Therapy without therapists? The human factor in psychotherapy – past, present, and future

Lecture by Elizabeth Lunbeck, Department of the History of Science (Harvard University).

Abstract

Psychotherapy is at a crossroads, the shape of its future up for grabs. The field is shadowed by myths and misconceptions, internally divided and externally pressured, its practices derided in the abstract even as they are embraced by legions of the distressed, suffering, and traumatized. Demand for therapy is at an all-time high, yet therapists are questioning their field’s established practices, asking whether the paradigmatic therapeutic setting, as well as long-established understandings of therapeutic process and cure, are viable or even defensible in a future defined by new forms of technologically-mediated relating. Meanwhile, the field is under pressure from edgy entrepreneurs whose dreams of penetrating the mind’s mysteries and, more radically, of doing away with the human in psychotherapy altogether are bolstered by infusions of eye-popping sums of venture capital. Is “therapy without therapists” psychotherapy’s future?

At stake in these debates is the human factor. Put simply, is the relationship between therapist and patient irreducibly human and central to its healing effects? Or is therapy better conceptualized as a process of interpretation, information exchange, and provision of perfectly tailored advice in which the therapist’s personality and self are marginal? Is the healing “magic” of therapy to be found in the relationship between two people, or can a relationship with an illusory, AI-generated other bestow the same healing effects? Can algorithms replace analysts? Does practising psychotherapy as traditionally conceived – the self-exposure and stress involved in mobilizing the self as an instrument – ask too much of therapists? Can we see in their recent embrace of not only technologically mediated therapy but also AI chatbots an implicit recognition of the human cost to them of doing therapy?