In conventional mental health care, the therapist—such as a psychologist or counsellor—develops an ongoing relationship with the client that is characterized by trust, empathy, and support. Regardless of the type of therapy being used, the longstanding consensus among researchers is that this relationship can be healing in itself; when therapists actively listen, indicate understanding, communicate effectively, and present a warm, approachable demeanor, clients not only report better experiences, but also show improved health outcomes.
However, technology is radically changing the relationship between therapists and clients—in some cases because the therapist is technology. Nowadays you can work through depression with the help of a chatbot, overcome a phobia using a virtual reality headset, or learn how to combat anxiety through a self-guided online program. If you prefer a real person on the other end, numerous services offer video appointments, phone calls, or text messaging with therapists whom you don’t ever have to meet.
This trend brings into question whether users will miss out on the advantages of in-person human connection. If you’ve been in a long-distance relationship or had a close friend move to another city, you know that no matter how often you communicate over live video or instant messages, it doesn’t feel as good as when you spend time physically together.
The same may be true of mental health care. With technology altering the way therapists and clients interact—and occasionally replacing therapists entirely—the risk is that their bond, along with the psychological value it confers, may be diminished. Perhaps for that reason, when asked how they would like to receive therapy, 67% of respondents in a recent survey preferred face-to-face meetings, compared to only 7% who would opt for internet-based treatment.
Conversely, there is an important issue that can arise in these relationships that digital mental health care is uniquely poised to address: stigma. People sometimes feel too ashamed to open up honestly about their struggles to another person, even when that person is an accepting, nonjudgmental therapist. In particular, out of fear that therapists will view them negatively, clients may engage in what social scientists call impression management: selectively choosing to only share information that portrays them in a positive light.
We are all guilty of this behavior on occasion; think about the last time you had a job interview or went on a first date. It’s natural to want to put your best foot forward. But in a clinical context, impression management is problematic because it undermines the opportunity for effective, personalized care. By withholding information, consciously or not, clients prevent therapists from fully understanding their problems and, in turn, from providing appropriate solutions. Unfortunately this behavior is especially likely during the first consultation, which sets the direction for all future sessions.
Technology enables people to bypass this barrier. Consider a fascinating study in which over 200 participants talked with a virtual human—that is, an artificially intelligent avatar who asked questions like a therapist would during an initial clinical interview and developed rapport through compassion (such as saying, “I’m sorry to hear that,”) and nonverbal behaviors (such as nodding). Half of the participants were led to believe that the virtual human was being operated by a real person in another room, whereas half thought it was an automated computer program.
Those in the first group felt more apprehensive about sharing personal details and remained more guarded. In contrast, participants who thought they were interacting with an automated program engaged in less impression management. In other words, they were more comfortable divulging secrets and being vulnerable to technology than to another person. This finding suggests that the technology-user relationship provides protection, at least ostensibly, that the therapist-client relationship does not. Without the anxiety of possible judgment or the threat to one’s self-esteem, and with the added security of anonymity, some people may feel more at ease to speak freely about their troubles.
Perhaps it will become possible to have the best of both worlds. Indeed, researchers are working on better simulating human connection through technology. For example, they are designing interfaces that mimic body language, demonstrate engaged listening, express empathy, reciprocate with sharing personal stories, employ emotional intelligence, and make people feel cared for. These advances may bridge the divide between human and virtual therapists and empower certain people to get the help they need but wouldn’t otherwise get for fear of stigma.
Nonetheless, the nuances of in-person interactions and the complexities of human psychology make the therapeutic alliance difficult to replicate virtually, to say the least. It’s hard to imagine that any technology can, or should, fully substitute the invaluable relationship between therapists and clients. After all, bonding with other people is a fundamental human need, crucial to our mental health and well-being.