Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder
Abstract
:1. Introduction
- To what extent are patients able to form a therapeutic relationship with priovi?
- What are the characteristics of this relationship?
- How does it differ from the working alliance with the human therapist
2. Materials and Methods
2.1. Recruitment and Sample
2.2. Procedure
2.3. Data Analysis
2.4. Intervention
3. Results
3.1. Qualitative Results
3.1.1. Priovi Is Helpful, Supportive and Always There
“I thought it was great that I could take it with me, use it on my cell phone. That was very valuable for me.”(priovi is always available, P4)
“Priovi’s advantage is that it’s accessible anytime and that I can look things up anytime. I can do the exercises anytime. […] With my therapist I can only do that once or twice a week.”(priovi is always available, P4)
“[Priovi’s validating communication style] means a lot to me. It’s a reason to keep working with the program. I think I would already have quit had it not been for that. I experienced enough lack of understanding from other human beings, I don’t need that electronically.”(priovi validates and normalizes, P5)
“I can just work more independently with it than I could with just face-to-face therapy. This makes me feel a whole lot more self-effective and less reliant; if something doesn’t work out, I don’t have to wait until I can discuss it in therapy, I can do something myself.”(priovi promotes self-efficacy, P9)
3.1.2. Priovi Evokes Emotions (But Not as Much as a Human)
“In a personal relationship, the judging part of my brain is more active [than in the relationship with priovi], because the program can’t devalue me. Not really. Not even I think “Priovi thinks I’m crap”. My mind can’t go there with priovi, but in a human relationship, it can.”(priovi can’t judge, P6)
“I’m a bit anxious about the program because I know that once I’m in an emotional spiral, I can’t get out of it quickly by myself.”(priovi leaves me alone with my emotions, P7)
“[…] kind text messages like ‘Have you already done something nice for yourself today?’ or ‘It’s great that you’re here’ or something like that, that’s like the sun shining on you… it just does tremendous good, to have something like that right in the middle of your busy day-to-day life, and it’s not only in that moment, it’s something to carry with you over the next couple of hours.”(priovi evokes pleasant emotions, P8)
“From one day to the next, I stopped getting any more text messages and that made me really fall apart because I thought I could rely upon getting one every day, and then suddenly I got nothing.”(priovi’s technical errors evoke emotional pain, P8)
3.1.3. Priovi Is Less Flexible
“I feel like I can stabilize what I’ve learned more cleanly with priovi because I always read the same explanations, I always do the same exercises. I feel this way there are fewer steps in between. With a human counterpart, there is always that other person’s judgment or impression that factors into it, and with priovi, there isn’t.”(priovi is always the same, P3)
“It’s just more personal with a human counterpart who can directly answer any question I have, which may not be included in the program. I think I need that human counterpart to learn how to trust and just to talk about things and ask things that the program can’t answer for me.”(priovi isn’t very flexible or individual, P9)
“Well, [the therapist] is just more flexible. And it may be easier for someone knowing my biography to identify triggers for current moods.”(priovi isn’t very flexible or individual, P7)
“Well, [priovi] works with general hypotheses, which are surely correct but also too general for me.”(priovi is general, P5)
“Priovi is like a box, it’s got its content but nothing more can fit in. But my therapist doesn’t stand still, there is always something new, there’s food for thought and new reactions. Priovi can’t think. It’s got its content and that’s it.”(priovi isn’t very flexible or individual, P6)
3.1.4. There Are Links between the Relationship to the Therapist and Priovi
“Well, what was also part of it was that I thought ‘my therapist will be glad and she thinks it’s good for me to do this’ and then I also knew it really does help me so I thought ‘I’ll just do my exercises’.”(good relationship to therapist motivates use of priovi, P4)
“Since I have such a close, trusting relationship with my therapist and really trust her completely, I knew this [priovi] can’t be bad, it’ll be okay if she says so. I just knew I could rely upon that.”(good relationship to therapist prevents fear of using priovi, P9)
“If I hadn’t worked so continuously on so many things with priovi, the trusting relationship to my therapist wouldn’t have gotten that much closer, as it did. It strengthened and improved it because I just worked continuously on this all and I realized I was making progress, I was feeling self-efficient. And that deepened the bond to my therapist.”(working with priovi strengthens bond to therapist, P9)
3.1.5. Priovi Is No Human
“[…] it really felt like having a friend, like I’d met Pia [Priovi’s protagonist] and when I had a problem I wondered if maybe there was something in priovi about it and I looked it up.”(Priovi feels almost like a person, P4)
“Right in the beginning, I was able to choose my nickname [as the name priovi would use to address me]. That, and the text messages I got, always kept me from feeling treated like ‘just a number’, neither by priovi nor by my therapist.”(It is possible to identify with priovi, P2)
“The difference is an emotional one. Electronics don’t have emotions. They don’t have brains. And therefore no human traits.”(priovi is less emotional than a human, P5)
“I could take the program to my family, who kind of frowned upon my borderline diagnosis and didn’t really know what it was, and then I could show them on the screen and they could read about it and they understood it. That made things much easier.”(priovi helps explaining BPD to others, P4)
“To me, it’s like several modules that you work through to attain a certain level of know-how, mostly on a cognitive level. Face-to-face therapy operates much more on an emotional level.”(priovi provides information, helps to understand and priovi is less emotional than a human, P7)
3.2. Quantitative Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A. Semi-Structured Interview: Therapeutic Relationship to Priovi/Therapist
- What does priovi mean to you?
- Are there any other programs or objects which have a similar significance to you? If so, what are similarities and differences compared to priovi?
- What does your therapist mean to you and how does it compare to what priovi means to you?
- How much do you feel priovi is embedded in your face-to-face therapy?
- 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”. What do you think about that? Are there any differences between priovi and your therapist regarding this?
- (also ask this question for other categories: „get to the solution“ and „relate to me“) [32]
- Studies also 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]
- What do you feel helped you most about priovi/traditional therapy?
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Characteristic | N | % |
---|---|---|
Gender | ||
Male | 2 | 12.5 |
Female | 14 | 87.5 |
Highest Education | ||
Secondary school (9 years) | 1 | 6.25 |
Secondary school (12/13 years) | 4 | 25 |
Vocational training | 6 | 37.5 |
University degree | 5 | 31.25 |
Employment Status | ||
Student/apprentice | 2 | 12.5 |
Voluntary service | 1 | 6.25 |
Employed | 8 | 50 |
Unemployed | 2 | 12.5 |
Incapacitated for work | 3 | 18.75 |
Comorbid Psychiatric Disorders (DSM IV) | ||
Axis I | ||
Affective disorders | 13 | 81.25 |
Substance use disorders | 6 | 37.5 |
Anxiety disorders | 12 | 75 |
Obsessive-compulsive disorder | 3 | 18.75 |
Posttraumatic stress disorder | 11 | 68.75 |
Eating disorders | 9 | 56.25 |
Axis II (except BPD) | ||
Obsessive-compulsive personality disorder | 5 | 31.25 |
Schizotypal personality disorder | 1 | 6.25 |
Avoidant personality disorder | 5 | 31.25 |
Paranoid personality disorder | 3 | 18.75 |
Narcissistic personality disorder | 1 | 6.25 |
Category | Subcategory | N | % |
---|---|---|---|
Priovi is helpful, supportive and always there | Priovi is always available | 8 | 88 |
Priovi validates and normalizes | 9 | 100 | |
Priovi motivates | 3 | 33 | |
Priovi promotes self-efficacy | 1 | 11 | |
Priovi helps being more aware | 2 | 22 | |
Priovi evokes emotions (but not as much as a human) | Priovi can’t judge | 3 | 33 |
Priovi leaves me alone with my emotions | 4 | 44 | |
Priovi’s technical errors evoke emotional pain | 1 | 11 | |
Priovi evokes pleasant emotions | 5 | 55 | |
Priovi evokes aversive emotions | 5 | 55 | |
Priovi is less flexible | Priovi isn’t very individual or flexible | 9 | 100 |
Priovi is general | 7 | 77 | |
Priovi is always the same | 2 | 22 | |
There are links between the relationship to priovi and the therapist | Good relationship to therapist prevents fear of using priovi | 2 | 22 |
Good relationship to therapist motivates to use priovi | 1 | 11 | |
Working with priovi strengthens bond to therapist | 1 | 11 | |
Priovi is no human | Priovi is less emotional than a human | 9 | 100 |
Priovi feels almost like a person | 4 | 44 | |
It is possible to identify with priovi | 2 | 22 | |
Priovi provides information, helps to understand | 6 | 66 | |
Priovi helps explaining BPD to others | 1 | 11 |
Measurement | M | SD | N |
---|---|---|---|
T1 | |||
WAItherapist total | 3.97 | 0.47 | 13 |
WAItherapist task | 3.83 | 0.61 | 13 |
WAIpriovi task | 3.54 | 0.86 | 12 |
T2 | |||
WAItherapist total | 3.89 | 0.73 | 16 |
WAItherapist task | 3.73 | 0.79 | 16 |
WAIpriovi task | 3.47 | 0.73 | 15 |
T3 | |||
WAItherapist total | 4.04 | 0.53 | 16 |
WAItherapist task | 3.83 | 0.68 | 16 |
WAIpriovi task | 3.33 | 0.83 | 16 |
T4 | |||
WAItherapist total | 4.11 | 0.57 | 16 |
WAItherapist task | 3.98 | 0.73 | 16 |
WAIpriovi task | 3.45 | 0.82 | 16 |
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Share and Cite
Köhne, S.; Schweiger, U.; Jacob, G.A.; Braakmann, D.; Klein, J.P.; Borgwardt, S.; Assmann, N.; Rogg, M.; Schaich, A.; Faßbinder, E. Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder. Int. J. Environ. Res. Public Health 2020, 17, 6436. https://doi.org/10.3390/ijerph17176436
Köhne S, Schweiger U, Jacob GA, Braakmann D, Klein JP, Borgwardt S, Assmann N, Rogg M, Schaich A, Faßbinder E. Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder. International Journal of Environmental Research and Public Health. 2020; 17(17):6436. https://doi.org/10.3390/ijerph17176436
Chicago/Turabian StyleKöhne, Sandra, Ulrich Schweiger, Gitta A. Jacob, Diana Braakmann, Jan Philipp Klein, Stefan Borgwardt, Nele Assmann, Mirco Rogg, Anja Schaich, and Eva Faßbinder. 2020. "Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder" International Journal of Environmental Research and Public Health 17, no. 17: 6436. https://doi.org/10.3390/ijerph17176436