Alliance in internet-based interventions: A systematic review and correlation multilevel meta-analysis.

Area of Science:

• Psychology
• Digital Mental Health
• Psychotherapy Research

Background:

• Internet-based interventions (IBIs) provide accessible mental healthcare.
• The role of the therapeutic alliance in IBIs is not well-defined.

Purpose of the Study:

• To analyze the association between the therapeutic alliance and outcomes in IBIs.
• To investigate how different components of the alliance predict treatment success in digital mental health.

Main Methods:

• A correlational meta-analysis of 82 effect sizes from 40 independent samples (n=2,864).
• Meta-analytic multilevel models were used to examine alliance-outcome associations and subscale variability.

Main Results:

• A small to moderate overall alliance-outcome association (r=.21) was found, confirming alliance relevance in digital contexts.
• Task (r=.25) and goal (r=.19) alliance components were more predictive of outcomes than bond (r=.12).
• No significant moderators (e.g., diagnosis, rater, face-to-face contact) were identified.

Conclusions:

• The therapeutic alliance robustly predicts outcomes in IBIs, similar to traditional therapy.
• Cognitive-collaborative aspects of the alliance appear particularly important in digital interventions.
• Further research is needed to refine the conceptualization and assessment of alliance in IBIs.