{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T15:08:59Z","timestamp":1777734539217,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"the Science and Technology Department of Hainan Province","award":["grant ZDYF2024SHFZ042"],"award-info":[{"award-number":["grant ZDYF2024SHFZ042"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21TW011762"],"award-info":[{"award-number":["R21TW011762"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001547","name":"China Medical Board","doi-asserted-by":"publisher","award":["grant 22-465"],"award-info":[{"award-number":["grant 22-465"]}],"id":[{"id":"10.13039\/100001547","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>The therapeutic alliance is a well-established predictor of psychotherapy outcomes. With the advancement of digitization, guided internet-based cognitive behavioral therapy (ICBT) has demonstrated effectiveness. However, the conceptual framework of the digital therapeutic alliance (DTA) within ICBT remains conceptually underdeveloped. Data were collected from a guided ICBT program in China. We conducted virtual individual semi-structured in-depth interviews among a purposive sample of intervention recipients (young sexual minority men, n\u2009=\u200920), and all implementers (counselors and supervisors, n\u2009=\u20096). Data were analyzed using qualitative template analysis. A DTA framework was developed with 4 key components: roles, interactions, characteristics, and influencing factors. Clients typically initiate the counseling process through online materials and assignments, treating the digital platform as a \u201csafe space,\u201d \u201cinvisible friend,\u201d \u201cwarm harbor,\u201d or \u201crepository of knowledge and tools.\u201d Counselors serve as guides and provide professional support asynchronously. High frequency of interaction and emotional connection via phone calls strengthened DTA. \u201cBeing client-driven,\u201d \u201cfostering an equal relationship,\u201d and \u201cbeing difficult to establish but easy to terminate\u201d were identified as characteristics. Influencing factors included client-related aspects (eg, motivation), counselor-related elements (eg, response timeliness), and platform-related considerations (eg, trust, confidentiality). This study develops a DTA conceptual framework, elaborating on the roles, interactions, characteristics, and influencing factors among clients, counselors, and digital platforms in guided ICBT. Findings inform strategies to enhance engagement, counselor training, and platform design in digital psychosocial interventions.<\/jats:p>","DOI":"10.1177\/00469580261436993","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:06:16Z","timestamp":1775883976000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Conceptual Framework of Digital Therapeutic Alliance in Internet-Based Cognitive-Behavioral Therapy: A Qualitative Study"],"prefix":"10.1177","volume":"63","author":[{"given":"Mengyao","family":"Yi","sequence":"first","affiliation":[{"name":"Central South University, Changsha, Hunan Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Hagaman","sequence":"additional","affiliation":[{"name":"Yale University, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lloyd","family":"Goldsamt","sequence":"additional","affiliation":[{"name":"New York University, York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shufang","family":"Sun","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3463-7195","authenticated-orcid":false,"given":"Mengshu","family":"Li","sequence":"additional","affiliation":[{"name":"Central South University, Changsha, Hunan Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3554-7693","authenticated-orcid":false,"given":"Xianhong","family":"Li","sequence":"additional","affiliation":[{"name":"Central South University, Changsha, Hunan Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1037\/h0085885"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2011.00270"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000172"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2020.101921"},{"key":"e_1_3_3_6_2","unstructured":"World Health Organization. WHO issues new and updated recommendations on treatment of mental neurological and substance use conditions. 2023. Accessed December 13 2024. https:\/\/www.who.int\/news\/item\/20-11-2023-who-issues-new-and-updated-recommendations-on-treatment-of-mental\u2013neurological-and-substance-use-conditions"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.65.4.582"},{"key":"e_1_3_3_8_2","first-page":"150","volume-title":"The Therapeutic Alliance: An Evidence-Based Guide to Practice","author":"Castonguay LG","unstructured":"Castonguay LG, Constantino MJ, Mcaleavey AA, Goldfried MR. The therapeutic alliance in cognitive-behavioral therapy. In: Muran JC, Barber JP, eds. The Therapeutic Alliance: An Evidence-Based Guide to Practice. 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Chapter 8 - a digital therapeutic alliance in digital mental health. In: Jacobson N, Kowatsch T, Marsch L, eds. Digital Therapeutics for Mental Health and Addiction. 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