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A second aim of this study is therefore to establish a more reliable picture of actual changes in well-being, symptom reduction and functioning, and to study the relationship between developments in the alliance, feedback and outcome measures.
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Also, it is yet unclear if feedback on alliance improves the alliance and if this process influences outcome.
Hence making it possible in a more independent way to examine if feedback (on alliance) actually influences the quality of the alliance; and to examine the relation between separately measured alliance scores, alliance scores provided by the feedback instrument and outcome scores.
It is yet unclear whether feedback on the alliance improves alliance, and it is equally unclear whether feedback on the alliance actually boosts outcome; let alone if these mechanisms work similar in a psychiatric and psychotherapeutic settings.
Subsequently, it is unknown if applying an alliance measure to a feedback system (like in PCOMS) actually contributes to the improvement of outcome.
This therapeutic alliance will allow for feedback and assistance if participants have any difficulties, and has shown better outcomes than internet interventions without this communication.
Scarce studies have been performed on the specific effect of feedback on alliance in relation to outcome (Whipple [ 16], Harmon [ 38] and Slade et al. [ 45], Crits Christoph [ 37]).
The airline, a member of the SkyTeam alliance, also plans to share feedback from the trial with its partners, which could choose to offer the service as well.
So the therapeutic relationship is split up between several people, which might complicate the feedback about the alliance.
Although Summers and Barber recommended in 2003 that psychiatry residency programs consider measuring therapeutic alliance as a tool for feedback, until now this has not been effectuated (Summers and Barber 2003).
Hypotheses were that use of feedback scales would improve treatment alliance and patient satisfaction.
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