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Digital mental health apps and the therapeutic alliance: initial review

  • Philip Henson (a1), Hannah Wisniewski (a1), Chris Hollis (a2), Matcheri Keshavan (a3) and John Torous (a4)...



As mental healthcare expands to smartphone apps and other technologies that may offer therapeutic interventions without a therapist involved, it is important to assess the impact of non-traditional therapeutic relationships.


To determine if there were any meaningful data regarding the digital therapeutic alliance in smartphone interventions for serious mental illnesses.


A literature search was conducted in four databases (PubMed, PsycINFO, Embase and Web of Science).


There were five studies that discuss the therapeutic alliance when a mobile application intervention is involved in therapy. However, in none of the studies was the digital therapeutic alliance the primary outcome. The studies looked at different mental health conditions, had different duration of technology use and used different methods for assessing the therapeutic alliance.


Assessing and optimising the digital therapeutic alliance holds the potential to make tools such as smartphone apps more effective and improve adherence to their use. However, the heterogeneous nature of the five studies we identified make it challenging to draw conclusions at this time. A measure is required to evaluate the digital therapeutic alliance.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: John Torous, MD, Departments of Psychiatry and Clinical Informatics,, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston 02446, MA, USA. Email:


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Digital mental health apps and the therapeutic alliance: initial review

  • Philip Henson (a1), Hannah Wisniewski (a1), Chris Hollis (a2), Matcheri Keshavan (a3) and John Torous (a4)...
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Professor Simon Hatcher

Simon Hatcher, Psychiatrist, Ottawa Hospital Research Institute
06 February 2019

There is a small but important error in the paper by Henson et al. They quote that in our work with the ACHESS app (MacKie et al) that the therapeutic alliance is related to " trust and communication". This should read "Trust and connection'. This is important as we were piloting a blended therapy of face to face treatment and technology where we wanted to see if we could create something that was more than the sum of the parts. What we found in this small qualitative study is that using the two together may increase the sense of connection with the therapist. We are now testing this in suicidal men in a larger cluster randomized controlled trial. ... More

Conflict of interest: None declared

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