Artificially intelligent therapists?

Telehealth has provided people with more options in how to give and receive mental health services. According to the American Psychological Association, telepsychology, in particular, has increased over 10% in the past ten years and has been successful in providing therapy to individuals who have difficulty accessing services otherwise. For example, telepsychology has been successful in treating US veteran and service members with PTSD who live in rural communities (Palmer, 2014). But technology does not stop there. Just when we thought we were familiarizing ourselves to telepsychology,technology takes it a step further with artificial intelligence. There is no need to sit with a human being in front of a digital screen anymore. Artificial intelligence is replacing human therapists with avatar therapists.

According to  an article in The Economist, Dr. Jonathan Gratch at the Institute for Creative Technologies in Los Angeles conducted a study examining whether people would be more willing to disclose information to an avatar therapist rather than a human therapist. They concluded that people were more forthcoming when speaking with an avatar therapist. Findings suggested that clients provide more measured responses when interacting with another human, but speak more liberally when not worrying about being judged by an avatar. Avatar therapy has also been successful in treating those with a diagnosis of schizophrenia to reduce their auditory hallucinations (Stewart, 2013) for similar reasons.

Admittedly, there is an inclination to be protective of the field and assert that technology cannot possibly replace human interaction. After all, a lot of therapy is about having healthy human relationships with other people and ourselves. However, the notion that disclosing to a truly non-judgmental observer, in the form of an avatar, can bring forth effective psychological healing is noteworthy to say the least.

I found myself thinking about the ‘observer effect’, a theory of quantum mechanics of which I admittedly have only a layperson’s understanding. Simply stated, the observer effect is when the behavior of electron particles change when measured by a device, or rather, when being observed. (For more information, research the “two slit experiment” or see: Dr Quantum video). If being observed can make particles change their behavior at the quantum level, how does that translate to human experience? In psychology, interpersonal neurobiology speaks to the observer effect when discussing the concept of interpersonal attunement. That is, a therapist who observes a client’s internal psychological state by attending to the client’s physiological, affective, and cognitive responses can help the client by regulating their own internal state. Each is observing the other, and in essence, feeding off each other. This phenomenon, although far more complex than what is described here, explains why in large group settings, individuals can feel or sense the internal state of the group. More specifically, a person who is calm entering a room with an anxious group can start to feel anxious prior to even engaging with the group or group members. With this in mind, we know that some therapeutic effect can be achieved by merely being observed, human or avatar, which is quite powerful.

So it is no surprise that, in addition to administering appropriate therapy interventions, an avatar therapist can be effective in symptom reduction and thus a preferred source of treatment for some people who are wary of disclosure to another human being. So why even use a human therapist? The concern for me is about relying on digital mediums to heal from human experiences. Sure, choosing an avatar therapist means avoidance of judgment by a human therapist. However, creating healing by avoidance of judgment can create the idea that struggle and strife, a natural part of the human experience, is unbecoming and something to be avoided. Thus, humans will be less inclined to share vulnerabilities and keep them hidden. What will it mean if people cannot show their true self, imperfections and all, to each other? Will we learn, or be conditioned, to only expose our vulnerabilities when guaranteed to be free from judgment so that we lose the capacity to tolerate and accept flaws ? What will happen to human intimacy if, in our relationships with other human beings, we cannot expose our vulnerabilities?

We should not underestimate the power of gradual conditioning. Ten years ago, stating that more than 1 in 6 people worldwide would own a smartphone was difficult to imagine. So was believing that people would spend more time staring at their phone screen than talking to each other while having dinner. Although artificial intelligence has a lot to offer people who have limited access to resources (e.g. financial, transportation) or to individuals who would otherwise be deterred from therapy (e.g. due to stigma), my opinion is that avatar therapy is better utilized as a bridge to therapy with humans, rather than a replacement. Avatar therapy can provide a safe, positive experience with the experience of seeking mental health services. Having a good, safe experience with an avatar therapist can prepare individuals to have a human experience with, well, a human therapist.

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