Bolster: Prototype Link
Therapy assistant app designed to be the in-between for therapists and their patients.
The Project
Over the course of 8 weeks students in the Maryland Institute College of Art’s User Experience M.P.S program were instructed to create a high fidelity prototype to answer a real-world problem using design thinking on our own. To complete this project I used the following methods and tools below.
The Problem: Therapy is Difficult
In Summer of 2022, my longtime friend and fourth year medical student of the State University at Buffalo, Alexander Schafer, came to me with some problems after completing his first psychiatry rotation.

Alex’s Pain Points:
Patients were forgetting what happened in-between their sessions. Since visits with a psychiatrist can be as much as six to eight weeks apart, the doctor was having to spend a good portion of the session catching up with what happened to the patient and prying out information from the patient that may have been forgotten, instead of getting right into what’s been affecting them. 
Patients had trouble recognizing patterns that were affecting their mental health. Not only did the doctor have to pull out significant events and discuss them, but also recognize commonalities and provide feedback that could help patients all on the spot. Alex felt this made therapy a passive experience instead of an active one where the patient has more 

I resonated with the problems that Alex shared with me a lot because for the first time in my life, I started therapy for my obsessive compulsive disorder and general anxiety disorder in March of 2022. 

My Pain Points:
• I was entering sessions anxious about what I was going to say, nearly to the point of an anxiety attack. 
• I was forgetting what was said in sessions. 
• I was forgetting what progress or setbacks happened in-between sessions. 
• I was journaling but still having trouble accessing important information before sessions. 
• I felt my progress was at a stand still.
Empathize: Research

Desk Research

Overview
Desk research was done by reading through medical journals, news articles, medical blogs and government statistics to complete my goals below.

Goals
1. Understand the mental healthcare industry
2. Familiarize myself with researched effective therapy techniques
3. Familiarize myself with common therapy pitfalls
4. Understand the market need
5. Understand professional’s problems and day-to-day work habits

Results
Increased number of Mental health care patients (CDC - Link)
Mental Health Care Professionals see upwards of 25 patients a day with hundreds of cases to keep track of (Psychiatry Online - Link)
Mental Health Care Professionals are at capacity (NYT - Link)
Mental Health Care Professionals shortage (NYT - Link)
Evidence based therapies like Cognitive Behavioral Therapy have less convincing data to back them up than initially assumed (Jonathan Shedler, PhD - Link)
Mobile apps alone have been shown to not be effective in treating patients (Harvard Health Publishing - Link)
A good doctor-patient relationship is the strongest element of psychotherapy that leads to lasting results. There is no firm consensus on how this relationship should be created and fostered (Focus Journal - Link)
An active partnership that manifests itself in patients being part of the decision making progress when it comes to their treatment has been proven to make them more active (Mayo Clinic - Link)
Do assigned homework from therapist to translated knowledge gain from sessions into the real world (Mayo Clinic - Link)
Professionals already use apps with patients to track mood and other symptoms effectively (APA - Link - Link)

Analysis
• There are more new patients in therapy than ever before, thus they lack skills of lifelong patients
• Mental Health Care professionals could benefit from tools to make them work more efficiently
• An app would be valuable if a patient uses it with a therapist
• A component of collaboration within this product could strength the active partnership aspect of therapy
• A to-do list component could be the “homework” professional assign to their patients
User Survey

Overview
A user survey was distributed to 11 participants through Google Forms where various questions were asked to complete my research goals below.

Goals
1. Quickly validate that more patients have problems with therapy
2. Understand the biggest problems patients have with therapy

Results
90% of patients have difficulty recalling progress or setbacks in therapy
70% of patients have difficulty recalling progress despite tracking these points frequent in an app or journal
70% of patients have a hard time communicating with their therapist
60% of patients haven’t taken notes during a session to reference later
40% of patients have never received a to-list from their therapist after a session
7 different forms of media were referenced by survey participants to learn about their condition

Analysis
• Patients have trouble creating journal entries that they can easily access later
• It’s difficult for patients to reference what they learned in therapy at a later point
• Patients go to many different places (potentially unreputable places) to find more about their condition
• Recalling what happened in-between sessions is the patients biggest problem on paper
User Interviews:

Overview
User interviews were conducted over the phone with six participants that participated in the Google Form Survey. This research was done to have patients vocalize their problems in greater detail, completing my research goals below.

Goals
1. Understand in greater detail the problems that were discussed in the Google Form Survey
2. Understand what are patients biggest perceived problems with their therapy process
3. Gather a sense of what they think would be an effective solution for their problems

Results
High value was placed on their relationship with their therapist because it allowed them to speak freely
The were mostly all forgetful at some point of their therapy journal, most often when starting therapy
Most had some level of anxiety before therapy related to figuring out what to talk about
Those that journaled did so in very different frequencies, over very different timed intervals
Most that journaled said they refrained from journaling during a session because they’d be distracted
Users would find an app useful because it’s right there when a problem or victory occurs  
Patients use apps like iMessage and Gmail to communicate with their therapist in-between sessions

Analysis
• Some kind of summary of their in-between session period may calm anxiety before a session
• Those that are starting therapy may have more trouble than others
• An app would be valued by patients because it’s quick to jot down notes in the moment
• The product would have to be flexible and adjust to how patients would use it.
Comparative Analysis

Overview
A comparative analysis was completed by examining different products in the health and wellness sector. In particular, apps that focus on specific conditions, self-help empowerment, professional practice management, therapy additional components both physical and digital. Attention was also given to indirect competitors to understand how patients solve their problems with the tools at hand.

Goals
1. Understand how much competition is out there
2. Understand which apps hold most critical acclaim
3. Discover potential gaps in the current digital space

Results
High value was placed on their relationship with their therapist because it allowed them to speak freely
The were mostly all forgetful at some point of their therapy journal, most often when starting therapy
Most had some level of anxiety before therapy related to figuring out what to talk about
Those that journaled did so in very different frequencies, over very different timed intervals
Most that journaled said they refrained from journaling during a session because they’d be distracted
Users would find an app useful because it’s right there when a problem or victory occurs  
Patients use apps like iMessage and Gmail to communicate with their therapist in-between sessions

Analysis
• There is room in the market for an app specifically designed to be a bridge between therapists and their patients, focusing on patient empowerment. 
• Physical solutions have the same pitfalls patients noted during my user interviews, it’s too big to carry around and be with you at all times to document occurrences. 
• Indirect competition is cumbersome and a privacy risk.
• Competition is steep in this sector so great care will have to be taken to remain focused on my specific problem.
Define: Problem Statement
After completing the research in the section above I was confident Alex and I had walked into a problem area that had unmet user needs. Based on the research above a strong picture was being created in my head of what was happening to a patient each time they went to therapy and how they conducted themselves outside of therapy. Below is a quick look at what this problem looks like in the wild.

Journey Map:
Persona - John Smith, First-time patient, Anxiety Disorder with OCD tendencies
How Might We’s:
Quick statements were created to define specific problems I wanted to focus on based on my research. You can see them below
How might we make therapy more actionable, so that patients have longer lasting success?
How might we improve the relationship between therapist and patients, so that patients feel like an active participant in their wellbeing?
How might we help patients journal in such a way that their notes can be quickly accessed and reviewed at a later time?
How might we help patients and therapists recognize patterns so that negative or positive habits are addressed?

The Problems Statement:
In 2022, more Americans are seeking help in psychotherapy than at any point before. Many of those Americans may be finding out that therapy is a difficult process. After the ordeal of finding a therapist that you resonate with and accept your insurance is complete, you now have to discuss perplexing aspects of your life in a very intimate setting only to be left to your own devices after a relatively short timed session. Among these problems patients also report having a hard time remembering what happened to them in-between sessions and connecting the dots between therapy sessions and their day-to-day life. How might we make therapy more actionable, so that patients have longer lasting success?


Ideate: Crafting Solutions
After completing the research in the section above I was confident Alex and I had walked into a problem area that had unmet user needs. Based on the research above a strong picture was being created in my head of what was happening to a patient each time they went to therapy and how they conducted themselves outside of therapy. Below is a quick look at what this problem looks like in the wild.

Sketching:
When starting to create ideas I found ample inspiration from the Human Interface Guidelines documentation from Apple and their suite of mobile apps like Health, Notes, iMessage, Reminders to name a few.
Design Constraints & Branding:
When creating visual solutions for this product I wanted the app to feel like a tool, relatively neutral. Concise, refined, actionable yet calm, these words were coming to mind when I developed the composed UI elements together and developed branding, which can be seen below. To symbolize both therapists and patients coming together to intersecting circles, make up the logo badge for the app which I came to call Bolster, as a nod to its capability to bolster a therapy’s practice.
Ideate: Crafting Solutions
After sketching, writing and talking more with my friend and other users I came upon my solution with a feature set.

Features:
1. Shareable Journal
2. Session Notes
3. Next Steps
4. Profile

Business and Technical Requirements
The business: This side of the app would work like MyChart, where therapists would buy a subscription to the product to be provided to their caseload. This way the patient doesn’t have to pay extra and the doctor would have more involvement with the usage of the app, instead of being added to a document they aren’t sure will help a patient.
Technical Requirements: Much like the Google Drive suite this app would need the ability for two people to collaborate on fields of information seamlessly. It would also need to connect to further health records on the profile side of things.

Development
The constraints were set and the ideas were flowing so it quickly became time to put mouse to pixel. As mentioned in my roadmap…
1. After sketching some solutions I quickly moved to medium fidelity wireframes,
2. I then completed a usability test with my classmates and a professor Behavioral Psychologist from Daemen University in Buffalo, New York
3. I updated my wireframes to a high fidelity prototype
4. I then had the prototype reviewed by my professors
5. I updated my prototype based on their feedback
6. I then completed a usability test with the users I interviewed at the beginning of the project.

Testing
Below you can see how the product evolved and what feedback made those changes happen. 
Next Steps:
Find a larger audience to test prototype due to conflicting results
Understand technical requirements better to prioritize real-world feature development
Understand HIPAA legalities
Craft a real business model
Tackle the potential next phases of this app that were theorized in the ideation phase below
Learnings:
+ Design systems rock
- Use a scheduling program for usability testing
+ A lot of desk research really pays off
+ Surveys can save time
+ Animations helped me tell my story
+ Users solve these problems already
- Put findings right in a presentation
- Organize consistently
+ Keep refining your problem
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