Understanding the therapeutic relationship in online psychological therapies.

Abstract

This thesis examined the development of the therapeutic relationship in online psychological therapies. Three papers are presented, a systematic review, an empirical paper and a critical appraisal paper. Paper one is a mixed methods systematic review of the literature on the therapeutic relationship in online Cognitive Behavioural Therapy (CBT) for anxiety and depressive disorders. The findings of 25 studies were synthesised. Quantitative data were analysed using a narrative synthesis. Qualitative data were analysed using a meta-aggregation. Quantitative findings showed that the therapeutic relationship is present in online CBT, however its utility as a method of predicting therapeutic outcomes remains unclear. Qualitative findings were used to create three synthesised findings. These show the need for therapists to develop a trusting relationship during online therapy that respects clients’ confidentiality. As well as the need to carefully select who should be offered online CBT, and support these clients in a person-centred way. Finally, therapists should pay particular attention to initial sessions of therapy as these can often be the most difficult for clients. Paper two examines the therapeutic relationship in online therapies provided by NHS Talking Therapies. Twelve participants were interviewed and their data were analysed using reflexive thematic analysis. Three themes were identified: being human, emotional safety, and technology. Recommendations for clinical practice are provided in both papers one and two. Paper three critically evaluates both studies in terms of rationale, study design, limitations, and their place within the wider clinical and research context. The authors personal reflections are also detailed.

Date of Award	29 Jul 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Sarah Peters (Main Supervisor) & Cintia Faija (Co Supervisor)