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Therapeutic alliance across delivery modalities: a systematic narrative review of comparative strength and outcome prediction in face-to-face, online and blended psychotherapy
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Xiaoyi ZHOU1, Huimin HUANG2, Ruoxu BI3, Lena VERDELI4, Hailong LYU1. Therapeutic alliance across delivery modalities: a systematic narrative review of comparative strength and outcome prediction in face-to-face, online and blended psychotherapy[J]. Journal of Zhejiang University Science B, 1998, -1(-1): .
@article{title="Therapeutic alliance across delivery modalities: a systematic narrative review of comparative strength and outcome prediction in face-to-face, online and blended psychotherapy",
author="Xiaoyi ZHOU1, Huimin HUANG2, Ruoxu BI3, Lena VERDELI4, Hailong LYU1",
journal="Journal of Zhejiang University Science B",
volume="-1",
number="-1",
pages="",
year="1998",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.25-00701"
}
%0 Journal Article
%T Therapeutic alliance across delivery modalities: a systematic narrative review of comparative strength and outcome prediction in face-to-face, online and blended psychotherapy
%A Xiaoyi ZHOU1
%A Huimin HUANG2
%A Ruoxu BI3
%A Lena VERDELI4
%A Hailong LYU1
%J Journal of Zhejiang University SCIENCE B
%V -1
%N -1
%P
%@ 1869-1951
%D 1998
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.25-00701
TY - JOUR
T1 - Therapeutic alliance across delivery modalities: a systematic narrative review of comparative strength and outcome prediction in face-to-face, online and blended psychotherapy
A1 - Xiaoyi ZHOU1
A1 - Huimin HUANG2
A1 - Ruoxu BI3
A1 - Lena VERDELI4
A1 - Hailong LYU1
J0 - Journal of Zhejiang University Science B
VL - -1
IS - -1
SP -
EP -
%@ 1869-1951
Y1 - 1998
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.25-00701
Abstract: The frequency of online psychotherapy, including pure online (PO: videoconference [PO-VC], telephone [PO-TEL], asynchronous therapist-guided [PO-Async]), or blended (BLD) modalities, has grown exponentially, yet how the therapeutic alliance (TA), a key outcome predictor, compares across these formats and face-to-face (FTF) treatment remains unclear. Objectives: To compare (1) the TA strength and (2) the TA-outcome association across FTF, PO and BLD modalities.
Methods: A systematic narrative review (PRISMA/SWiM) was performed by searching PubMed, PsycArticles, and Web of Science. Studies were deemed eligible if they quantitatively compared TA across at least two modalities in adults with depressive or anxiety disorders. PO arms were classified as telepsychotherapy (PO-VC/TEL) or therapist-guided digital interventions (PO-Async). The findings were synthesized by direction and consistency. Results: Nine studies (three primary RCTs; six secondary analyses) were finally included. TA strength was broadly comparable across all three modalities. One study found significantly lower patient-rated WAI scores at week 2 in PO-Async versus FTF, resolving by week 8. The TA-outcome association was mixed, varying by modality, rater perspective, and timepoint. Conclusions: TA was broadly equivalent across FTF, online, and blended formats, though asynchronous PO might show a transient week-2 lag. The TA-outcome association was less consistent in PO/BLD than FTF. As a preliminary hypothesis, digital delivery may shift the functional emphasis of the alliance from affective bonding toward task/goal engagement.
Open peer comments: Debate/Discuss/Question/Opinion
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