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Artificial intelligence and counseling: Four levels of implementation

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Abstract

Artificial Intelligence (AI) is increasingly prominent in public, academic, and clinical provinces. A widening research base is expanding AI’s reach, including to that of the counseling profession. This article defines AI and its relevant subfields, provides a brief history of psychological AI, and suggests four levels of implementation to counseling, corresponding to time orientation and influence. Implications of AI are applicable to counseling ethics, existentialism, clinical practice, and public policy.
https://doi.org/10.1177/0959354319853045
Theory & Psychology
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Artificial intelligence and
counseling: Four levels of
implementation
Russell Fulmer
Northwestern University
Abstract
Artificial Intelligence (AI) is increasingly prominent in public, academic, and clinical provinces. A
widening research base is expanding AI’s reach, including to that of the counseling profession.
This article defines AI and its relevant subfields, provides a brief history of psychological AI,
and suggests four levels of implementation to counseling, corresponding to time orientation and
influence. Implications of AI are applicable to counseling ethics, existentialism, clinical practice,
and public policy.
Keywords
artificial intelligence, artificial intelligence and ethics, artificial intelligence and existentialism,
chatbots, psychological artificial intelligence
Artificial Intelligence (AI) is expected to play an influential role in the mental health care
of the future (Luxton, 2014, 2016). Many theorists and researchers predict AI to shape
the existential future of life on earth (Barrat, 2015; Bostrom, 2014; Kurzweil, 2014;
Müller, 2016) with special implications for jobs and careers (Ross, 2017). Late physicist
Stephen Hawking discussed AI potentially bringing about the end of humanity, stressing
the importance of enacting safety measures including raising awareness and a deepened
understanding of the risks, challenges, and short- and long-term impacts of AI develop-
ment (Hawking, Russell, Tegmark, & Wilczek, 2014). In 2016, some of the world’s larg-
est companies formed an alliance to help ensure that AI develops in a beneficent manner.
Amazon, Apple, Deep Mind, Google, Facebook, IBM, and Microsoft are founding part-
ners in the “Partnership on Artificial Intelligence To Benefit People and Society,” a col-
laboration that promotes interdisciplinary inclusiveness in AI and its societal impact
Corresponding author:
Russell Fulmer, Northwestern University, 618 Library Place, Evanston, IL 60201, USA.
Email: russell.fulmer@northwestern.edu
853045TAP0010.1177/0959354319853045Theory & PsychologyFulmer
research-article2019
Article
2 Theory & Psychology 00(0)
(Gaggioli, 2017a). This partnership aims to bring together activists and experts in other
fields including psychology to discuss AI’s current and future role and impact on society.
Efforts are thus being made to approach AI as a societal shift with multidisciplinary
implications. Specifically, the developers of AI are prudently seeking input from mental
health professionals, as the psychological sciences have played a central role in AI devel-
opment since its formal inception (Frankish & Ramsey, 2014).
Counselors have forecasted AI to infiltrate their profession for some time (Illovsky,
1994; Sharf, 1985). But only within the past decade have improvements in computer
processing power and natural language processing ability—along with advancements in
artificial neural networks—brought about a new wave of AI ability (Hirschberg &
Manning, 2015; Kurzweil, 2006; Russell & Norvig, 2003). These advancements have
positioned AI in the spotlight. The Artificial Intelligence Index (2017) Annual Report
states, “Artificial Intelligence has leapt to the forefront of global discourse, garnering
increased attention from practitioners, industry leaders, policymakers, and the general
public” (p. 5). AI research is advancing extremely fast. According to the AI Index Annual
Report, “even experts have a hard time understanding and tracking progress across the
field” (p. 5). AI applications already assist health-care professionals with clinical train-
ing, treatment, assessment, and clinical decision-making (Hamet & Tremblay, 2017;
Luxton, 2014). AI has become a vast, interdisciplinary field that often intersects with
counseling. One purpose of this article is to review AI progress in domains relevant to
clinical counseling.
What AI actually is stands as a deceptively complex question largely because defining
intelligence alone is challenging (Gardner, 2017; Monnier, 2015). Before explaining cur-
rent implementations and future implications for the counseling profession, I will define
and explain relevant terms and concepts associated with AI. Next, I will review the past,
present, and future of AI in relation to counseling. Finally, I will reveal four metalevels
of AI implementation to the counseling profession: one historical, one current, one pos-
sible in the near future, and one conceivable in the long-term. Each theoretical level
shows an increasing amount of relevancy, facility, and influence of AI on the counseling
profession.
Artificial intelligence: Description and explanation
Understanding how AI has and will impact the counseling profession begins with estab-
lishing reliable definitions. Breaking the term down into its component parts means
defining the terms “artificial” and “intelligence.” Artificial implies the synthetic or
human-designed rather than the naturally derived. The “artificial” of AI involves mechan-
ics, electronics, or computers. The concept of intelligence—specifically defining and
measuring it as a variable, combined with its connotations—has been long debated in the
literature (Cherniss, Extein, Goleman, & Weissberg, 2006; Davies, 2002; Fagan, 2000;
Schroeder, 2017; Sternberg, 1985). The confusion also exists within the AI community
(Legg & Hutter, 2007).
Intelligence is thought to extend beyond a strict cognitive capacity into the emotional
realm (Goleman, 2005) and is theorized to have multiple extensions (Gardner, 2006). A
useful synthesis of the myriad conceptions of intelligence is offered by artificial
Fulmer 3
intelligence researcher Max Tegmark (2017), who states that intelligence is the “ability
to accomplish complex goals” (p. 39). Subsequently, I offer the following definition of
AI as the ability of non-biological mechanisms to accomplish goals. The qualifier “com-
plex” is deleted from Tegmark’s definition because intelligence is not a dichotomous
concept; rather, both simple and complex goals can be attained. Intelligence in its rudi-
mentary or advanced states occupies different points on a continuum, encapsulated
within the same category, differing quantitatively. AI is akin to an operating system, like
the human brain. Indeed, neuroscience has informed a substantial portion of prevailing
AI research (Hassabis, Kumaran, Summerfield, & Botvinick, 2017; Lecun, Bengio, &
Hinton, 2015). The embodiment of AI can take various forms, from a computer screen
avatar to a robot.
Machine learning and algorithms
Artificial intelligence brings big-picture, philosophical ramifications, raising ontological
and epistemological questions (Copeland, 1998). Yet, AI begins within the purview of
the diminutive and precise, requiring mathematics and formal logic as demonstrated by
the AI subfield of machine learning. For an AI to progress to the level of a functioning
counselor, it must have the capacity to learn. Machines that learn are paradigmatically
dissimilar from their traditional predecessors. A major point of divergence is in the
agency to possess control. A human who builds a standard machine retains control over
the machine. Accidents occur with machinery—an automobile accident, for example—
but even then the accident is not caused by the vehicle’s agency. Human error in naviga-
tion, human error in construction, or inclement weather may be culprits, but accidents do
not occur because the automobile makes a wrong decision.
Conversely, a machine that learns through its own experiences may possess skills and
abilities unknown to its human originators. One example is AlphaGo, a computer pro-
gram designed to play the board game Go (Gibney, 2016). AlphaGo learned by playing
thousands of games against human competitors and fellow computers, improving to the
point that, in 2016, the program beat world champion Lee Sedol four games to one.
During the match with Sedol, the developers of AlphaGo did not know which move it
would play next. Their best guess would likely be wrong, lest one of the programmers
beat the world champion. The victory of AlphaGo is considered a milestone in the his-
tory of machine learning since Go is known as a game requiring not only rote memoriza-
tion, but strategy and intuition. AlphaGo showed autonomy, acting independently of
human input (albeit in a narrow fashion). Nonetheless, this example of machine learning
demonstrates that “smart” machines can act in unforeseen ways and outperform humans
in tactical proficiency.
Considering that machine learning may only be in its infancy in terms of potential
(Arel, Rose, & Karnowski, 2010), it raises numerous questions for the counseling profes-
sion. For example, if counselors-in-training can learn, improve upon their mistakes, and
eventually cross the threshold to independent practice—and an AI shows the same skill-
set but learns much more quickly—how might autonomous AIs influence the field? Like
Go, counseling too involves intuition and strategy. Would an advanced AI, functioning
as a counselor, make moves questionable to even experienced counselors, but that pay
dividends in the end?
4 Theory & Psychology 00(0)
If AI one day advances to the level of competent counseling practice, it will be through
the underlying mechanisms that drive machine learning called algorithms. What culmi-
nates in a computer program besting a world champion Go player or, potentially, an AI
employing a counseling technique, begins with a set of logic-driven instructions detail-
ing how a task should be performed. The notion of an algorithm does not lend itself well
to a rigorous definition (Gurevich, 2012); however, Pedro Domingos (2015) provides a
constitutive explanation of an algorithm as “a sequence of instructions telling a computer
what to do” (p. 1). AI is a broad area, machine learning is a subfield, and algorithms are
specific operations—like written communications that can both therapeutically inform
and give conversational voice to the AI.
The road to counseling
The term “artificial intelligence” was devised by mathematics professor John McCarthy,
who helped to organize a summer conference at Dartmouth College in 1956 about
whether machines could be made to think (Copeland, 1998). McCarthy’s proposal laid
out the basic premise of AI research: that if a feature of intelligence, such as learning,
could be broken down into its component parts and operationally defined with precision,
then a machine could be made to simulate it (McCarthy, Minsky, Rochester, & Shannon,
2006). The conference attendees set out to discover how to make machines use language
(see McCarthy et al., 2006, for a complete discussion).
That conference is known as one of many AI milestones of the modern era, including
the first meeting of AI and counseling. In many respects, counselors are in the business
of communication and depend on various forms: oral, written, non-verbal, art, and music
therapy. In 1956, those AI researchers set out to learn how machines can be made to com-
municate. Ten years after the Dartmouth conference appeared, the first chatterbot capa-
ble of communicating in a way reminiscent of a human counselor was developed. Also
known as chatbots or virtual agents, chatterbots are computer programs designed to
simulate human conversation (Deryugina, 2010). This debut bot, named Eliza, was final-
ized in 1966 (Weizenbaum, 1966). Designed to replicate a Rogerian therapist, Eliza was
known for answering questions with questions (Mauldin, 1994). In their output, machines
capable of communication give the appearance of machine-level cognitive ability. At
present, chatbots do not literally think, but rather give the illusion of intelligent conversa-
tion by imitating it (Abdul-Kader & Woods, 2015; Mauldin, 1994; Warwick & Shah,
2014).
While the metaphysics of AI may be of indirect interest to counselors, a question
proposed by AI founding father, Alan Turing, is directly relevant. Turing (1950) pro-
posed a scientific research question: How well can a machine imitate human conversa-
tion? The question brought the debate paradoxically more into the empirical and
subjective realms. The Turing test places a computer system against human subjective
experience. Known as The Imitation Game, the test asks human participants to interact
through text with an unknown entity (Saygin, Cicekli, & Akman, 2000). The entity could
be a computer program or a human being, typing. If the participant guesses that he or she
is conversing with a computer, the computer program fails. If the computer imitates
human conversation sufficiently and convinces the participant, the program passes. In a
Fulmer 5
field heavily invested in human conversation, the Turing test may prove pivotal when
considering counseling implementation, ethics, working conditions, and accessibility.
Perception is reality to many people. Counselors would be well served to monitor
public perception about psychological artificial intelligence. In doing so, counselors
could decide that using psychological AI as a supplement to traditional counseling may
benefit clients and the profession alike. To a small degree, chatbots like Eliza have mim-
icked counseling skills for some time. Counselors themselves may disagree. However, if
or when the public views psychological AI as relatively synonymous with counseling,
counselors would be wise to pay heed.
Four levels of implementation in counseling
The American Counseling Association (ACA) defines counseling as “a professional
relationship that empowers diverse individuals, families, and groups to accomplish men-
tal health, wellness, education, and career goals” (Kaplan, Tarvydas, & Gladding, 2014,
p. 366). The definition can be broken down into three pillars of counseling: (a) forming
a professional relationship, (b) empowering, and (c) accomplishing goals.
The act of counseling requires the fulfillment of all three pillars. However, we might
say that if one or two of the requirements are met by an AI, then that AI is getting closer
to functioning as, if not being, a counselor. For example, an AI capable of empowering
an individual towards accomplishing a wellness goal is partially functioning as a coun-
selor because two of the three requirements are met. If AI takes on a more prominent role
in counseling, we should expect to see the functions of a counselor met—or potentially
exceeded—by artificial intelligence.
Based on the premise that AI has been and will continue to be applicable to counseling,
I describe four levels of implementation: historical, contemporary, near future, and long-
term. The levels propose to help navigate an AI-infused reality by correlating them with
time orientation and influence on the field of counseling and comparing them to the ACA-
sanctioned definition of counseling. Where the first level, historical, shows that AI’s past
involvement with counseling was minimal, the final level has yet to happen but is marked
by AI showing sophisticated and highly influential involvement in the field.
Level 1: Historical
Historical AI implementations in counseling did not establish a professional relationship
and likely neither empowered nor helped people accomplish their goals to any signifi-
cant degree. Traditionally, counselors have made little use of artificial intelligence.
Connections drawn between the two fields are indistinct and indirect. First-level interac-
tion involved chatbots showcasing rudimentary applications of natural language process-
ing (NLP), a field of AI concerned with understanding and modeling human language
(Tanana, Hallgren, Imel, Atkins, & Srikumar, 2016). The field of NLP has advanced
from its 1960s inception in that now complex models can be applied via powerful com-
puter-generated statistical processors to assess statistical probabilities of sequences of
words, inflection, and semantics in large samples of natural language (Tanana et al.,
2016). These progressions have led to AI-assisted programs designed for therapeutic use,
6 Theory & Psychology 00(0)
in which AIs have been programmed to simulate mental health patients, for example.
While being imperfect, these programs do show some therapeutic efficacy and warrant
further research (Dalfonso et al., 2017; Luxton, 2014).
Level 2: Contemporary
Modern AI implementations in counseling do not establish a professional relationship and
empower to an unknown degree, but likely help clients accomplish their goals to some
degree. Level two is marked by AI-assisted implementations in counseling backed by
research. Contemporary implementations take two major forms. The first is through text-
based bots like Woebot, a text-based agent that employs Cognitive Behavioral Therapy
(CBT) by conveying CBT self-help techniques in conversation-like interactions with users.
Woebot has been shown to alleviate symptoms of depression and anxiety in young adults
(Fitzpatrick, Darcy, & Vierhile, 2017). Another example is Tess, a psychological AI using an
integrative theoretical orientation which included conversational, informational, and CBT-
like approaches. Research suggests that Tess can reduce depression and anxiety in college
students by providing interventions applicable to real life through AI-generated conversations
(Fulmer, Joerin, Gentile, Lakerink, & Rauws, 2018). The second form is through virtual real-
ity. Ellie, termed a virtual human interviewer, combines virtual reality with affective comput-
ing (Gaggioli, 2017b). Appearing on a screen as a virtual human, Ellie is capable of analyzing
a client’s verbal responses, facial expressions, and vocal intonations (Darcy, Louie, & Roberts,
2016). In many respects, Ellie represents the higher end of today’s therapeutic AI applica-
tions. Noteworthy are Ellie’s abilities in assessment, as her capacity to identify distress indi-
cators may prove beneficial in the diagnosis and treatment of Posttraumatic Stress Disorder
(PTSD), in addition to depression and anxiety (DeVault et al., 2014).
Today’s AI implementations show the utility of a wide range of counseling theories,
with CBT being most prominent. There is movement beyond strictly text-based com-
munication into visual and auditory domains as well as AI-based assessments that may
lead to greater reliability in diagnosis (DeVault et al., 2014; Hahn, Nierenberg, &
Whitfield-Gabrieli, 2016). Research is leading to improvements in data sensors, NLP,
and general machine learning by applying more complex models when computing com-
municative and behavioral input and output, and continuing to elucidate the processes
underlying human sensory and perception systems as well as learning paradigms so that
they may be implemented in computers. Coupled with research attesting to therapeutic-
AI efficacy, AI may play a greater role in the counseling of the future. Levels three and
four represent how that future may come to fruition.
Level 3: The medium to distant future, i.e., the dawn of artificial general
intelligence
Level three is characterized by the onset of Artificial General Intelligence (AGI). AIs
at this level may possess the expertise necessary to form professional relationships
with clients. Additionally, an AGI would have the capability of empowering and help-
ing clients accomplish their goals. Modern AI is known as having narrow intelligence
Fulmer 7
because it is designed to accomplish singular goals, like providing psychoeducation. In
contrast, an AGI would be versatile, able to reach many goals and complete tasks in a
way reminiscent of, or superior to, a human being (Yampolskiy & Fox, 2012). AGI has
not been developed yet and experts differ on their predictions of when it will happen,
with some suggesting we are a few decades away while others predict a century or
longer (Tegmark, 2017). Consequently, the previous level, two, may encompass an
extended period.
There is a stark difference between second and third level AI implementations to
counseling. Computers typically learn much more quickly than humans. The advent of
an AGI built for the purpose of counseling would likely learn the art and science of the
profession in its totality and swiftly. With a high-level skillset, and a capability of seeing
a vast range of clientele, “AGI Counselors” would incite a host of ethical, legal, and
philosophical questions. A prominent question will be if the AGI Counselor is indeed
establishing a professional relationship, with all the responsibilities and protections that
implies. To practicing counselors, this may sound implausible. Nevertheless, there is
already copious discussion in the literature about the moral rights of conscious robots,
including what constitutes consciousness and the moral responsibilities tied to it, and
whether AIs can be developed to represent evaluative diversity (Gerdes, 2016; Lin,
Abney, & Bekey, 2014; MacDorman & Kahn, 2007; Malle, 2015; Santos-Lang, 2015;
Tavani, 2018; Wallach & Allen, 2010).
There may be a contrast between a body of research that suggests the AGI is effective
at counseling (sometimes more so than human counselors) and those who fear a takeover
and job loss from the AGI. The fear of job loss from automation and, eventually, AI is
growing in many fields (Kaplan, 2015; Ross, 2017). It is conceivable that the same fear
would exist among counselors who may feel that their AGI counterparts have assumed
the same level of communicative and empathetic skills to completely replace them.
Level three implementations of AI in counseling will constitute a fundamental change to
the profession. For the first time, counselors may be more than human.
Level 4: The age of superintelligence
Level four is characterized by “superintelligence.” Such an AI would easily meet all
three counseling criteria—relationship, empowerment, and goal accomplishment—
along with other, possibly more helpful and effective criteria not yet established by
humans. The idea of a superintelligence was proposed by philosopher Nick Bostrom
(2014) and refers to a high-level AI that far surpasses human-level intelligence.
Superintelligence represents the time when AGI learns to the point of accomplishing
goals of a caliber impossible for human beings. The proficiency of such an AI is
unfathomable at this point. Some suggest the onset of high-level intelligence will usher
in the next stage of human evolution (Reese, 2018), others fear its consequences for
humanity (Bostrom, 2014), while others believe these fears to be unfounded (Agar,
2016).
The age of superintelligence remains conjecture. Nonetheless, Müller and Bostrom
(2016) and the Future of Humanity Institute at Oxford University who surveyed theorists
and researchers doing technical work on AI found:
8 Theory & Psychology 00(0)
The median estimate of respondents was for a one in two chance that high-level machine
intelligence will be developed around 2040–2050, rising to a nine in ten chance by 2075.
Experts expect that systems will move on to superintelligence in less than 30 years thereafter.
They estimate the chance is about one in three that this development turns out to be “bad” or
“extremely bad” for humanity. (p. 555)
If or when such developments occur, the field of counseling—and indeed civilization—
will be transformed.
Summary
Each implementation level sees AI growing more into the fabric of counseling (see
Table 1). The past saw nominal AI implementation to the counseling field, but the
present has seen an AI resurgence. There are strong indications of more AI research in
the future as the European Commission, U.S., and China devote billions of dollars to
funding such endeavors (Cath, Wachter, Mittelstadt, Taddeo, & Floridi, 2018; Kelly,
2018; Larson, 2018). Whether the research surge brings about levels three and four
remains to be seen.
Discussion
This article intended to define and explain AI concepts, to discuss how AI pertains to
clinical counseling, and to present AI-in-counseling implementation levels from a theo-
retical viewpoint. Four metalevels of implementation were presented. The levels corre-
spond to time orientation, with level one relating to historical and level four to future
implementations affecting humanity in the long-term. I acknowledge that the future is
unknowable to some degree, but as climate scientists forecast a hotter world due to global
warming based on data patterns, so too are AI prognostications grounded in current
research (Hulme, 2016).
Artificial intelligence and counseling already interface. In the future, the extent to
which they interweave will depend largely on AI’s rate of growth, which, if current
trends continue, will fall somewhere between sequential and exponential. With exponen-
tial growth, for example, an AI capable only of posing elementary questions one day
could learn advanced assessment, diagnosis, and ways to embody the ethical, cognitive,
emotional, and relational characteristics of expert therapists (Jennings, Sovereign,
Table 1. Impact of AI level implementation on pillars of counseling process.
Level 1:
Historical
Level 2:
Contemporary
Level 3: Artificial
General Intelligence
Level 4:
Superintelligence
Pillar of
Counseling
Professional
relationship
No No Central ethical
question
Yes
Empowers Likely no Unknown Yes Yes
Helps accomplish
goals
Likely no Likely yes Yes Yes
Fulmer 9
Bottorff, Mussell, & Vye, 2005; Skovholt & Jennings, 2004) essentially overnight.
Exponential growth is not certain, but explosive growth is certainly plausible (Pratt,
2015; see Kurzweil, 2006, for a technical explanation of how this might occur).
The presence of AI and high-technology in counseling looks to continue, and even
current-level AI implementations in counseling raise a host of practice-oriented and ethi-
cal questions regarding how and when AI use is appropriate or effective, to which degree
it can be used in place of a human counselor, how it may affect a person seeking human
connection via counseling, whether data produced during AI use could be stored in a
hacker-proof manner, and whether counselor and client AI are adequately trained and
informed on AI practices.
At present, the counseling literature contains a paucity of articles addressing AI from
a descriptive, correlative, or experimental basis. More research could inform clinical
practice if clinicians employ AI-assisted supplements, such as the psychological AI Tess,
to help their clients. Research could also inform thought-leadership if a need arises for
the ACA to address AI at a public policy level. Perhaps the most immediate need for
research is in counseling ethics.
Using Green’s (2018) outline of ethical concerns surrounding AI as a guide, research
must focus on the ways in which AI counseling services can avoid negative side effects,
overgeneralizations, and potentially harmful exploration in strategies and techniques.
Further, attention must be dedicated to ensuring AI functional transparency, or ensuring
that AI actions can be understood by those designing, manufacturing, implementing, and
interacting with it. Another ethical concern revolves around data security and privacy
practices when implementing AI services. Finally, investigations should seek to deter-
mine the extent to which both counselors and clients need to be versed in AI technology
and implementation to ensure fairness, beneficence, and non-maleficence in practice and
counselor and client safety and wellbeing (Green, 2018).
The counseling community needs further information about the effect AI services
could have on people specifically seeking out human interactions because they feel
unheard, unseen, and unworthy of the care of others. The shift from human to human-like
interactions in counseling, as well as other fields, may bring about a plethora of unchar-
tered existential questions. Coupled with the onslaught of induced unemployment, socio-
economic inequality, growing technological dependency, and human de-skilling, these
existential questions may warrant closer attention and preparation by researchers and
those who specialize in human emotion and crisis, such as counselors (Green, 2018). AI
brings power and influence that can be abused. Research helps prepare the profession to
address ethical questions when they arise.
More research is needed about psychological artificial intelligence. Considering its
burgeoning nature, there is a dearth of research on the topic and noteworthy is the absence
of literature about ethical ramifications. This article fills a research gap at the theoretical
level, offering a taxonomy with the proposed levels of implementation and providing
structure for forthcoming literature. For example, the nature of a clinical ethical dilemma
will look different at level one compared to level four. Theoretical pieces carry inherent
advantages and limitations. Advantages include providing constitutive definitions to
guide future inquiry and high-level context to frame AI implementation and influence on
the field. A limitation is the lack of specificity and clinical examples found in an abstract,
10 Theory & Psychology 00(0)
categorical offering. Further, as AI is developing into a vast interdisciplinary field with
weekly or even daily developments, no single article can capture its actual reach and
consequence. Examining AI’s impact on a diverse clientele in clinical counseling and
identifying ways to prevent bias and discrimination from creeping into AI is a necessary,
but yet unexplored focus of research. The intersection of AI and counseling is growing,
and a corresponding body of research is needed to match.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this
article.
ORCID iD
Russell Fulmer https://orcid.org/0000-0002-4582-5167
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Author biography
Russell Fulmer is a faculty member with the Counseling@Northwestern program through The
Family Institute at Northwestern University. His central research interests involve psychological
artificial intelligence (AI) and the psychodynamic system. He recently published a randomized
controlled trial that showed the efficacy of an AI mental health support agent (Tess) to help college
students battle anxiety and depression. His current work examines ethical issues faced by clini-
cians when using psychological AI in practice.
... AI counseling chatbots are conversational software agents that answer questions using natural language processing in one-on-one client communications (Bulla et al., 2020). One of the first uses of that particular technology was its relevance in the provision of psychoeducation, which complements counseling sessions with a professional counselor (Fulmer, 2019). Advanced AI chatbots incorporate avatars to closely simulate human interaction. ...
... Recent studies claim however, that these visual cues have a negative effect on the willingness of the client for self-disclosure (Kang & Kang, 2023). Thus, technological developments to integrate AI in counseling services is an undertaking that needs to be taken with careful consideration (Cabrera et al., 2023;Kang & Kang, 2023;Vilaza & McCashin, 2021;Fulmer, 2019). ...
... To illustrate, several AI chatbots have been developed to supplement digital mental health interventions such as Eliza©, developed in 1966 and was the first chatterbot designed to mimic a therapist conversing with a client using Rogerian Therapy Approach (Fulmer, 2019), Tess©, an AI developed addressing psychological distress (Fulmer et al., 2018;Stephens et al., 2019), Ada©, a chatbot designed to perform client diagnosis (Jungmann et al., 2019), Wyza©, a chatbot utilizing psychotherapeutic approaches such as Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Motivational Interviewing (Beredo & Ong, 2021), Vivbot©, a chatbot designed incorporating concepts on positive psychology (Vijayarani & Balamurugan, 2019), Mylo (Manage Your Life Online)©, a chatbot designed to teach self-help tools to help clients in preventing a possible self-harm (Wrightson-Hester et al., 2023), Anna©, a chatbot designed to complement a digital-based mental health intervention assisting the clients to combat negative emotions (Boucher et al., 2021), and Woebot©, a text-based technology that engages clients via text messages incorporating CBT techniques (Fitzpatrick et al., 2017). ...
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... Additionally, the existence of applications aimed at developing AI-supported counseling skills could help resolve clients' psychological issues and likely show greater effects as future models improve in performance. However, the studies in the literature (Fulmer, 2019;Maurya, 2023Maurya, , 2024Shorey et al., 2019) are predominantly built on developing psychotherapy or counseling skills. Understanding clients' emotions in the counseling and psychotherapy process, comprehending their problems, and generating the most appropriate solutions are extremely important aspects (Goldman et al., 2005;Greenberg, 2004;Rogers, 1951). ...
... Small chatbots and early models like Eliza have occasionally emulated counseling skills, but questions about the proficiency level in this domain of highly sophisticated models such as ChatGPT remain open. Artificial intelligence is widely used in many fields, including the field of counseling psychology (Fulmer, 2019). Currently, applications of artificial intelligence in counseling psychology are primarily concentrated in two significant areas: enhancing the counseling skills of psychological counselors (Maurya, 2023;Tanana et al., 2019) and addressing the psychological issues of clients (Guleria & Sood, 2023;Monreal & Palaoag, 2024;Shorey et al., 2019;Trappey et al., 2022). ...
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... Individual studies apply artificial intelligence (AI) to every developmental stage across the lifespan, demonstrating that AI has physiological, psychological, family, relational, and sociological implications (Fulmer, 2019;Keles & Bagci, 2023;Molina & Garip, 2019). However, to date, no synthesis of those studies exists, and neither has a conceptual model been proposed that clearly delineates how AI can influence human development. ...
... This paper is by necessity interdisciplinary. Although AI applications influence mental health and the counseling field in many ways (Fulmer, 2019), there remains an overall dearth of AI-specific research in marriage and family counseling and clinical mental health per se. We proffer that addressing AI and its impacts on clients, counselors, family, and society-at-large is worthwhile and relevant to counseling, even though articles cannot at this juncture be grounded in counseling-specific literature. ...
... Our results highlight AI's interdisciplinary reach, with applications fronted by psychology, medicine, philosophers, and robotics. Nearly all AI applications have implications for counseling because they influence mental health, human development, health, and well-being (Fulmer, 2019). However, a noted absence from the research is counseling and AI research per se. ...
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... M. Kaplan et al., 2014). The concept provided may be deconstructed into three f undamental components of counseling, namely: (a) establishing prof essional alliances, (b) f ostering empowerment, and (c) attaining objectives (Fulmer, 2019). ...
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... AI technology refers to the ability of non-biological mechanisms to accomplish various assigned goals (Fulmer, 2019). The National Artificial Intelligence Roadmap initiated by the Ministry of Science, Technology, and Innovation reflects the government's commitment toward the development of AI in Malaysia (MOSTI, 2021). ...
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... One significant challenge facing the existence of the school counselors is the advent of artificial intelligence (AI) technology (Fulmer, 2019). While AI has proven to be highly effective in streamlining administrative tasks and delivering essential information to students, it poses a potential risk if school counselors confine their professional identity to these functions alone. ...
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Background Students in need of mental health care face many barriers including cost, location, availability, and stigma. Studies show that computer-assisted therapy and 1 conversational chatbot delivering cognitive behavioral therapy (CBT) offer a less-intensive and more cost-effective alternative for treating depression and anxiety. Although CBT is one of the most effective treatment methods, applying an integrative approach has been linked to equally effective posttreatment improvement. Integrative psychological artificial intelligence (AI) offers a scalable solution as the demand for affordable, convenient, lasting, and secure support grows. Objective This study aimed to assess the feasibility and efficacy of using an integrative psychological AI, Tess, to reduce self-identified symptoms of depression and anxiety in college students. Methods In this randomized controlled trial, 75 participants were recruited from 15 universities across the United States. All participants completed Web-based surveys, including the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Positive and Negative Affect Scale (PANAS) at baseline and 2 to 4 weeks later (T2). The 2 test groups consisted of 50 participants in total and were randomized to receive unlimited access to Tess for either 2 weeks (n=24) or 4 weeks (n=26). The information-only control group participants (n=24) received an electronic link to the National Institute of Mental Health’s (NIMH) eBook on depression among college students and were only granted access to Tess after completion of the study. Results A sample of 74 participants completed this study with 0% attrition from the test group and less than 1% attrition from the control group (1/24). The average age of participants was 22.9 years, with 70% of participants being female (52/74), mostly Asian (37/74, 51%), and white (32/74, 41%). Group 1 received unlimited access to Tess, with daily check-ins for 2 weeks. Group 2 received unlimited access to Tess with biweekly check-ins for 4 weeks. The information-only control group was provided with an electronic link to the NIMH’s eBook. Multivariate analysis of covariance was conducted. We used an alpha level of .05 for all statistical tests. Results revealed a statistically significant difference between the control group and group 1, such that group 1 reported a significant reduction in symptoms of depression as measured by the PHQ-9 (P=.03), whereas those in the control group did not. A statistically significant difference was found between the control group and both test groups 1 and 2 for symptoms of anxiety as measured by the GAD-7. Group 1 (P=.045) and group 2 (P=.02) reported a significant reduction in symptoms of anxiety, whereas the control group did not. A statistically significant difference was found on the PANAS between the control group and group 1 (P=.03) and suggests that Tess did impact scores. Conclusions This study offers evidence that AI can serve as a cost-effective and accessible therapeutic agent. Although not designed to appropriate the role of a trained therapist, integrative psychological AI emerges as a feasible option for delivering support. Trial Registration International Standard Randomized Controlled Trial Number: ISRCTN61214172; https://doi.org/10.1186/ISRCTN61214172.
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A controversial question that has been hotly debated in the emerging field of robot ethics is whether robots should be granted rights. Yet, a review of the recent literature in that field suggests that this seemingly straightforward question is far from clear and unambiguous. For example, those who favor granting rights to robots have not always been clear as to which kinds of robots should (or should not) be eligible; nor have they been consistent with regard to which kinds of rights—civil, legal, moral, etc.—should be granted to qualifying robots. Also, there has been considerable disagreement about which essential criterion, or cluster of criteria, a robot would need to satisfy to be eligible for rights, and there is ongoing disagreement as to whether a robot must satisfy the conditions for (moral) agency to qualify either for rights or (at least some level of) moral consideration. One aim of this paper is to show how the current debate about whether to grant rights to robots would benefit from an analysis and clarification of some key concepts and assumptions underlying that question. My principal objective, however, is to show why we should reframe that question by asking instead whether some kinds of social robots qualify for moral consideration as moral patients. In arguing that the answer to this question is “yes,” I draw from some insights in the writings of Hans Jonas to defend my position.
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