You have probably heard of ELIZA at one time or another. In the mid-1960s, Joseph Weizenbaum, a computer scientist at the Massachusetts Institute of Technology, developed a computer program to simulate a Rogerian psychotherapist. ELIZA, as the program was called, asked open-ended questions to encourage the user to discuss his or her emotions.
Weizenbaum was surprised to see users talk intimately about their problems. In fact, when the experiment was over, some subjects refused to believe they were not exchanging messages with a real, live therapist.
It has been almost 50 years since ELIZA was originally developed. When you consider all of the dazzling technological achievements of the past five decades, you might wonder “if such a simple program worked so well in the 1960s, just imagine the artificial therapist of today!” While it’s true there have been advances, they have not been in the ways early pioneers expected. In particular, we have not seen a steady march from ELIZA to a humanoid therapist with a programmed theory of mind and algorithms for understanding and empathy.
In this article I’ll introduce computerized therapy and explain why, despite a conspicuous absence of insightful robots, it is more important than ever.
What Is Computerized Therapy?
It is worthwhile taking a moment to define “computerized therapy.” It is separate from the closely related field of online mental health interventions. Live therapy is traditionally conducted through face-to-face sessions between a patient and a therapist. Today it is possible for psychotherapy to take place over the Internet via emails or videoconferencing. This is commonly known as online therapy or e-Therapy. Similarly, self-help treatments were initially available through books, CDs, DVDs, etc., but can now be made available as web-based programs.
While Internet-supported interventions necessarily involve the use of computers, the term “computerized therapy” places the emphasis on a different point: a computer is playing more than a passive role in delivering the clinical content. In other words, the computer is more than just a means of delivery, and may or may not be connected to the Internet.
The idea of a computer performing therapy is not nearly as radical as it may sound. Patients are not engaged in deep conversation with robots. From a technical perspective, a basic computerized therapy system is easy to understand.
The following thought experiment is helpful for explaining, and more importantly demystifying, how some systems work. Did you read the Choose Your Own Adventure book series when you were a kid? Basically, the idea is that the reader makes decisions at key points and these choices affect how the story unfolds.
Imagine a self-help book along these lines. For example, it might say “If the idea of socializing at your office Christmas party makes you nervous, go to page 143” and on page 143 you find exercises to help manage your anxiety. The rules encapsulate clinical knowledge and are used to deliver targeted interventions. Imagine adding more and more decision points and pieces of personalized content to the book. Eventually, you reach a point where each reader takes a unique path through the book based on their own idiosyncratic mental profile.
The problem with actually publishing such a book is that there are vast numbers of possible conditions, symptoms, causes, behaviors, thoughts, etc. The book would be too cumbersome to use. However, the idea is sound and perfectly suited for implementation in software. This, in a nutshell, is one of the key ideas behind computerized therapy. It is also why I consider the field to be a natural progression of the self-help paradigm.
Some forms of therapy, such as cognitive behavioral therapy (CBT), are particularly well suited for this algorithmic delivery style. However, other therapy techniques, such as those that rely more heavily on the therapist/client relationship, are considerably more difficult to automate.
The Advantages of Computerized Therapy
The example above illustrates an important advantage of computerized therapy over traditional self-guided treatments: the ability to automatically adapt the clinical content to the needs of the user. Personalization is an active, and promising, area of research. There are other advantages as well:
- Unlimited scalability. It is at the intersection between computerized therapy and Internet-based interventions where things get really exciting. For fully automated online systems, there are no practical limits on the number of clients that can be treated simultaneously. If you ever have any doubts about this, just consider this fact: Facebook has over a billion users. Between open source web development platforms and cloud computing services such as Google App Engine and Amazon Web Services, developing and deploying highly scalable systems is now within everyone’s reach.
- Enhanced content.Computerized therapy can be much more than text on a screen. The programs can be rich in multimedia content, with text, images, videos, animations, audio voiceovers, and interactive exercises. A well-designed treatment program can be a very compelling user experience.
- Evolving content.With a book, the moment it is published its contents are frozen. However, online computerized therapies can be modified at any time to make sure they are using only the latest, evidence-based treatment methods.
The Case for Computerized Therapy
Can a computer therapist ever be as effective as a human therapist? This question is open for debate, and I certainly have my own opinions. However, I think it is safe to say that computers will not be replacing humans anytime soon,
There are several reasons why we should peruse new ways to disseminate treatments, but one stands out above all others: to reach a wider audience. There are countless people worldwide who are living with a mental illness for which effective treatments are available, yet the vast majority of these people will never attend an in-person therapy session. There are a number of reasons for this:
- In poor countries, one-on-one time with a professionally trained therapist is a luxury far beyond the means of the general population.
- Even in the wealthiest countries, there are many people who cannot afford therapy. Some countries are fortunate to have mental health provisions in their national health care system. However, these systems are often overburdened, with lengthy waiting lists and a limited number of sessions per patient.
- Due to the stigma that often surrounds mental health problems, there are people who are hesitant or unwilling to attend live therapy, even when the option is readily available. However, many of these people have no hesitations about participating in anonymous computerized treatments. With today’s technology we have the ability to reach these people and substantially improve their quality of life.
Computerized therapy, and its sister field of Internet-supported interventions, is still young and rapidly evolving. It is a hot topic in academic psychology, and a handful of commercial products are now available. Significant challenges still lie ahead, including clinical, legal, technological, assessment and ethical issues. However, there is little doubt that online and computerized systems will play an important role in the future of therapy.