Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results

Online therapy, defined as the provision of mental health services through the Internet, is a growing field that has sparked an abundance of interest and controversy. A primary concern in the practice of online therapy is whether a working alliance, considered a central component of successful therapy, can develop when participants are geographically separated. Working alliance scores were compared between a small, primarily female sample of online therapy consumers and a representative sample of traditional face-to-face therapy clients. Results revealed significantly higher means on the goal subscale and composite score of the Working Alliance Inventory in the online sample, suggesting that a working alliance can be adequately established in therapy delivered online. No significant differences in the level of working alliance were found within the online therapy sample with respect to modality of communication, client presenting problem, or therapist. Themes from comments suggest the importance for participants of the disinhibiting effects of the medium.

[1]  Carl Vogel,et al.  Proper methodologies for psychological and sociological studies conducted via the Internet , 1996, Behavior Research Methods, Instruments, & Computers.

[2]  T. Tracey,et al.  Working alliance in the early phase of counseling. , 1990 .

[3]  Lee Rainie,et al.  The online health care revolution: how the web helps americans take better care of themselves , 2000 .

[4]  Mark A. Hubble,et al.  The heart and soul of change: What works in therapy. , 1999 .

[5]  Barbara A. Kerr,et al.  Computer-mediated counseling: an empirical study of a new mental health treatment , 1998 .

[6]  A. Horvath.  Empirical validation of Bordin's pantheoretical model of the alliance: The Working Alliance Inventory perspective. , 1994 .

[7]  J. Walther,et al.  Relational communication in computer-mediated interaction , 1990 .

[8]  Mary Lee Nelson,et al.  Counselor training level and the formation of the psychotherapeutic working alliance. , 1991 .

[9]  Y. Hamburger,et al.  The relationship between extraversion and neuroticism and the different uses of the Internet. , 2000 .

[10]  Bert Bredeweg,et al.  “INTERAPY”: THE EFFECTS OF A SHORT PROTOCOLLED TREATMENT OF POSTTRAUMATIC STRESS AND PATHOLOGICAL GRIEF THROUGH THE INTERNET , 2000, Behavioural and Cognitive Psychotherapy.

[11]  A. Horvath,et al.  The development of the Working Alliance Inventory. , 1986 .

[12]  Susan X. Day,et al.  The Subjective Experiences of Therapists in Face-to-Face, Video, and Audio Sessions. , 2000 .

[13]  A. Barak.  Psychological applications on the internet: A discipline on the threshold of a new millennium , 1999 .

[14]  Stéphane Bouchard,et al.  Cognitive Behavior Therapy for Panic Disorder with Agoraphobia in Videoconference: Preliminary Results , 2000, Cyberpsychology Behav. Soc. Netw..

[15]  T. Tracey,et al.  Factor structure of the Working Alliance Inventory. , 1989 .

[16]  Myrna L. Friedlander,et al.  Contribution of Therapist Experience and Personal Characteristics to the Working Alliance. , 1996 .

[17]  J. Finn,et al.  An exploration of helping processes in an online self-help group focusing on issues of disability. , 1999, Health & social work.

[18]  Karen A. Pasveer,et al.  The making of a personality inventory: Help from the WWW , 1998 .

[19]  N. Abeles,et al.  Therapeutic alliance and outcome: Impact of treatment length and pretreatment symptomatology. , 1988 .

[20]  William C. Schmidt,et al.  World-Wide Web survey research: Benefits, potential problems, and solutions , 1997 .

[21]  E. Bordin.  The generalizability of the psychoanalytic concept of the working alliance. , 1979 .

[22]  E. R. Welfel,et al.  The nature, scope, and ethics of psychologists' e-therapy Web sites: What consumers find when surfing the Web. , 2003 .

[23]  Edgar Erdfelder,et al.  GPOWER: A general power analysis program , 1996 .

[24]  Malcolm R. Parks,et al.  `Making Moosic': The Development of Personal Relationships on Line and a Comparison to their Off-Line Counterparts , 1998 .

[25]  R. Hatcher,et al.  Patients' view of the alliance of psychotherapy: exploratory factor analysis of three alliance measures. , 1996, Journal of consulting and clinical psychology.

[26]  C. B. Taylor,et al.  Reducing risk factors for eating disorders: comparison of an Internet- and a classroom-delivered psychoeducational program. , 2000, Journal of consulting and clinical psychology.

[27]  A. Horvath,et al.  Development and validation of the Working Alliance Inventory. , 1989 .

[28]  A. Horvath,et al.  Relation between Working Alliance and Outcome in Psychotherapy: A Meta-Analysis. , 1991 .

[29]  E. Adams,et al.  Clients' Expectations About Counseling and Perceptions of the Working Alliance , 1996 .

[30]  M. Lambert.  Psychotherapy outcome research: Implications for integrative and eclectical therapists. , 1992 .

[31]  Adam O. Horvath,et al.  The therapeutic relationship. , 1999 .

[32]  K. Gergen,et al.  Life on the line: the therapeutic potentials of computer-mediated conversation. , 1998, Journal of marital and family therapy.

[33]  A. Horvath,et al.  The role of the therapeutic alliance in psychotherapy. , 1993, Journal of consulting and clinical psychology.

[34]  S. Booth-Kewley,et al.  Computer-Administered Surveys in Organizational Settings , 1993 .

[35]  A. Horvath,et al.  The therapeutic relationship: from transference to alliance. , 2000, Journal of clinical psychology.

[36]  M. Gutfreund,et al.  Patients' and therapists' shared and unique views of the therapeutic alliance: an investigation using confirmatory factor analysis in a nested design. , 1995, Journal of consulting and clinical psychology.

[37]  Carolyn E. Adams-Price,et al.  The Star Fleet Ladies Auxiliary: Evolution of an OnLine Women's Mailing List , 2000, Cyberpsychology Behav. Soc. Netw..

[38]  Jeremy D. Safran,et al.  The relative predictive validity of two therapeutic alliance measures in cognitive therapy , 1991 .

[39]  Clara E. Hill,et al.  A comparison of six measures of working alliance. , 1989 .

[40]  Jennifer Preece,et al.  Empathic communities: balancing emotional and factual communication , 1999, Interact. Comput..