Therapeutic Relationship in eHealth-A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder.

Sandra Köhne,Mirco Rogg,Jan Philipp Klein,Eva Faßbinder,Nele Assmann,Stefan Borgwardt,Ulrich Schweiger,Diana Braakmann,Gitta A Jacob,Anja Schaich

doi:10.3390/ijerph17176436

Abstract

eHealth programs have been found to be effective in treating many psychological conditions. Regarding Borderline Personality Disorder (BPD), few programs have been tested; nevertheless, results are promising. The therapeutic alliance is an important factor predicting treatment outcome in BPD. However, we do not know yet to what extent BPD patients form a therapeutic alliance with an eHealth tool and how this relationship differs from the relationship with their human therapist. This study aims to address this question using priovi, an interactive schema therapy-based eHealth tool for BPD. Semi-structured interviews were conducted to explore how patients perceived the therapeutic alliance with priovi and its differences compared to the alliance with their human therapist (N = 9). Interview data were analyzed following the procedures of qualitative content analysis. Additionally, the Working Alliance Inventory (WAI-SR) was administered in two versions (regarding the human therapist and priovi, N = 16) every three months during the treatment phase of one year. Results indicate that patients were able to form a good therapeutic relationship with priovi, but it differed from the relationship to their human therapist. Important categories were “priovi is helpful, supportive and always there” and “priovi is less flexible”. WAI ratings for the task subscale were high in both relationships but significantly higher in WAItherapist compared to WAIpriovi in two measurements (nine-months measurement: t = 2.76, df = 15, p = 0.015; twelve-months measurement: t = 3.44, df = 15, p = 0.004). These results indicate that BPD patients can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises.

Highlights

Borderline Personality Disorder (BPD) is a prevalent [1] and complex mental illness associated with high utilization of mental health services [2,3] and serious impairments in psychosocial and occupational functioning [4,5,6], leading to high societal costs [7]
All items were recorded in both WAIs, and paired t-tests were carried out to check for significant differences between the two
This study shows that BPD patients were able to form a relationship with the online tool priovi but that this relationship differed significantly from their relationship to the therapist

Summary

Introduction

Borderline Personality Disorder (BPD) is a prevalent [1] and complex mental illness associated with high utilization of mental health services [2,3] and serious impairments in psychosocial and occupational functioning [4,5,6], leading to high societal costs [7]. I want to understand the kind of relationship you developed with priovi. This may sound strange, as priovi is a program, but some studies have shown that people can form certain kinds of relationships with objects or programs. What are similarities and differences compared to priovi?. How much do you feel priovi is associated with your therapist?. Studies suggest that in order to have a successful therapeutic relationship, it is necessary to feel “known as a person”. Are there any differences between priovi and your therapist regarding this?. Studies suggest that technological interventions such as priovi mainly help via specific elements like psychoeducation or exercises whereas traditional therapy mainly helps via unspecific things like the therapeutic relationship. What do you think about that? [25]

Objectives

Methods

Results

Discussion

Conclusion