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Background: Internet-delivered cognitive behaviour therapy (ICBT) arose as a response to barriers associated with face-to-face therapy and has shown to be efficacious especially when offered with therapist assistance.
Objective: Despite the importance of therapist-assistance to ICBT, there has been minimal research on this topic. No scales have been developed to specifically assess presence of therapist behaviours during ICBT. As such, the purpose of this study was to: 1) develop an ICBT rating scale that captures the main elements of the therapist/client interactions in secure email messages, and 2) evaluate a random selection of ICBT therapists using this scale to assess average ratings on therapist/client interactions during the course of ICBT.
Method: The initial scale was developed based on past content analysis of therapist behaviours during ICBT. Five therapists trialed this initial measure and provided feedback on their experiences during a focus group. The measure was then revised and inter-rater reliability was established between three student raters. The scale was used to examine emails that were sent to 50 patients who completed an 8-week transdiagnostic ICBT course for depression and anxiety (Wellbeing Course).
Results: Review of ratings suggested that most therapists were providing high quality emails. Multiple significant correlations were found which indicated that clients who sent more emails to their therapist were receiving better quality emails, that therapists who were solely focused on delivering ICBT, and therapists with a psychology background obtained higher ratings on the scale.
Practical Implications: Numerous directions for future research exist, such as exploring the applicability of the scale to other ICBT units.