Computerized cognitive behavioural therapy and the therapeutic alliance: A qualitative enquiry

Objectives. Computerized cognitive behavioural therapy (cCBT) for depression has a growing evidence base, and is recommended as a treatment choice for depression in recent National Institute for Health and Clinical Excellence (NICE, 2009) guidelines to health services in England and Wales. cCBT programs are designed to translate the evidence-based tasks and techniques of CBT into an accessible, multimedia format, but it is less clear whether they also translate critical common factors of therapy, which may be necessary for engagement and associated with therapeutic outcomes. This study investigates whether and to what extent three widely used cCBT programs for depression incorporate and convey key features that serve to establish, develop, and maintain a therapeutic alliance with program users. Design. This study adopted a qualitative approach to develop a thematic framework of alliance features specific to cCBT. Method. Three online cCBT programs designed to treat mild-to-moderate depression were investigated for alliance-related themes and sub-themes. Results. The analysis revealed substantial evidence of therapeutic alliance features across the sample of cCBT programs, the prevalence and quality of which varied across relational stages. Conclusions. cCBT programs build on traditional self-help tools, offering unique relational features. Findings raise theoretical implications, in addition to guidance for future cCBT program development and service provision.