I loved Clive Thompson’s piece in the New York Times magazine entitled; “May AI Help You?” in which he correctly identified what chatbots represent to those who use them. Rather than a replacement for a human, chatbots are an interface. A modern analogue facilitating intuitive interaction with technology, just like Microsoft used the analogue of the office to help us understand what to do with “documents” and “files” on our 90’s desktops.
Too often I am asked some version of; “do you really think Woebot can replace therapy?” and my heart sinks a little each time. This is missing the point entirely. As an intervention scientist, I know that the answer to the significant problem of access to care is not to build an artificial therapist. It’s to make better self-directed tools, for which there is over 20 years of solid evidence to support their efficacy. Self-directed programs based on Cognitive Behavioral Therapy (CBT) have been shown to work, the problem is that they’re not very engaging. In other words, people tend not to stick to the programs, so their reach is limited because only the most motivated people can finish them.
Woebot was built as a self-directed CBT program, delivered in a conversational way to address that problem of engagement. The beauty of the robot character is that it is absolutely clear that there is no therapist there. Woebot can ask you the right questions, but you are doing this work on your own.
We are always going to need human therapists. Rather than being a replacement, chatbots work really well when used alongside a CBT therapist. The trouble with the “AI replacing therapists” narrative is that we rarely get to talk about all of the great reasons why this tech is so complementary to existing practice. The following are some that I think about.
Accessible under stress
The beauty of a chatbot is that it’s just a conversation. When I’m feeling overwhelmed, I don’t want to spend any mental calories figuring out how to swipe or click my way through helping myself. All I have to do is talk about it.
Homework that doesn’t feel like homework
Studies have shown that the more a patient practices CBT in between sessions, the better the outcome they are likely to have. For years I tried different ways to encourage my patients to monitor their symptoms, mood, and challenge their thoughts in between sessions. I’ve literally never found an easier way to engage them than this. Because it is just a conversation, when Woebot checks in to see how someone is doing, it feels natural and so they are more likely to respond. This is homework that doesn’t feel like homework. It’s not perfect, but it’s a lot better than a paper and pen.
CBT in the context of everyday life
Imagine your therapist could be with you all the time, to whisper reaffirming wisdom in your ear when you feel insecure, to help you challenge your thinking when you’re overcome with guilt for returning to work after having a baby, or to give you a guided meditation to help you drift off to sleep. While a therapist cannot do this, Woebot has been designed to respond to the lived experience of people with just-in-time tools tailored to the situation. If anything this enhances the learning you get from your CBT specialist, it certainly doesn’t replace it.
Just because Khan Academy teaches my child Math online, does it mean that he no longer needs a math teacher? Of course not. In fact, these programs are complementary and are a large reason why teachers have embraced some educational technology. I think it would benefit patients if we, as a field, could get beyond the replacement narrative and do the same.