Table 2.
Characteristics of the therapists (T) and patients (P) influencing implementation.
| Theme | Example quote |
|---|---|
| Facilitators | |
| Attitude (T) | I really see it as a standard treatment option that we offer. I think it can be just as effective and useful as face-to-face therapy. (R7) |
| Ability to be flexible (T) | When I noticed patients were struggling, I would call them and discuss which parts of the program were do-able for them and which were not. (R8) |
| Self-efficacy (T) | You have to sit down and make time to give feedback, but I do know immediately what feedback I want to give. (R7) |
| Communication about GOP (T) | During the face-to-face intake I try to clarify that they have a choice. Many patients then say that an online program would not work for them. But when I take the time to explain the possibilities and content of the program, it sometimes changes their mind. (R6) |
| Motivation (P) | Patients who came to us for the ICBT always had found the program themselves, via our website. They came to us and told us ‘this is what I want to do’. (R1) |
| Barriers | |
| New skills required (T) | Online therapy is a bit difficult for me. I'm doing it, I have to, but I've never really learned about the do's and don'ts. (R12) |
| Time management (T) | I think that this program takes me relatively more time, because I'm often thinking about how to plan and how to respond. I keep checking the program to see if my patients have done their assignments. (R6) |
| Communication via e-mail (T) | I stayed very positive and reinforcing. Maybe I had to be a bit more strict, or not. That's something I find difficult with online therapy. (R4) |
| Comorbidity (P) | What I found difficult, is that many people do not only suffer from fatigue, but also have other psychological problems. Some more than others. That can make it difficult to stick to the process and make progress, to work with the ICBT exactly as intended. (R10) |
| Negative attitude/non adherence (P) | Patients feel more obliged when I see them face-to-face. So, the fact that they know they have to see me again increases their responsibility to perform their assignments. I notice that online therapy results in less motivation. (R8) |
| Suitability for a specific subgroup (P) | When I look at the patients who worked with ICBT and accepted it, I see these people are younger, and relatively more often men. They are a bit whizzkids. (R3) |
| Low load capacity (P) | Some people don't like the idea of reading many texts, or read any text at all. Often because of low energy, or concentration problems. (R4) |