Online CBT program supporters – their training and experiences

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The supporter component of internet-delivered interventions (IDIs) is strongly advocated as increasing the likelihood of positive outcomes for users (Richards & Richardson, 2012). Implementing supported interventions however, is not always possible due to lack of resources or the availability of trained therapists. In light of this, the field is seeing a rise in graduate level and even volunteer supporters in the provision of iCBT with much success (Richards et al., 2015). The vision set out for the delivery of psychotherapy into 2022 (Norcross et al., 2013) sees the use of online interventions not limited to support provided by those with doctoral or clinical qualifications. Alternatively, a variety of other supporters including master’s level counselors and personal coaches may be utilized.  

Key Questions

  • What training is required of these supporters?
  • What are the core competencies that training seeks to develop and what organizational aspects best facilitate this?
  • Do supporters’ experiences provide evidence for the existence of a therapeutic alliance between IDI user and supporter?

SilverCloud’s research on supporter training and experiences sought to shed some light on the above questions (not published yet). Supporters, in the Irish charity Aware, felt that their training on the provision of support on SilverCloud was sufficient as a result of having a well-defined role with clear expectations, skills practice and a supportive structure in which to work. Practicing responses and interactive learning was a highly valued aspect of training and served to inform not only online review writing but to problem solve potential issues. Ongoing supervision and support was also related to greater skill acquisition and therapeutic adherence, as has been found in other research (Beidas et al., 2017; Sholomskas et al., 2005).

Supporter Core Competencies

Core competencies that training sought to develop were: knowledge of the CBT model, technical skills and responsiveness (acknowledging and encouraging progress, being empathetic, language-use). Responsiveness, in this context, involves responding to evidence of client progression or lack thereof (Kramer & Stiles, 2015). It involves more than merely directing clients to certain content and being empathic is regarded as a strong prerequisite. In line with this, supporters were well aware of both the benefits and limitations of working within the realms of asynchronous written language. In the absence of contextual, verbal and non-verbal cues, their language was tentatively considered and selected.

A Community of Practice

Notably, a community of practice was created between supporters, Assistant Psychologists and supervisors.  This saw volunteers work better within their role and was facilitated by a network of support which meant that the volunteers had others to seek support from and share experiences with. The provision of online support can be isolating in nature so having continued support enhanced not only the sense of connection and well-being being felt amongst the supporter team but also their skill acquisition and the quality of support they provided. The transfer of practical knowledge seemed to be essential and interestingly this was deepened by experience and interactions as opposed to explicit teaching (Hoadley, 2012). Indeed, best practice was achieved through both training and experience and enhanced by the sharing of a common passion/goal in the work.

Therapeutic Alliance

Building of a therapeutic alliance seemed to largely depend on client engagement and their personal preferences. As in research on face to face therapy, the therapeutic alliance was not built in all instances. While research on alliance in iCBT is in its infancy, our findings add to evidence for its existence and impact, at least from a supporter perspective. A benefit here is that a choice exists for the client as to how much information they choose to share with their supporter and whether they wish for a relationship to further develop.

Our research into the experiences of SilverCloud volunteer supporters provided unique insights into their experiences, not only to enhance our understanding of the competencies required of such but also to demonstrate that they are fundamentally similar to those of professional therapists in CBT. We are encouraged by our steps forward in this and will continue to better disentangle the similarities between these and how they differ. That supporters described being responsive to clients and established therapeutic alliances places onus on researchers and providers alike to better understand the nature of the supporter role and its processes.

About the author

profile photoCaroline Earley (MSc) is a clinical trials associate at SilverCloud Health. Caroline is especially interested in the qualitative experiences of both users and supporters. She has worked in the area of suicide prevention amongst adolescents at Columbia University and in the provision of CBT for anxiety. Currently undertaking psychotherapy training, Caroline hopes to apply her knowledge from face-to-face practice to research and innovation within technology-delivered mental health interventions.

References

Beidas, R., Barmish, A., & Kendall, P. C. (2007). Manuals and workshops in the dissemination of child anxiety treatment to trainees. Manuscript under review

Hoadley, C. (2012). What is a community of practice and how can we support it? In Theoretical foundations of learning environments (second edn.), eds. D. Jonassen and, S. Lund, 286-300. New York: Routledge

Kramer, U., & Stiles, W. B. (2015). The responsiveness problem in psychotherapy: A review of proposed solutions. Clinical Psychology: Science and Practice, 22(3), 277-295. https://doi.org/10.1111/cpsp.12107

Norcross, J. C., Pfund, R. A., & Prochaska, J. O. (2013). Psychotherapy in 2022: a Delphi poll on its future. Professional Psychology: Research and Practice, 44(5), 363. DOI:10.1037/a0034633

Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Revised, 32, 329–342. Doi: 10.1016/j.cpr.2012.02.004

Richards, D., Timulak, L., Vigano, N., Hayes, C. (2015). A randomised controlled trial of an internet-delivered treatment: Its potential as a low-intensity community intervention for adults with symptoms of depression. Behaviour, Research and Therapy, 75, 20-31. Doi: 10.1016/j.brat.2015.10.005

Sholomskas, D. E., Syracuse-Siewart, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K.M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115. Doi: 10.1037/0022-006X.73.1.106