Can New Mental Health Tech Enhance the Therapeutic Relationship?

Its mental health history in the making: As augmented mental health systems hit the market, the power to objectively monitor emotional and behavioral health is in the hands of mental health professionals for the very first time—the benefits are numerous and priceless. But how does employing such new technology impact the therapeutic relationship, an integral tool for transformation in modern forms of therapy?

Some Therapist’s Fear Tech Disrupts the Therapeutic Relationship

Despite the inevitability, research reports that many mental health professionals and therapists have various concerns about using technology in therapy. How new technologies affect the therapeutic relationship (also known as the therapeutic alliance) is one of the most prominent.

The therapeutic relationship is a measure of the quality of the relationship between a mental health care provider and a patient and is a key factor in explaining and predicting the outcome of face-to-face interventions.

For a psychodynamic approach, the therapeutic alliance is primary, played out through transference, unconscious feelings towards the therapist based on their past, and countertransference, unconscious feelings towards the client in response. While in cognitive behavioral therapy, the therapeutic relationship is what drives the patient to extend therapy into the reality of their everyday life; utilizing a self-help and homework approach with the long-term goal of the patient becoming their “own therapist”.

A stronger alliance is more likely to result in better results from therapy. From depression severity to therapy dropout rates, the strength of the therapeutic alliance is integral to therapy success.

What is Augmented Mental Health?

Augmented mental health leverages the IoT and evidence-based use of the latest technologies to objectively monitor mental health in real-time to enhance and extend the capabilities and efficacy of traditional mental health care.

From psychotherapists and psychiatrists to counselors and psychiatric nurses, the era of augmented mental health brings in new data-informed ways for mental health professionals in all specialties to monitor and guide patient progress, create new evidence-based treatment plans, remotely guide personalized interventions, and provide appropriately stepped, collaborative care as and when needed.

Augmented mental health solutions are  a new hybrid that intertwines face to face and digital care to support both the digital and human therapeutic relationship.

Whether its real-time emotion monitoring or personalized therapy delivery and adherence software, the excitement about the huge range of new opportunities that come with augmented mental health naturally comes with new concerns, especially when the affordability and convenience of augmented mental health systems can transform the face of therapy literally overnight.

How Does Augmented Mental Health Impact the Therapeutic Relationship?

Biomimicry of leading therapists

Despite initial concerns, research is finding that the “digital therapeutic relationship” a patient feels towards digital health technologies, can be used to unleash the power of the patient-provider or “human therapeutic relationship”.

The trade secret?

Just as biomimicry engineers have been inspired by humpback whales to advance wind turbine efficiency or squids in creating next-gen camouflaging technologies, digital health engineers mimic the most effective therapists with strong therapeutic relationship building skills and practices.

Working smart, not hard, augmented mental health platforms leverage the millennia of evolutionary trial-and-error that generated the healing nature of human interaction and the billions (or more) of man-hours that modern professionals have spent honing and testing their therapeutic relationship building skills.

Maintaining the therapeutic relationship

Research is demonstrating that although the therapy format may change externally, the core of effective therapy—a strong therapeutic alliance—remains fundamentally unchanged when boosting the mental health outcomes of face-to-face therapy using the various features of augmented mental health systems.

For example, take the patient perception of the therapeutic alliance when a high definition 3D hologram of the clinician is projected in real-time to deliver therapy. Research concluded that there were no differences between the hologram and face-to-face format in delivering Rational and Emotive Behavioral Therapy (REBT) therapy in terms of efficacy (i.e., reducing distress and the level of irrational beliefs) or in terms of the patient’s perception of the therapeutic alliance.

Importantly, when it comes to the therapeutic relationship, research on using smartphones to aid and monitor the outcome of psychotherapy has found it to be comparable to traditional paper and pen methods of monitoring.

Strengthening the therapeutic relationship

Augmented mental health can also have benefits beyond releasing the therapeutic relationship (as well as patient monitoring and receipt of personalized care) from the confines of the office. Therapists transitioning to augmented mental health care can even strengthen the therapeutic relationship relative to using traditional models.

It’s important to reiterate that the evidence supports that therapists should strive to use intelligent systems and tools that inherently complement and mirror the qualities of an effective, modern day, evidence-based (human) therapist.

Basic mHealth services, have qualities that are undesirable in a therapist, including poor responsiveness to personal cues, a limited ability to provide reassurance and clarification of misunderstandings, and difficulty in providing timely corrective feedback, thereby limiting the therapeutic alliance.

With augmented mental health, therapist’s armed with real-time, objective mental health data can further strengthen the therapeutic relationship: not only can highly personal insights be explored in person (that may have never been uncovered with traditional methods), provision of feedback and support can be near-instantaneous.

In fact, research suggests that when developers of digital health technologies incorporate the therapeutic relationship-building qualities that a patient desires in a therapist into their design, the result is a therapeutic relationship with stronger communication with the app and therapist, more effective patient education, greater trust and patient disclosure, increased patient compliance, and better health outcomes.

Many of these relationship-building qualities are what differentiates advanced augmented mental health systems from their more basic mHealth predecessors including:

1. High responsivity to needs/data
   
   The patient’s perceptions of both a therapist’s responsiveness or an app’s responsiveness in attending to their mental health needs is an important component of the therapeutic relationship. Research coming from patients in the United Kingdom, United States, and Canada support that high responsiveness equates to a stronger relationship through the eyes of the patient. Further, studies have found this in turn results in more effective therapy and more satisfied and healthier clients.  
   
   Augmented mental health is based around high responsivity, i.e., responding immediately to suddenly altered states of being through real-time monitoring. It doesn’t get faster than that, the degree of responsivity is essentially limitless.
   
   This is a phenomenal benefit considering the potential damage known to be caused to the therapeutic relationship from fragmenting care.
   
   As quickly as a patient’s mental state changes so does the response from augmented mental health systems. Take the early warning signs of an anxiety attack instantly triggering a pre-approved mobile CBT intervention as an example. If the patient was able to calm themselves down using the prescribed techniques, augmented mental health devices (and by extension the therapist) can detect and respond to this. If not, the system generates an appropriate response for failed treatment, which may include offering different solutions and techniques or instant connection with the primary therapist or other support team member depending on the treatment plan in place.
   
   
2. Highly individualized, tailored responses
   
   Developing a personalized plan for a patient is an inherent part of more client-centered therapies that dominate mental health care today, where the better the therapeutic relationship is, the more personalized the therapy tends to be.
   
   The delivery of AI or therapist-provided and personalized support, advice, educational materials, and interventions with augmented mental health is driven by real-time, personal mental health data. When responses are tailored to real-time emotional and mental health statuses, behavioral patterns, and preferences, it doesn’t get more personal than that.
   
   This data-enhanced personalization of therapy is also reflected in the therapist’s office, where therapists can use patient monitoring dashboards to assess progress with and improve upon the current treatment plan by taking the patient’s completely unique data into consideration.

In Conclusion

Although we still have much to learn, the take-home message is that mental health professionals desiring confidence in supporting the therapeutic relationship with technology should look to next-gen digital health that mimics the most effective therapists, i.e., that enhances the personalization of treatment and responsiveness to their patient’s needs.

Ultimately, inherently evidence-based augmented mental health systems AUGMENT the therapeutic alliance by mirroring the relationship building qualities of the best therapists.


References

Boschen, MJ. (2009). Mobile telephones and psychotherapy: I: Capability and applicability. the Behavior Therapist, 32(8), 168-175.

Berry, K., Salter, A., Morris, R., James, S., & Bucci, S. (2018). Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire. Journal Of Medical Internet Research, 20(4), e90. doi: 10.2196/jmir.8252

Birch, Ryan F., "The Effect of Technology on Therapy Alliance" (2016).Doctor of Psychology (PsyD).Paper 197. http://digitalcommons.georgefox.edu/psyd/197

Cameron, S., Rodgers, J., & Dagnan, D. (2018). The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression: A meta-analytic review. Clinical Psychology & Psychotherapy. doi: 10.1002/cpp.2180

Clarke, J., Proudfoot, J., Whitton, A., Birch, M., Boyd, M., & Parker, G. et al. (2016). Therapeutic Alliance With a Fully Automated Mobile Phone and Web-Based Intervention: Secondary Analysis of a Randomized Controlled Trial. JMIR Mental Health, 3(1), e10. doi: 10.2196/mental.4656

Cooper, A., Strunk, D., Ryan, E., DeRubeis, R., Hollon, S., & Gallop, R. (2016). The therapeutic alliance and therapist adherence as predictors of dropout from cognitive therapy for depression when combined with antidepressant medication. Journal Of Behavior Therapy And Experimental Psychiatry, 50, 113-119. doi: 10.1016/j.jbtep.2015.06.005

Corso, K., Bryan, C., Corso, M., Kanzler, K., Houghton, D., Ray-Sannerud, B., & Morrow, C. (2012). Therapeutic alliance and treatment outcome in the primary care behavioral health model. Families, Systems, & Health, 30(2), 87-100. doi: 10.1037/a0028632

East, M., & Havard, B. (2015). Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System. JMIR Mental Health, 2(1), e10. doi: 10.2196/mental.3954

McMinn, M., Bearse, J., Heyne, L., Smithberger, A., & Erb, A. (2011). Technology and independent practice: Survey findings and implications. Professional Psychology: Research And Practice, 42(2), 176-184. doi: 10.1037/a0022719

Norcross, J., & Wampold, B. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102. doi: 10.1037/a0022161

Reis, H., Clark, M., Pereira Gray, D., Tsai, F., Brown, J., Stewart, M., & Underwood, L. (2008). Measuring Responsiveness in the Therapeutic Relationship: A Patient Perspective. Basic And Applied Social Psychology, 30(4), 339-348. doi: 10.1080/01973530802502275

Strack, S., & Millon, T. (2013). Personalized Psychotherapy: A Treatment Approach Based on Theodore Millon's Integrated Model of Clinical Science. Journal Of Personality, 81(6), 528-541. doi: 10.1111/jopy.12013

Torous, J., & Hsin, H. (2018). Empowering the digital therapeutic relationship: virtual clinics for digital health interventions. Npj Digital Medicine, 1(1). doi: 10.1038/s41746-018-0028-2

Wiarda, N., McMinn, M., Peterson, M., & Gregor, J. (2014). Use of technology for note taking and therapeutic alliance. Psychotherapy, 51(3), 443-446. doi: 10.1037/a0035075