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.

The marketplace has spoken and, at least for now, it’s showing preference for hybrids and plug-in hybrids (PHEVs) over battery electrics. That makes Toyota’s foot dragging on EVs (and full speed ahead on hybrids) look fairly wise, though the timeline along a bumpy road still gets us to full electrification by 2035.

Italian supercar producer Lamborghini, in business since 1963, is also proceeding, incrementally, toward battery power. In an interview, Federico Foschini , Lamborghini’s chief global marketing and sales officer, talked about the new Urus SE plug-in hybrid the company showed at its lounge in New York on Monday.

The Urus SE interior gets a larger centre screen and other updates.
Lamborghini

The Urus SE SUV will sell for US$258,000 in the U.S. (the company’s biggest market) when it goes on sale internationally in the first quarter of 2025, Foschini says.

“We’re using the contribution from the electric motor and battery to not only lower emissions but also to boost performance,” he says. “Next year, all three of our models [the others are the Revuelto, a PHEV from launch, and the continuation of the Huracán] will be available as PHEVs.”

The Euro-spec Urus SE will have a stated 37 miles of electric-only range, thanks to a 192-horsepower electric motor and a 25.9-kilowatt-hour battery, but that distance will probably be less in stricter U.S. federal testing. In electric mode, the SE can reach 81 miles per hour. With the 4-litre 620-horsepower twin-turbo V8 engine engaged, the picture is quite different. With 789 horsepower and 701 pound-feet of torque on tap, the SE—as big as it is—can reach 62 mph in 3.4 seconds and attain 193 mph. It’s marginally faster than the Urus S, but also slightly under the cutting-edge Urus Performante model. Lamborghini says the SE reduces emissions by 80% compared to a standard Urus.

Lamborghini’s Urus plans are a little complicated. The company’s order books are full through 2025, but after that it plans to ditch the S and Performante models and produce only the SE. That’s only for a year, however, because the all-electric Urus should arrive by 2029.

Lamborghini’s Federico Foschini with the Urus SE in New York.
Lamborghini

Thanks to the electric motor, the Urus SE offers all-wheel drive. The motor is situated inside the eight-speed automatic transmission, and it acts as a booster for the V8 but it can also drive the wheels on its own. The electric torque-vectoring system distributes power to the wheels that need it for improved cornering. The Urus SE has six driving modes, with variations that give a total of 11 performance options. There are carbon ceramic brakes front and rear.

To distinguish it, the Urus SE gets a new “floating” hood design and a new grille, headlights with matrix LED technology and a new lighting signature, and a redesigned bumper. There are more than 100 bodywork styling options, and 47 interior color combinations, with four embroidery types. The rear liftgate has also been restyled, with lights that connect the tail light clusters. The rear diffuser was redesigned to give 35% more downforce (compared to the Urus S) and keep the car on the road.

The Urus represents about 60% of U.S. Lamborghini sales, Foschini says, and in the early years 80% of buyers were new to the brand. Now it’s down to 70%because, as Foschini says, some happy Urus owners have upgraded to the Performante model. Lamborghini sold 3,000 cars last year in the U.S., where it has 44 dealers. Global sales were 10,112, the first time the marque went into five figures.

The average Urus buyer is 45 years old, though it’s 10 years younger in China and 10 years older in Japan. Only 10% are women, though that percentage is increasing.

“The customer base is widening, thanks to the broad appeal of the Urus—it’s a very usable car,” Foschini says. “The new buyers are successful in business, appreciate the technology, the performance, the unconventional design, and the fun-to-drive nature of the Urus.”

Maserati has two SUVs in its lineup, the Levante and the smaller Grecale. But Foschini says Lamborghini has no such plans. “A smaller SUV is not consistent with the positioning of our brand,” he says. “It’s not what we need in our portfolio now.”

It’s unclear exactly when Lamborghini will become an all-battery-electric brand. Foschini says that the Italian automaker is working with Volkswagen Group partner Porsche on e-fuel, synthetic and renewably made gasoline that could presumably extend the brand’s internal-combustion identity. But now, e-fuel is very expensive to make as it relies on wind power and captured carbon dioxide.

During Monterey Car Week in 2023, Lamborghini showed the Lanzador , a 2+2 electric concept car with high ground clearance that is headed for production. “This is the right electric vehicle for us,” Foschini says. “And the production version will look better than the concept.” The Lanzador, Lamborghini’s fourth model, should arrive in 2028.

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