Charlotte van Lotringen is a PhD candidate at the University of Twente. She is researching how technology can be integrated into mental health care in a compassionate way. Central questions she explores include: how can digital tools help alleviate suffering? Could technology even help enhance the compassion between therapist and client? In her research, she combines theory and practice using a design-oriented approach. The interplay between science, design, and care plays a key role.
8D | Research + Design = Impact supported Van Lotringen in creating a card set that helps mental health professionals and clients use smartwatches in a meaningful way within lifestyle-focused treatments. The card set is currently being used as a research tool in a Single-Case Experimental Design (SCED) study. This study is exploring whether and how the card set influences the compassion experienced in treatment, the acceptance of the smartwatches, and the therapeutic relationship as perceived by mental health professionals.
“My research is focused on finding ways for technology to better fit into mental health care practice. Rather than seeing technology purely as a way to improve efficiency – by reducing workload or cutting costs – we focus on how digital tools can strengthen the therapeutic relationship and help to ease suffering. This perspective aligns with a core value shared by many therapists and clients in mental health care: compassionate and human contact. Technology often has a reputation for being ‘cold’ and creating distance between people. That perception gets in the way of adopting technological tools in mental health care, even when they could make a real positive difference.”
“Instead of seeing technology purely as a way to increase efficiency, we look at how digital tools can help strengthen the therapeutic relationship and ease suffering.”
“The research programme is funded by NWO, Dimence Group, and Minddistrict and consists of several components. We began with a systematic literature review on compassionate technology: digital applications that can support or enhance compassion in care relationships. This review showed that this connection is rarely made, even though compassion is an essential value for the people involved. In interviews I conducted with clients and therapists, they described in their own words what they consider important in treatment: listening, human connection, empathy, and giving or receiving support to alleviate suffering. All aspects related to compassion. However, the way digital tools are introduced within mental health organisations often does not align with this core value, and they are rarely evaluated from this perspective. That is why, together with mental health professionals, we developed a measurement tool: the Compassionate Technology Scale for Professionals. This allows care professionals to assess the extent to which technology is perceived as compassionate.”
Equipped with these insights, Van Lotringen shifted her focus to practice, where she examined the use of smartwatches in lifestyle treatments. Many mental health organisations already have smartwatches available, but they are often left unused. Van Lotringen explains: “On the ward I am currently working with, both clients and therapists expressed a clear need for guidance on how to use the smartwatches effectively. For me, this was a great opportunity to see how the conclusions from our earlier research translate into practice and, above all, to understand what is needed to successfully integrate compassionate technology into daily clinical work.”
“In a series of five co-design sessions, I worked together with therapists and clients to explore how smartwatches could play a meaningful role in group treatments. The central question was: what informational tools are needed to introduce this technology in a way that strengthens compassion between therapist, client, and group members, rather than undermining it?”
To gain insight into the experiences of clients and therapists, Van Lotringen collaborated with the ward to create visual timelines of the treatment process, mapping out the potential added value of the smartwatch. She then developed various prototypes containing information on how to use smartwatches in lifestyle treatments, such as posters, infographics, and discussion cards. Van Lotringen explains: “Some prototypes focused on increasing efficiency, while others aimed to enhance compassion. We tested the prototypes through role-playing exercises. In the end, therapists showed a strong preference for a card set that used clear language and emphasised compassion. This format proved to offer the most space for nuance, tailoring to individual needs, and fostering real conversations between therapist and client.”
“It is not a tool that dictates how to use the smartwatch, but rather an invitation to have a conversation about the potential added value of this technology within treatment. The card set helps therapists and clients reflect together, considering both the benefits of a smartwatch and the aspects that should be taken with a grain of salt or approached with caution. It is important that the use of technology is not imposed. The card set can therefore also be used without a smartwatch. However, when a smartwatch is available, the cards provide guidance on how to integrate it into treatment in a compassionate way.”
“The card set helps therapists and clients reflect together on the benefits of a smartwatch, as well as on the aspects that should be approached with caution.”
“After the co-design sessions and prototype testing, I approached 8D to further develop the card set graphically and to receive support with several important design decisions. Bas, the designer, asked important and challenging questions: who will use the cards, and in what setting? How can we ensure everyone is able to participate? Through an iterative process, we found answers to questions such as: how can we create an intervention where clients without a smartwatch do not feel excluded, while still giving technology a clear place within it? A valuable contribution from Bas was his idea to add discussion statements to the cards, making it possible for the group to interactively choose the cards that are most relevant to them. He also paid close attention to visual clarity and accessibility, asking questions like: how do you communicate the message clearly without overloading the material with text?”
“The card set is currently being used in a SCED study, in which we follow several therapists over an extended period; initially without the card set and now with the card set in use. After each treatment session, both clients and therapists complete a short questionnaire, including questions about how compassionate the treatment was perceived to be. In this way, we are investigating whether this blended approach – combining technology with human reflection – actually contributes to the quality of the therapeutic relationship.”
“Especially in mental health care, it is important that research stays closely connected to practice.”
“After my psychology degree, I was mainly focused on quantitative research. Over time, I have come to strongly believe in the value of qualitative research with a design approach. Especially in mental health care, it is important that research stays closely connected to practice. An in-depth approach, with room for nuance and tailoring, can be highly valuable. For me, it is increasingly about asking: what is it that you really want to understand or achieve? That is what should determine your approach.”
“It has great potential, but it does require close collaboration between researchers, designers, care professionals, and clients. For some, compassion may at first seem vague or soft, but in reality, it is a very clear and powerful value. When you take compassion as your starting point, many decisions regarding design and implementation naturally fall into place.”
van Lotringen, C., Lusi, B., Westerhof, G. J., Ludden, G. D., Kip, H., Kelders, S. M., & Noordzij, M. L. (2023). . The Role of Compassionate Technology in Blended and Digital Mental Health Interventions: Systematic Scoping Review. JMIR Mental Health, 10(1), e42403. https://doi.org/10.2196/42403
A systematic scoping review that defines the concept of compassionate technology and elaborates on it in the context of blended and digital mental health interventions. The study identifies design principles and mechanisms of action that can help promote compassion through technology.
van Lotringen, C. M., ten Klooster, P. M., Austin, J., Westerhof, G. J., Kelders, S. M., & Noordzij, M. L. (2024). Development of the Compassionate Technology Scale for Professionals (CTS-P): value driven evaluation of digital mental health interventions. BMC Digital Health, 2(1), 77. https://doi.org/10.1186/s44247-024-00132-6
Mixed-method studie naar hoe zorgprofessionals digitale interventies evalueren op het gebied van compassie. Op basis van kwalitatieve en kwantitatieve data is een meetschaal (CTS-P) ontwikkeld voor het beoordelen van digitale ggz-technologie vanuit waarden als menselijkheid, verbondenheid en autonomie.
van Lotringen, C. M., Jeken, L., Westerhof, G. J., Ten Klooster, P. M., Kelders, S. M., & Noordzij, M. L. (2021). Responsible relations: a systematic scoping review of the therapeutic alliance in text-based digital psychotherapy. Frontiers in Digital Health, 3, 689750. https://doi.org/10.3389/fdgth.2021.689750
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