Theme: Is it a relationship?

This theme explores whether participants interpreted their interactions as being like a relationship. Participants were asked directly whether they felt a “connection” to or a “relationship” with the TBI they used, as a way to open up the discussion towards the relevance of concepts usually reserved for human-human

129

interaction. Does the therapeutic relationship remain a valid concept when applied to TBIs? How do people talk about their interaction with the TBI, and is the concept of having a “relationship” with technology one that makes sense and is acceptable to TBI users?

4.4.4.1 Subtheme: Objection to a human-technology “relationship”

Use of terminology such as “relationship” or “connection” were rarely used spontaneously by participants. Participants often expressed that it was unusual or strange to frame their interactions with technology like this, and stated that they wouldn’t have considered it in this way without being asked by the researcher. Those that did agree that they had a relationship with the technology after being asked were also in the minority; around two-thirds of the participants rejected this notion

outright:

“Probably because it’s not a person. You didn’t have a relationship in that way with it. Just what it was – just I wouldn’t. It’s really funny you asked that question because that wouldn’t have even crossed my mind, to actually even consider that I

had some sort of relationship with it.” – P108

What is particularly interesting is that while most participants rejected the phrase “relationship”, there were many elements of participants’ discussions that indicate they were experiencing a relationship of some sort with the TBI.

4.4.4.2 Subtheme: A “human face”

For some, the notion of a relationship was most acceptable when it pertained to elements of the TBI demonstrating a human presence. For example, people built up relationships with the supporter that helped them to use the TBI:

“I think I did [feel a relationship] with the supporter. Definitely with the supporter, but not with the online thing.” – P108

Similarly, feelings of familiarity with human contributors to TBI content could contribute to a sense of a relationship. For example, this could be with those providing voiceovers; in cases where the participant already had an established relationship with the TBI’s creator; or input from other users that provided TBI content:

130

“I think um initially when [TBI creator name] was writing all the homilies himself, it [the relationship] was with him and the website. (…) when the new team came along

and then they got on board the users, so it became more of a community, and the users are contributing. And I do feel part of that.” – P112

It appeared that participants found it easy to build a relationship with the TBI features that clearly communicated a “human face”. How did people feel about their interactions with the technology that does not involve this?

4.4.4.3 Subtheme: Functionality

Some participants conceptualised their interaction with the technology in terms of functionality; the technology existed to serve a purpose and constituted a series of tasks that could help them with their mental health. Engaging with the intervention did not involve having a personal, human-like relationship with the technology, and instead, the TBI was conceptualised as being only a tool or a set of tasks.

“It really is analogous to the dumbbells in the gym (…) It really is the usage of a tool. It really is the same as going to the gym, it’s “right this is something I’m going

to work on”, be it for self-improvement or for rehabilitation” – P106

It should be noted that despite not feeling a “relationship”, this didn’t necessarily mean that TBI use was not beneficial. The functional aspects were still helpful (at least to an extent) for these participants, as they could be used to bring about improvement in their individual situations. However, a lack of personalisation may be what limits TBIs being seen as more than just a tool, and preventing a therapeutic relationship being established.

4.4.4.4 Subtheme: Role of interactivity in the therapeutic relationship Some participants rejected the notion of an “interaction” with a TBI

altogether. This was often the case when the TBI was perceived as being simply uni- directional; a user could read through the information, but nothing about the TBI required substantial individual input (see Theme “Interactivity” for more details). With TBIs that offer standardised content without tailoring, the degree to which its content matches the user’s needs relies upon chance. It appears that this limited the development of the user-TBI relationship, as many participants that rejected feeling a

131

relationship also discussed how the TBI was not interactive or personalised. Similarly, the notion of a “relationship” was also rejected when the participant did not feel the content was relatable. It is interesting that participants accepted that a relationship could develop with more intelligent designs that took account of their circumstances more accurately.

“It’s not a website that learns from your responses, and then tailors its questions accordingly. So it’s not an intelligent website. (…) It might be that a large percentage of people in the same situation as myself doing the course, respond in the

same way such a large percent of the time, that they are able to build some intelligence into the course. I would certainly not exclude [the possibility of feeling a

relationship], if that was the case.” – P105

This indicates that developing a relationship with a TBI isn’t impossible; rather, current limitations in design sophistication is preventing this occurring. A sense that the TBI is applicable to your individual circumstances and needs appears to be key for developing this relationship. Those that did say they felt a relationship emphasised the feeling of being understood by the TBI, by the provision of relatable content and choice offered in how it was used.

“Does it understand me? I think that’s it, it does understand the user. So you don’t even realise how comfortable you feel with it until somebody asks you (laughs) your

relationship with a website” – P101

This theme has illustrated the range of attitudes participants have shown towards the idea of having a relationship with a TBI, and the reasons that may underlie their feelings. Asking people whether they had a relationship with the TBI was clearly perceived as strange, and it seems that people aren’t used to viewing their interactions with technology in terms of a “relationship”. Whilst people frequently rejected the notion outright, many elements of discussions across

participants indicate what can make an interaction with a TBI feel somewhat like a relationship, particularly when they system responds to the individual in an

132