽  
Reeva Lederman ◽  
Sandra Bucci ◽  
Katherine Berry

UNSTRUCTURED The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Stimac Grbic ◽  
I Pavic Simetin ◽  
A Istvanovic

Abstract Issue Care for people with severe mental disorders requires approach that is focused on a person's strengths, not his weaknesses, and is a shift from a deficit model that is often associated with mental illness. Care users and their family members play an important role in this approach. Description of the Problem Mental disorders are the leading group of diseases in Croatia, according to the number of days of hospital treatment. The number of hospitalizations is high, and the rate of hospitalization for depression has tripled in the last twenty years. Such indicators highlight the need for reorientation of mental health care, from hospital-based to community-based, by organizing mobile community intervention teams. Results In Croatia, psychosocial peer teams were established by the NGO Ludruga, financed by local government, to provide peer support to persons with mental disorders. The main activities are: development of a personal recovery plan, home visits and providing psychological support to persons with mental disorders, organizing support groups and education of peer workers. The teams consist of a peer worker, social worker, psychologist, and operate under the supervision of a psychiatrist. The teams have been operating for five years, have had over a hundred users so far and are a significant help to the healthcare system in preventing rehospitalizations. Lessons The goal of therapeutic interventions in mental health care should be recovery. Recovery involves empowering a person to take responsibility for themselves and their health. Peer workers play an important role in the recovery process, providing hope for recovery. Their role must also be recognized by the health system. Key messages People with mental disorders and their families should be co-creators of care and recovery-oriented interventions. Only by comprehensive interventions, tackling all determinants of health, therapeutic goal can be achieved.


2018 ◽  
Author(s):  
Monica Strand ◽  
Deede Gammon ◽  
Lillian Sofie Eng ◽  
Cornelia Ruland

BACKGROUND Peer support groups for people with long-term mental health problems are at the heart of recovery-oriented approaches in mental health care. When conducted face-to-face (offline) or on the Internet (online), peer support groups have proven to have differing strengths and weaknesses. Little is known about the benefits and challenges of combining the two formats. OBJECTIVE The aim of this study was to gain insights into the benefits and challenges of combining online and offline peer support groups facilitated through an Internet intervention designed to support recovery processes. METHODS In this exploratory and descriptive study, an e-recovery portal called ReConnect was used by service users in two mental health communities in Norway for 6-12 months. The portal included an online peer support forum which also facilitated participation in local in-person ReConnect-cafés. Both formats of peer support were facilitated by an employed service user consultant with lived experience of mental health problems and with training in peer support. Qualitative data about service users’ experiences of using the portal were collected through focus groups and individual interviews and inductively analyzed thematically with focus on benefits and challenges of peer support online and offline. RESULTS A total of 14 service users 22-63 years of age with various diagnoses, receiving services at both primary and specialist levels of mental health care participated in three focus groups and 10 individual interviews. Two main themes were identified in the analysis: 1) balancing anonymity and openness, and 2) enabling connectedness. These themes are further illustrated with the subthemes: i) dilemmas of anonymity and confidentiality, ii) towards self-disclosure and openness, iii) new friendships, and iv) networks in the local community. Three of the subthemes mainly describe benefits. Challenges were more implicit and cut across the subthemes. Identified challenges were linked to transitions from anonymity to revealing one’s identity, how to protect confidentiality, or to participation at face-to-face meetings in the local community. CONCLUSIONS Our study suggests that online peer support groups and offline meetings complement each other, and the combination is mainly beneficial to users. The identified benefits appeared to arise from participants’ options of one format or the other, or that they could combine formats in ways that suited their individual values and comfort zones. We also identified challenges related to combination of formats, and both formats require appropriate facilitation of peer support. Combining online formats that enable anonymity, a non-judgmental atmosphere, and 24/7 accessibility regardless of location, with offline formats that foster local, in-person community ties, is a promising concept for facilitating recovery-oriented care, and warrants continued research.


2021 ◽  
Author(s):  
Anne Nobels ◽  
Ines Keygnaert ◽  
Egon Robert ◽  
Christophe Vandeviver ◽  
An Haekens ◽  
...  

AbstractBackgroundSexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging.MethodsBetween July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape.OutcomesIn 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before.InterpretationSexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures.


2021 ◽  
pp. 103985622110435
Author(s):  
Andrew James Amos ◽  
Jocelyn Middleton ◽  
Fergus W. Gardiner

Objective: To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact. Methods: A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensland in mid-2020. With the onset of COVID-19, the survey was modified to measure the impact of the pandemic. Results: Just over half of the services’ clients participated in the survey (50.4%), of whom more were female (63.2%). Of the participants, 46.3% in Far North and 8.6% in Central West Queensland identified as Indigenous. Strong resistance to telehealth before the pandemic across groups (76%) was moderated during COVID-19 (42.4%), an effect that appeared likely to continue past the pandemic for Central West clients (34.5%). Far North clients indicated their telehealth reluctance would return after the pandemic (77.6%). Conclusions: Our results suggest that remote Australians strongly prefer in-person mental health care to telehealth. Although the COVID-19 pandemic increased acceptance of telehealth across regions while social distancing continued, there was evidence that Indigenous Australians were more likely to prefer in-person contact after the pandemic.


Nursing ◽  
2021 ◽  
Vol 51 (10) ◽  
pp. 56-60
Author(s):  
Angel Johann Solorzano Martinez

2019 ◽  
Vol 44 (3) ◽  
pp. 149-155 ◽  
Author(s):  
Annie Snow ◽  
Julie Cerel ◽  
Diane N Loeffler ◽  
Chris Flaherty

AbstractContemporary research suggests that transgender and gender-nonconforming (TGNC) adults encounter formidable barriers to health care, including access to quality therapeutic interventions. This systematic review is one of the first to specifically explore obstacles to TGNC mental health care. A rigorous literature review identified eight relevant studies: six qualitative designs and two quantitative designs. Thematic synthesis revealed three major barriers to care and five corresponding subthemes: (1) personal concerns, involving fear of being pathologized or stereotyped and an objection to common therapeutic practices; (2) incompetent mental health professionals, including those who are unknowledgeable, unnuanced, and unsupportive; and (3) affordability factors. Results indicate an acute need for practitioner training to ensure the psychological well-being of TGNC clients.


Author(s):  
Elke Humer ◽  
Christoph Pieh ◽  
Martin Kuska ◽  
Antonia Barke ◽  
Bettina K. Doering ◽  
...  

Psychotherapists around the world are facing an unprecedented situation with the outbreak of the novel coronavirus disease (COVID-19). To combat the rapid spread of the virus, direct contact with others has to be avoided when possible. Therefore, remote psychotherapy provides a valuable option to continue mental health care during the COVID-19 pandemic. The present study investigated the fear of psychotherapists to become infected with COVID-19 during psychotherapy in personal contact and assessed how the provision of psychotherapy changed due to the COVID-19 situation and whether there were differences with regard to country and gender. Psychotherapists from three European countries: Czech Republic (CZ, n = 112), Germany (DE, n = 130) and Slovakia (SK, n = 96), with on average 77.8% female participants, completed an online survey. Participants rated the fear of COVID-19 infection during face-to-face psychotherapy and reported the number of patients treated on average per week (in personal contact, via telephone, via internet) during the COVID-19 situation as well as (retrospectively) in the months before. Fear of COVID-19 infection was highest in SK and lowest in DE (p < 0.001) and was higher in female compared to male psychotherapists (p = 0.021). In all countries, the number of patients treated on average per week in personal contact decreased (p < 0.001) and remote psychotherapies increased (p < 0.001), with more patients being treated via internet than via telephone during the COVID-19 situation (p < 0.001). Furthermore, female psychotherapists treated less patients in personal contact (p = 0.036), while they treated more patients via telephone than their male colleagues (p = 0.015). Overall, the total number of patients treated did not differ during COVID-19 from the months before (p = 0.133) and psychotherapy in personal contact remained the most common treatment modality. Results imply that the supply of mental health care could be maintained during COVID-19 and that changes in the provision of psychotherapy vary among countries and gender.


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