{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:46:39Z","timestamp":1790207199913,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,4,6]],"date-time":"2016-04-06T00:00:00Z","timestamp":1459900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Psychology and Psychoth"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      There has been limited research on therapeutic alliance in the context of therapist\u2010assisted Internet\u2010delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200983) or generalized anxiety (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist\u2010assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder\u20107 and Patient Health Questionnaire\u20109 were collected pre\u2010, mid\u2010 and post\u2010treatment, and the Therapeutic Alliance Questionnaire was assessed mid\u2010 and post\u2010treatment. Therapeutic alliance ratings were high both at mid\u2010treatment and post\u2010treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid\u2010treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid\u2010treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process. Copyright \u00a9 2016 John Wiley &amp; Sons, Ltd.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Practitioner Message<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This research demonstrated that therapeutic alliance ratings were very strong at both mid\u2010 and post\u2010treatment among patients who received Internet\u2010delivered cognitive behaviour therapy (ICBT) for depression or anxiety in clinical practice.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Among patients receiving ICBT for depression, lower ratings of therapeutic alliance were associated with patients reporting concurrent treatment by a psychiatrist and with the receipt of fewer phone calls and emails from the therapist.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Among patients receiving ICBT for generalized anxiety, ratings of alliance were higher when patients were treated by registered providers as compared to graduate students.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Therapeutic alliance ratings did not predict outcome in ICBT for depression or anxiety.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Practitioners have reason to be confident that a therapeutic relationship can be formed in ICBT when delivered in clinical practice.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cpp.2014","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T09:23:10Z","timestamp":1460280190000},"page":"451-461","source":"Crossref","is-referenced-by-count":53,"title":["Therapeutic Alliance in Internet\u2010Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety"],"prefix":"10.1002","volume":"24","author":[{"given":"Heather D.","family":"Hadjistavropoulos","sequence":"first","affiliation":[{"name":"Department of Psychology University of Regina  Regina SK Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole E.","family":"Pugh","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Regina  Regina SK Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Hesser","sequence":"additional","affiliation":[{"name":"Department of Behavioural Sciences and Learning Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Behavioural Sciences and Learning, Link\u00f6ping University and Department of Clinical Neuroscience Karolinska Institute  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,4,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/16506070903116935"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S135246581000069X"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocrd.2014.10.003"},{"key":"e_1_2_6_5_1","volume-title":"The internet and CBT: A clinical guide","author":"Andersson G.","year":"2015"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000354779"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2012.05.003"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-977X(09)70970-8"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2014.08.003"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.2292"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp08X263794"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.73.2.203"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2012.07.002"},{"key":"e_1_2_6_14_1","volume-title":"Applied missing data analysis","author":"Enders C. 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