8 Psychotherapy8.6 Other therapeutic and skills-based approaches
8.6.2 Digital therapy and the therapeutic alliance
2 min read
Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What digital therapy covers
Digital delivery is a format, not a single therapy. Its evidence therefore applies to a specific intervention, population and level of support. The formats differ in how much human contact the patient gets.
Format | Human input | What sets it apart clinically |
|---|---|---|
Video or telephone therapy | Live therapist contact | The same therapy, delivered through a different medium |
Guided online treatment | Planned clinician support around the modules | Support and monitoring are part of the treatment itself |
Unguided self-help | No routine therapist contact | Do not assume it is suitable or effective just because guided treatment is |
Blended care | Digital tasks combined with live sessions | The digital and live parts follow one shared formulation |
Before treatment starts, assess clinical need, the patient's preference and whether a digital format suits them. Agree in advance what will happen if they get worse.
The alliance at a distance
The therapeutic alliance still needs shared goals, agreed tasks and a trusting relationship. This holds even when contact is remote or asynchronous (messages sent and answered at different times, not live).
Less non-verbal information. Silence, distraction or withdrawal are harder to read. Check understanding and ask for feedback directly.
The frame. Agree where sessions take place, expected response times, confidentiality, recording arrangements and what happens if contact fails.
Ruptures. These may follow a technical failure, a missed message or a sense that the therapy feels impersonal. Discuss them with the patient rather than assuming they have disengaged.
Access and safety
Privacy. Check whether the patient could be overheard or monitored at home, particularly if they are in a coercive relationship.
Remote safety plan. Confirm where the patient is, what support they have and how urgent help will be obtained if needed.
Digital exclusion. Barriers include hard-to-use interfaces, limited literacy, sensory impairment, cost, and a lack of reliable equipment or connection.
Choice of medium. Review it if remote work is limiting communication, engagement or safety.
Automated tools. These need clear limits and governance. An unmonitored chatbot is not the same as a therapist delivering an evaluated intervention.