Can Artificial Intelligence Replace Human Therapists?

Could artificial intelligence reduce the need for human therapists?

Websites, smartphone apps and social-media sites are dispensing mental-health advice, often using artificial intelligence. Meanwhile, clinicians and researchers are looking to AI to help define mental illness more objectively, identify high-risk people and ensure quality of care.

Some experts believe AI can make treatment more accessible and affordable. There has long been a severe shortage of mental-health professionals, and since the Covid pandemic, the need for support is greater than ever. For instance, users can have conversations with AI-powered chatbots, allowing then to get help anytime, anywhere, often for less money than traditional therapy.

The algorithms underpinning these endeavours learn by combing through large amounts of data generated from social-media posts, smartphone data, electronic health records, therapy-session transcripts, brain scans and other sources to identify patterns that are difficult for humans to discern.

Despite the promise, there are some big concerns. The efficacy of some products is questionable, a problem only made worse by the fact that private companies don’t always share information about how their AI works. Problems about accuracy raise concerns about amplifying bad advice to people who may be vulnerable or incapable of critical thinking, as well as fears of perpetuating racial or cultural biases. Concerns also persist about private information being shared in unexpected ways or with unintended parties.

The Wall Street Journal hosted a conversation via email and Google Doc about these issues with John Torous, director of the digital-psychiatry division at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School; Adam Miner, an instructor at the Stanford School of Medicine; and Zac Imel, professor and director of clinical training at the University of Utah and co-founder of LYSSN.io, a company using AI to evaluate psychotherapy. Here’s an edited transcript of the discussion.

Leaps forward

WSJ: What is the most exciting way AI and machine learning are being used to diagnose mental disorders and improve treatments?

DR. MINER: AI can speed up access to appropriate services, like crisis response. The current Covid pandemic is a strong example where we see both the potential for AI to help facilitate access and triage, while also bringing up privacy and misinformation risks. This challenge—deciding which interventions and information to champion—is an issue in both pandemics and in mental health care, where we have many different treatments for many different problems.

DR. IMEL: In the near term, I am most excited about using AI to augment or guide therapists, such as giving feedback after the session or even providing tools to support self-reflection. Passive phone-sensing apps [that run in the background on users’ phones and attempt to monitor users’ moods] could be exciting if they predict later changes in depression and suggest interventions to do something early. Also, research on remote sensing in addiction, using tools to detect when a person might be at risk of relapse and suggesting an intervention or coping skills, is exciting.

DR. TOROUS: On a research front, AI can help us unlock some of the complexities of the brain and work toward understanding these illnesses better, which can help us offer new, effective treatment. We can generate a vast amount of data about the brain from genetics, neuroimaging, cognitive assessments and now even smartphone signals. We can utilize AI to find patterns that may help us unlock why people develop mental illness, who responds best to certain treatments and who may need help immediately. Using new data combined with AI will likely help us unlock the potential of creating new personalized and even preventive treatments.

WSJ: Do you think automated programs that use AI-driven chatbots are an alternative to therapy?

DR. TOROUS: In a recent paper I co-authored, we looked at the more recent chatbot literature to see what the evidence says about what they really do. Overall, it was clear that while the idea is exciting, we are not yet seeing evidence matching marketing claims. Many of the studies have problems. They are small. They are difficult to generalize to patients with mental illness. They look at feasibility outcomes instead of clinical-improvement endpoints. And many studies do not feature a control group to compare results.

DR. MINER: I don’t think it is an “us vs. them, human vs. AI” situation with chatbots. The important backdrop is that we, as a community, understand we have real access issues and some people might not be ready or able to get help from a human. If chatbots prove safe and effective, we could see a world where patients access treatment and decide if and when they want another person involved. Clinicians would be able to spend time where they are most useful and wanted.

WSJ: Are there cases where AI is more accurate or better than human psychologists, therapists or psychiatrists?

DR. IMEL: Right now, it’s pretty hard to imagine replacing human therapists. Conversational AI is not good at things we take for granted in human conversation, like remembering what was said 10 minutes ago or last week and responding appropriately.

DR. MINER: This is certainly where there is both excitement and frustration. I can’t remember what I had for lunch three days ago, and an AI system can recall all of Wikipedia in seconds. For raw processing power and memory, it isn’t even a contest between humans and AI systems. However, Dr. Imel’s point is crucial around conversations: Things humans do without effort in conversation are currently beyond the most powerful AI system.

An AI system that is always available and can hold thousands of simple conversations at the same time may create better access, but the quality of the conversations may suffer. This is why companies and researchers are looking at AI-human collaboration as a reasonable next step.

DR. IMEL: For example, studies show AI can help “rewrite” text statements to be more empathic. AI isn’t writing the statement, but trained to help a potential listener possibly tweak it.

WSJ: As the technology improves, do you see chatbots or smartphone apps siphoning off any patients who might otherwise seek help from therapists?

DR. TOROUS: As more people use apps as an introduction to care, it will likely increase awareness and interest of mental health and the demand for in-person care. I have not met a single therapist or psychiatrist who is worried about losing business to apps; rather, app companies are trying to hire more therapists and psychiatrists to meet the rising need for clinicians supporting apps.

DR. IMEL: Mental-health treatment has a lot in common with teaching. Yes, there are things technology can do in order to standardise skill building and increase access, but as parents have learned in the last year, there is no replacing what a teacher does. Humans are imperfect, we get tired and are inconsistent, but we are pretty good at connecting with other humans. The future of technology in mental health is not about replacing humans, it’s about supporting them.

WSJ: What about schools or companies using apps in situations when they might otherwise hire human therapists?

DR. MINER: One challenge we are facing is that the deployment of apps in schools and at work often lacks the rigorous evaluation we expect in other types of medical interventions. Because apps can be developed and deployed so quickly, and their content can change rapidly, prior approaches to quality assessment, such as multiyear randomized trials, are not feasible if we are to keep up with the volume and speed of app development.

Judgment calls

WSJ: Can AI be used for diagnoses and interventions?

DR. IMEL: I might be a bit of a downer here—building AI to replace current diagnostic practices in mental health is challenging. Determining if someone meets criteria for major depression right now is nothing like finding a tumour in a CT scan—something that is expensive, labour-intensive and prone to errors of attention, and where AI is already proving helpful. Depression is measured very well with a nine-question survey.

DR. MINER: I agree that diagnosis and treatment are so nuanced that AI has a long way to go before taking over those tasks from a human.

Through sensors, AI can measure symptoms, like sleep disturbances, pressured speech or other changes in behaviour. However, it is unclear if these measurements fully capture the nuance, judgment and context of human decision making. An AI system may capture a person’s voice and movement, which is likely related to a diagnosis like major depressive disorder. But without more context and judgment, crucial information can be left out. This is especially important when there are cultural differences that could account for diagnosis-relevant behaviour.

Ensuring new technologies are designed with awareness of cultural differences in normative language or behaviour is crucial to engender trust in groups who have been marginalised based on race, age, or other identities.

WSJ: Is privacy also a concern?

DR. MINER: We’ve developed laws over the years to protect mental-health conversations between humans. As apps or other services start asking to be a part of these conversations, users should be able to expect transparency about how their personal experiences will be used and shared.

DR. TOROUS: In prior research, our team identified smartphone apps [used for depression and smoking cessation that] shared data with commercial entities. This is a red flag that the industry needs to pause and change course. Without trust, it is not possible to offer effective mental health care.

DR. MINER: We undervalue and poorly design for trust in AI for healthcare, especially mental health. Medicine has designed processes and policies to engender trust, and AI systems are likely following different rules. The first step is to clarify what is important to patients and clinicians in terms of how information is captured and shared for sensitive disclosures.

Australian football superstar and Matildas captain Sam Kerr has joined one of the world’s most exclusive luxury watch brands, reflecting on the sacrifices behind a career at the pinnacle of professional sport and revealing she only signed with her new club last week.

As Richard Mille’s first and only Australian partner, Kerr has joined an elite group of global athletes, artists and innovators associated with one of the world’s most prestigious watchmakers.

Speaking in Sydney, the 32-year-old reflected on her next chapter, the extraordinary growth of women’s football and the personal sacrifices required to reach the top of the game.

Founded in 2001, Richard Mille has built a reputation for producing some of the world’s most technically advanced and exclusive timepieces. The Swiss watchmaker is renowned for its use of ultra-lightweight materials, Formula One-inspired engineering and limited-production watches that often sell for hundreds of thousands of dollars and, in some cases, more than $1 million.

Its ambassadors include tennis great Rafael Nadal, Formula One stars Charles Leclerc and Lando Norris, actress Michelle Yeoh and sprint champion Shelly-Ann Fraser-Pryce.

During the Sydney event, Kerr wore the Richard Mille RM 07-04 Automatic Sport, a lightweight model featuring a pink case, blue strap and skeletonised movement. Designed for active lifestyles, the watch reflects the brand’s philosophy of combining high-performance engineering with luxury craftsmanship.

For Kerr, becoming the brand’s first Australian partner is a source of considerable pride.

“Of course, being the only Australian is incredible to me,” she said. “I am very proud to be Australian and I like to put Australia on the map.”

The announcement comes as Kerr prepares for the next stage of her football career following her departure from Chelsea after six-and-a-half years.

While speculation around her future has been mounting for months, Kerr revealed a decision was only finalised recently.

“Everyone thinks that it was decided and I’ve known that (it was) reported that I’d signed somewhere in April, but honestly, I only signed my contract on Wednesday last week,” she said.

“I really hadn’t decided what I was going to do until last week.”

Kerr said she expects details of her new club to be announced around the beginning of July once her Chelsea contract officially concludes.

Despite her excitement about what lies ahead, she admitted leaving one of the world’s biggest football clubs has been emotional.

“I am really sad about it,” she said. “It’s been my home for 6.5 years. I have so many good memories there. I have so many amazing teammates. I’m sad to leave.

“It sucks to leave such a big club like Chelsea too, but it comes to an end to everything, right?”

The 32-year-old also reflected on the transformation of women’s football during her career, describing the Matildas’ rise from relative obscurity to household-name status as one of her proudest achievements.

“What the Matildas have done over the last four or five years has been incredible,” she said.

“The most important thing for me is that you leave the game in a better place.”

Kerr noted that when she began playing, there were few professional pathways for women, limited sponsorship opportunities and crowds that bore little resemblance to those regularly attending matches today.

“We are a part of that generation that still knows what it was like when there was no one in the crowd,” she said.

Today, she said, crowds of tens of thousands remain something the team never takes for granted.

“Even last night we had 20,000 on a Tuesday night nearly. That’s special to us,” she said.

“We feel very lucky that people come out and spend their money and come to a game and watch us.”

Yet behind the accolades, sponsorships and sold-out stadiums, Kerr said there have been significant personal sacrifices.

“I’ve been living out of home since I was 17 years old. I’ve missed a lot of my family’s life,” she said.

“I’ve missed a lot of weddings. I’ve missed funerals. I’ve missed so many things that people don’t see.”

Kerr revealed she was unable to return home for her grandmother’s funeral last year because of football commitments.

“You have to love what you’re doing. You have to want to sacrifice,” she said.

“Everyone makes sacrifices, of course, and what I do is a massive privilege, but there comes a lot of sacrifice with it.”

Away from football, Kerr said Australia remains central to her identity despite spending much of her adult life overseas.

“I think we take for granted in Australia the beaches, the ocean, the open spaces,” she said.

As she prepares for a new club, a new season and a new role with Richard Mille, Kerr said she remains motivated by the same passion that first drew her to the game as a teenager.

“It was really organic,” she said of her relationship with the luxury watchmaker.

“It’s a real family brand.”

Can Artificial Intelligence Replace Human Therapists?

Three experts discuss the promise—and problems—of relying on algorithms for our mental health.

Leaps forward

Judgment calls

The Matildas captain has joined one of the world’s most exclusive luxury watch brands, sharing candid insights into the sacrifices required to succeed at the highest level of world football.