(NOTE: This is a draft of a commissioned piece that might be a bit too radical for the place it was intended…)
One day, in the not-so-distant future, a psychologist goes to work…
I move from kitchen to home office, coffee in hand and sit in a comfy chair. With earphones in, I’ve been listening to my phone update me on my schedule. My AI-driven contacts app has noted an email from a client who has cancelled and wants to rebook. A quick search for a free time slot in my calendar finds an opening that matches one of the client’s requested times. I tap several response selections provided by my email app, and with my AI-driven schedule manager copied into the email response, I hit ‘send’.
My first appointment is soon ready. I turn on my computer and the flat screen display, ensuring the camera has me in frame and focus. At the appointed time, the video conference app engages, and we are connected. What ensues for the next hour is a typical psychotherapy session. The only difference from a prototype session is that each of us sits in front of a screen to mitigate the fact that we are 500 km apart. We end with a download of a recording of the session for later transcription and review for case notes.
I open my bookkeeping program, check the invoice details, and send this to the client as we sign off. The invoice has a unique web link, connecting to my secure web portal that allows for several payment options – PayPal, credit card, e-transfer. It’s even still possible to mail me a check. I just take a photo of it with my phone to deposit it. As my next session is ready to connect, I note that my AI assistant has rebooked my client and set an automatic SMS message for the day before, to remind them. My bank app notifies me that I have an e-transfer waiting for deposit. And so my day unfolds.
Late that night, my client feels anxious. They’ve forgotten the exercises I’ve suggested and can’t sleep. They don’t feel that things are bad enough to call me, but they would like to chat to take the edge off. They log into my web portal and have a 15-minute conversation with an AI-driven chatbot that is “trained” in CBT, and after a brief conversation, they sign off, ready to sleep. The next morning as I walk my coffee from kitchen to office, my phone flags for me the summary of my client’s late-night chat. I review it for key issues and add a reminder to call them on my next break for a check in.
The difference between the practice described in this scenario, compared to what many of us do today, is the insertion of technology solutions at points where we would otherwise have done something manually. This scenario is not really a future fantasy. Every point you’ve just read is available today from a variety of sources. In fact, this is the practice of the present.
Once upon a time a conversation between human and computer was a novelty. Eliza responded with pseudo-Rogerian flare, reflecting to the typist their words. When those words included feelings, we were often amazed at the sense of how we felt. It was simplistic, but the computer seemed to understand us. Today we converse with artificial intelligence chat bots almost daily, sometimes not knowing they are there. (See https://chatbotnewsdaily.com/ for many examples.) While we are not quite at the mainstream with AI-supported psychotherapy (see Luxton, 2013), according to Gartner (Panetta, 2017), many of the core technologies (conversational interfaces, machine learning, expert advising systems) sit on the two to five year horizon. Certainly, AI-driven chatbots for mental health exist and have survived randomized controlled trials (Fitzpatrick, Darcy, & Vierhile, 2017).
If our near-future landscape is headed for an unprecedented disruption, we need to ask how the regulatory environment is evolving to match the pace of change. If we frame the scenario of the future as primarily a change in the various media of clinical practice – smartphone instead of paper diary, screen instead of face-to-face, e-transfer instead of cash, cloud-based files instead of a file cabinet, then we remain in good stead. Our Standards of Practice and the Canadian Code of Ethics guide us on the process of ensuring privacy, consent, secure record management, and our competence in general when dealing with new practice issues. The principles of obtaining informed consent remain the same, regardless of the therapeutic medium. What may change is the additional discussion in consent of how the medium might influence the client’s experience. The “always on” culture of texting and social media may lead clients to assume our eternal presence. Again, the process of consent might now include a statement of which media (phone, email, SMS), and during what hours, a client may contact you, outside of an emergency. Simply put, in terms of technology and our clinical practice, we must view the adoption of technology as a core competency and attend to it in the same way we would introduce a new clinical practice, as per Section 5 of the Standards.
Looking ahead, some observers of the professions raise a cautionary note. Susskind and Susskind (2015) are clear that professions as guardians of specialized knowledge and technique may not last in the form we understand them today. In their view, much of what we do as professionals may be accomplished without the human touch. Even the complex and nuanced can be reduced to procedural tasks amenable to machine learning. We don’t like to hear this – that our hard won professional identities can be so easily usurped. What remains for us (and may not be lost to us in the near future, if the public’s reaction to Google Duplex is any indication) are the human connections that we, as a profession, are so familiar with. What will the future look like? It will look like you and me. Sitting. Listening. Extending our care to each other, whether in the same room, or across the aether.
Meanwhile, if you build the practice of the future today, pay attention to how each aspect is affected by the cornerstones of our profession – privacy, consent, and competence.
Fitzpatrick, K., Darcy, A., and Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): A randomized controlled trial. Journal of Medical Internet Research: Mental Health, 4(2):e19 DOI: 10.2196/mental.7785
Panetta, K. (2017, August 15). Top trends in the Gartner hype cycle for emerging technologies, 2017. Retrieved from https://www.gartner.com/smarterwithgartner/top-trends-in-the-gartner-hype-cycle-for-emerging-technologies-2017/
Susskind, R, and Susskind, D. (2015). The future of the professions: How technology will transform the work of human experts. Oxford University Press.