The Wall Street Journal reports that mental health chatbots are replacing therapists without any scientific evidence behind them. The writer provides an anecdote about a psychology student, Eri Petherbridge, who sees a therapist three times a week. The therapist suggested she talk to a chatbot between visits. The following is from WSJ:
Her therapist doesn’t always agree with the chatbots’ analysis. But these digital companions have allowed Petherbridge to cut back on how often she does in-person therapy. That might be the point. For some, that also could be a problem.
Millions of people see a therapist. Not all of them have actual mental health disorders. In The Case Against Mental Health Parity: Faulty Assumptions (2002) John Goodman wrote:
If someone else is paying the bill, the patient has no reason to choose the less expensive option. An apparent reflection of the problem of moral hazard is a National Bureau of Economic Research study finding that 38 percent of all mental health patients – representing 28 percent of all treatment visits – are people who do not have any mental health disorder.
For people with no mental health disorder an AI chatbot may be the perfect emotional support for garden variety angsts. Talking to a computer chatbot for nearly free may feel therapeutic – even cathartic – while not as stressing for the budget as $125 an hour in cash for an actual therapist. However, turning to AI for emotional support may not always be in patients’ best interest if they need real help.
One problem is that chatbots are designed to be too helpful. Chatbots do not excel at tough love, something that patients sometimes need. A therapist needs to be able to push back in the right circumstances. Just as spilling your feelings to a sympathetic friend is different than telling them to a trained therapist, there is a difference in training between chatbots and therapists. More from WSJ:
Some mental-health AI bots are programmed to be companions, offering emotional support for everyday issues such as work stress or sleeping trouble. Others are designed to act more like therapists that can assess and manage deeper feelings or crises, serving as an extension of a human provider. Often, these services have diminutive and friendly-sounding names.
This sort of reminds me of people who use Doctor Google rather than seeing an actual doctor. Google has immense power to inform patients about diseases and conditions but cannot provide actual care. Only a doctor can make referrals and prescribed drugs and therapy. I also wonder about the mental commitment of patients knowing they’re talking to a machine rather than to an empathetic human. Dr. Christine Crawford, a psychiatrist and chief medical officer for the National Alliance on Mental Illness, told WSJ:
“It will never, ever, ever be as good or superior as meeting with a human clinician,” Crawford said. Chatbots can’t pick up cues from patients’ facial expressions, or notice when their eyes are welling with tears.
“What is really contributing to the work within therapy and the healing is the relationship between you and the therapist—someone that you see regularly who cares about you, who you feel comfortable being open and vulnerable with, and who also calls you out on your stuff,” she said.
It is tough to find a therapist these days. Nearly half do not accept new patients, and more than one-third do not take insurance. For the worried well an AI chatbot may be exactly what some people need, but not all. AI chatbots are not regulated by the U.S. Food and Drug Administration. WSJ reports that a few states have taken steps to regulate mental health AI chatbots. The fear is that some patients may become dependent on them and the technology has not developed sufficient guardrails. Overall, AI mental health chatbots appear to be a positive factor but it remains to be seen how good they are (or will become) at identifying those patients who need the expertise or intervention of a human psychiatrist or psychologist.
Read more at WSJ: Chatbots Are Replacing Therapists With Little Scientific Evidence Behind Them