IEEE Technology and Society Magazine - December 2019 - 31

able to recognize when confidentiality needs to be broken, and how?
This is straying into the domain of
machine ethics, for which there are
also no easy answers [10].

the first AI natural language processing systems, ELIZA, simulated
a Rogerian psychotherapist [7],
[8]) there are some concerns with
this approach.
Probably the biggest challenge
in working with those in therapy (in
whichever way the therapy is delivered) is identifying when a client
might be at risk of serious self-harm,
including suicide. In F2F work, the
therapist should be able to gauge
the client's mood, often through
very subtle behavioral changes and
subtle non-verbal cues. A mental
health chatbot would have to integrate a number of visual and verbal
cues in order to spot a potentially
suicidal client, particularly if the client is "building up" to a first attempt
where there does not appear to be
an obvious correlation between signals and deed. Perhaps a machine
learning algorithm could identify a
pattern, but this would be a significant technological accomplishment.
Moreover, while clients may not
necessarily frame it as such, loneliness is an extremely common
presenting issue. A "TherapyBot"
could potentially supplement part
of the therapist's work, but it could
not essentially replicate or recreate human contact with clients.
Rather, human contact appears
to be essential to the therapeutic
relationship. The role of sociallyinteractive robots as surrogate pets
seems to offer comfort, company,
and stimulation for the elderly and
in the treatment of dementia [9], but
genuine rather than synthetic empathy seems to be the kind of contact
and connection that is most needed
to help a client develop and begin
to recover. This appears, at least for
now, to be something only another
human being can offer.
Finally, issues of privacy, trust,
and confidentiality are particularly
salient. One of the key questions
here is: would a "TherapyBot" be
DECEMBER 2019

Problems and Possibilities
In conclusion, digital technologies
and online platforms offer a remarkable opportunity to enhance the
human element of therapy, and
many people are now being offered
such life-changing opportunities to
get support in their lives. It has
enabled the therapy profession to
be far more accessible to distressed
and "in need" individuals who may
not otherwise have been able to
access face-to-face treatment.
For therapist s think ing of
embarking on this way of working,
we have seen that there are certain things that need serious consideration. Online therapy clearly
poses both problems and possibilities for clients and therapists alike.
As such, both parties who wish to
work in this way need to be fully
informed of and familiar with the
advantages and limitations of this
type of intervention.
Moreover, due to ever-changing
technological developments and
broadening of our knowledge of how
human relationships and cognitive
functions are changed by technology and "being online," with those
substantial benefits come potentially serious risks. Practitioners, both
individually and collectively - especially through professional organizations - need to be super-vigilant, to
ensure that the benefits outweigh
the risks.
For the future, we may well see
therapy services both private and
state-provided that are able to blend
state-of-the-art technology with more
"traditional" services, in an accessible, cost-effective, and most importantly, efficacious way. Technology
should never be seen an opportunity
∕

IEEE TECHNOLOGY AND SOCIETY MAGAZINE

only to reduce costs, and certainly
not as a complete replacement for
creating a physical human connection that could help build the lasting
change needed for a client to make a
full recovery.

Author Information
Jennifer Jetter is a BACP accredited
Counselor/Psychotherapist. She practices as a School Counselor, manages
a Schools Counseling Outreach Project in an inner-city Youth Counseling
Service, and manages a Bereavement
Counseling service. Email: jennifer
counselling01@outlook.com.

References
[1] V. Della Mea, "What is e-Health (2): The
death of telemedicine?," J. Med. Internet
Res., vol. 3, no. 2, p. e22, 2001.
[2] J. Marcal Lopes, P. Marrone, S. Luiz Pereira,
and E. Mario Dias, "Health 4.0: Challenges for
an orderly and inclusive innovation," IEEE
Tech. Soc. Mag., vol. 38, no. 3, pp. 17-19, 2019.
[3] S. Makin, "Searching for digital technology's effects on well-being," Nature, 2018;
https://www.nature.com/articles/d41586
-018-07503-w.
[4] H. Siddique, "Mental health disorders
on rise among children," Guardian, Nov.
2018; https://www.theguardian.com/society/
2018/nov/22/mental-health-disorders
-on-rise-among-children-nhs-figures.
[5] Z. Williams, "All I hear is anger and frustration": How Brexit is affecting our mental
health," Guardian, Apr., 2019; https://
www.theguardian.com/politics/2019/
apr/04/anger-and-frustration-how-brexit-is
-affecting-our-mental-health.
[6] A. Braun, "Are chatbots really the
answer for young people's mental health?,"
Mental Health Today, May 2019; https://
www.mentalhealthtoday.co.uk/blog/therapy/
are-chatbots-really-the-answer-for-young
-peoples-mental-health.
[7] J. Weizenbaum, "ELIZA - A computer
program for the study of natural language
communication between man and machine,"
Commun. ACM, vol. 9, no. 1, pp. 36-45, 1966.
[8] C. Bassett, "The computational therapeutic: Exploring Weizenbaum's ELIZA as
a history of the present," AI & Society, vol.
34, no. 4, pp. 803-812, 2019.
[9] J.K. Sheba, L.T. Phuc, A. Salman, S. Kumar,
M. Elara, and E. Martinez-Garcia, "Development
of rehabilitative multimodal interactive pet
robot for elderly residents," Procedia Computer Science, vol. 133, pp. 401-408, 2018.
[10] A. Winfield, K. Michael, J. Pitt, and V. Evers,
"Machine Ethics: The design and governance
of ethical AI and Autonomous Systems," Proc.
IEEE, vol. 107, no. 3, pp. 509-517, 2019.

https://www.nature.com/articles/d41586-018-07503-w https://www.nature.com/articles/d41586-018-07503-w https://www.theguardian.com/society/2018/nov/22/mental-health-disorders-on-rise-among-children-nhs-figures https://www.theguardian.com/society/2018/nov/22/mental-health-disorders-on-rise-among-children-nhs-figures https://www.theguardian.com/society/2018/nov/22/mental-health-disorders-on-rise-among-children-nhs-figures https://www.theguardian.com/politics/2019/apr/04/anger-and-frustration-how-brexit-is-affecting-our-mental-health https://www.theguardian.com/politics/2019/apr/04/anger-and-frustration-how-brexit-is-affecting-our-mental-health https://www.theguardian.com/politics/2019/apr/04/anger-and-frustration-how-brexit-is-affecting-our-mental-health https://www.theguardian.com/politics/2019/apr/04/anger-and-frustration-how-brexit-is-affecting-our-mental-health https://www.mentalhealthtoday.co.uk/blog/therapy/are-chatbots-really-the-answer-for-young-peoples-mental-health https://www.mentalhealthtoday.co.uk/blog/therapy/are-chatbots-really-the-answer-for-young-peoples-mental-health https://www.mentalhealthtoday.co.uk/blog/therapy/are-chatbots-really-the-answer-for-young-peoples-mental-health https://www.mentalhealthtoday.co.uk/blog/therapy/are-chatbots-really-the-answer-for-young-peoples-mental-health

IEEE Technology and Society Magazine - December 2019

Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - December 2019