How might AI chatbots replace mental health therapists?

There is a striking shortage of mental health care providers in the United States. New research suggests that AI chatbots can fill in the gaps — and be remarkably effective while doing so.

Artificial intelligence can deliver mental health therapy "with as much efficacy as — or more than — human clinicians," said NPR. New research published in the New England Journal of Medicine looked at the results delivered by a bot designed at Dartmouth College.

What did the commentators say?

There was initially a lot of "trial and error" in training AI to work with humans suffering from depression and anxiety, said Nick Jacobson, one of the researchers, but the bot ultimately delivered outcomes similar to the "best evidence-based trials of psychotherapy." Patients developed a "strong relationship with an ability to trust" the digital therapist, he said.

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Other experts see "reliance on bot-based therapy as a poor substitute for the real thing," said Axios. Therapy is about "forming a relationship with another human being who understands the complexity of life," said sociologist Sherry Turkle. But another expert, Skidmore College's Lucas LaFreniere, said it depends on whether patients are willing to suspend their disbelief. "If the client is perceiving empathy," he said, "they benefit from the empathy."

AI therapists could "further isolate vulnerable patients instead of easing suffering," Nigel Mulligan, a lecturer in psychotherapy at Dublin City University, said at The Conversation. It is easy to understand why people would turn to a "convenient and cost-effective resource" for mental health services, but while bots can be "beneficial for some," they are generally not an "effective substitute" for a human therapist. Humans can offer "emotional nuance, intuition and a personal connection." AI, though, cannot duplicate that nuance, making it "unsuitable for those with severe mental health issues."

The technology can make mental health services "more accessible, more personalized, and more efficient," Dr. Jacques Ambrose said at NewYork-Presbyterian's blog. Large language models have the ability to "analyze the vast amount of patient data in psychiatry" and come up with tailored treatments specific to a client. But there are concerns about privacy and the "human-to-human connection" that makes therapy effective. The best approach is one that creates a "partnership between the clinician and the technology."

What next?

In February, the American Psychological Association made a presentation to the Federal Trade Commission warning against chatbots "masquerading" as therapists that "could drive vulnerable people to harm themselves or others," said The New York Times. "People are going to be misled, and will misunderstand what good psychological care is," said Arthur C. Evans Jr., the Association's chief executive.

There are some efforts to limit the reach of AI therapy. In California, a bill has been introduced that would ban tech companies from deploying an AI program that "pretends to be a human certified as a health provider," said Vox. Chatbots are "not licensed health professionals," said state Assembly Member Mia Bonta, "and they shouldn't be allowed to present themselves as such."