Amid increases in electronic health record adoption, many psychotherapists are concerned that in-session computing may harm the client–provider relationship, also known as the therapeutic alliance. The emerging practice of collaborative documentation (CD) is one strategy designed to prevent this outcome. Little empirical work has examined the effects of in-session computing generally or CD specifically within the psychotherapeutic context. This study explores how CD is being implemented in psychotherapy and examines how both the frequency of computing and the use of CD affects the therapeutic alliance. Psychotherapists in this study engaged in an average of 42 (SD = 38.5) computing episodes. CD was present in 39% of sessions (N = 21). Regression models found that among providers, increases in computing frequency predicted decreases in alliance (ß = -.18, p < .05). Conversely, among clients, the use of CD improved alliance (ß = .43, p < .01). Findings suggest that psychotherapists use computers often, but parties view the effect of electronic health records differently. Reconciling this disparity and continuing to develop effective technology-based best practices is imperative.

Dr. Matthews is currently an assistant professor at Fordham University Graduate School of Social Service. Prior to her academic career, Dr. Matthews worked as a clinical social worker in an integrated community health and mental health center. Drawing from these experiences, her research focuses on advancing person-centered approaches to treatment within integrated primary care and behavioral health settings. In particular, Dr. Matthews’ work has closely examined the emergent role of health information technology in the delivery of high quality interdisciplinary care.