In the mid-1960s, Joseph Weizenbaum, a pioneer in computer science working at the Massachusetts Institute of Technology (MIT) artificial intelligence (AI) laboratory, developed a very simple computer program named ELIZA that was capable of having a conversation with a human being. ELIZA’s responses were programmed in a way that mimicked what might happen in a nondirective social interaction.

On the A.L.I.C.E. AI Foundation website, Richard Wallace, a computer scientist, describes Weizenbaum’s astonishment at the responses to ELIZA: “Weizenbaum tells us that he was shocked by the experience of releasing ELIZA (also known as ‘Doctor’) to the nontechnical staff at the MIT AI laboratory. Secretaries and nontechnical administrative staff thought the machine was a ‘real’ therapist and spent hours revealing their personal problems to the program. When Weizenbaum informed his secretary that he, of course, had access to the logs of all the conversations, she reacted with outrage at this invasion of her privacy. Weizenbaum was shocked by this and similar incidents to find that such a simple program could so easily deceive a naïve user into revealing personal information.” Concerned by the response to ELIZA, Weizenbaum “shut down the early ELIZA program” because he saw it as a threat.

More recently, Wallace developed A.L.I.C.E., another humanlike program that acts like a surrogate and can interact with users much like another human being would. A.L.I.C.E. (which stands for Artificial Linguistic Internet Computer Entity) is more advanced than ELIZA and is easily accessed online at alicebot.org/index.html.

Human surrogate programs such as ELIZA and A.L.I.C.E. may currently be inadequate at replicating the complexity of human-to-human communication, especially when one’s mental health is at issue. But technological advancement certainly makes the development of human surrogate programs and other technologies worthy of the attention of counseling professionals.

These advancements are already having significant effects on everyday life in developed countries. Incredible changes have taken place just within the past few decades. Between the 1970s and the present, a span of just over 40 years, computers have transformed from cumbersome and slow desktop machines to hand-held mobile devices that allow users access to an incredible amount of information instantaneously. Worldwide communications, both auditory and visual, now occur at the touch of a button on these devices. The extent of these changes is staggering, and we can assume that such changes will continue, likely affecting everyday human life in meaningful ways. Technological advances may also drastically affect the mental health treatment enterprise.

The technological “singularity” is a futuristic concept that has garnered the interest of many forward-thinking individuals. It is defined as the moment in time when artificial intelligence (the computational and information processing capacity of machines) will surpass human intelligence, as predicted by Ray Kurzweil in his 2005 book, The Singularity Is Near. At the singularity, computers will begin to solve problems faster than humans can. What’s more, computers will also be able to advance the technology necessary to make faster, more complex and more capable computers. Kurzweil anticipates that there will be an explosion in knowledge — an exponential growth of information processing and data analysis to the degree that computers may generate a consciousness of sorts that is equivalent to human consciousness.

In 1999, in the book The Age of Spiritual Machines: When Computers Exceed Human Intelligence, Kurzweil described his vision of the developments he projected for 20 years later, in 2019: “A $1,000 computing device is now approximately equal to the computation ability of the human brain. Computers are now largely invisible and are embedded everywhere. Three-dimensional virtual-reality displays, embedded in glasses and contact lenses, provide the primary interface for communication with other persons, the web and virtual reality. Most interaction with computing is through gestures and two-way natural-language spoken communication. Realistic all-encompassing visual, auditory and tactile environments enable people to do virtually anything with anybody, regardless of physical proximity. People are beginning to have relationships with automated personalities as companions, teachers, caretakers and lovers.”

And Kurzweil was not alone. Even earlier, in 1993, Vernor Vinge described the singularity as follows: “We are on the edge of change comparable to the rise of human life on Earth. The precise cause of this change is the imminent creation by technology of entities with greater than human intelligence.”

Vinge, like Kurzweil, predicted the singularity would occur early in the 21st century. Such predictions might be dismissed as the “stuff of science fiction” if some of its elements were not already happening.

Kurzweil believed that by 2029, it might be possible to scan a human’s consciousness into a computer. When something akin to consciousness happens in machines, humans will be able to interact with computer-generated surrogates that can perform any number of functions — perhaps even counseling that addresses complex human problems — in a way that mimics the best of human capacity.

The techno-human counseling paradigm

It has taken approximately 120 years for counseling to evolve to the degree that large encompassing treatment frameworks are operative and identifiable. I defined these frameworks as “counseling paradigms” in my 2012 book Paradigms of Counseling and Psychotherapy. The field now acknowledges that individuals (physical and nonphysical), systems and even socially constructed truths may be treated through the interactive process defined as counseling.

Initially, these professional frameworks emerged slowly, with the communication of information proceeding through paper and ink methods at the outset, and then through electronic media such as radio and television (movies and TV shows presented the counseling relationship). People began to realize that mental health was a valid concern, and mental health problems began to be recognized as legitimate targets for professional intervention. The vehicle for service delivery was the therapeutic relationship, a person-to-person live interaction in which problems were expressed, delineated and treated by means of communication between a client and a professional counselor.

The possibility that the technological revolution will take counseling to the point of the singularity is a confounding possibility because it literally may change the rules. It would be equivalent to what is defined as a “second order change” (a change “outside the box”). Counseling may shift to a relationship between specially designed clinical technology and clients who access services via electronic media, meaning that the next counseling paradigm could be the techno-human counseling paradigm.

A glimpse into the future: Possibilities

Counseling as protocol treatment accessed over electronic media: Currently, a simple Internet search of the term online counseling produces pages of websites offering such services for a fee. Appointments can be booked online. Skype sessions can be paid for by PayPal or any other form of credit. Some websites appear highly sophisticated and professional, whereas others appear poorly designed and seem to offer services more akin to quackery than professional counseling. But as electronic media become more sophisticated, and as computers grow capable of addressing more complex questions through programming, the nature of treatment may change dramatically. Valid protocol treatments and counseling services might become easily accessible online. Any number of services to address any number of problems, from depression to victimization, may become available to clients in any part of the world.

It is unlikely that counseling will continue to occur the “old-fashioned way.” In fact, the idea of an individual counselor providing face-to-face counseling may go by the wayside, except for concierge or boutique practices. In my view, it is more likely that counseling technological conglomerates — organizations designed to provide mental health services over media that are privately accessed by individuals — will provide the majority of counseling in the future. These conglomerates will probably devise means and methods to provide counseling by auditory or auditory/visual surrogates — in other words, computerized counselors programmed to address just about any issue that a person might encounter. It’s likely that the conglomerates will employ mental health professionals, statisticians, programmers, bookkeepers and website technicians.

The routing that will occur in the future with these surrogates will be much more sophisticated than the routing that occurs currently when, for example, we encounter a computerized voice directing our telephone questions on matters of business or services (e.g., banking, telecommunications). Likely, these mental health surrogates will not only have answers to questions but will also be adept at responding to nonverbal cues and voice intonation. Routing options for any one problem will be exponential so that the program covers innumerable contingencies.

Creating peak experiences: Electronic stimulation of the brain through multisensory input will likely allow technologically enhanced highs that mimic what Abraham Maslow defined as a “peak experience.” Mapping of the brain and its functions will provide information that programmers can then use to produce sensory stimulation akin to that of spiritual, sexual and drug-induced highs. These experiences may then be used in narratives for defining an individual’s experience as groundbreaking, altering and transformative.

On-site, real-time electronic instruction: Clients will be able to access instructions electronically in real time and in real-life situations. For example, a person who has social concerns will be able to follow cues from a smart device (an earphone or visual on a set of glasses/contact lenses) to handle challenging social circumstances in real time (as the encounter occurs). Computer-generated mentors will be able to guide individuals from moment to moment on their behaviors, thoughts, feelings and interactions, effectively serving as live feeds for personal guidance. These devices will likely be embedded in everyday outerwear and will not be observable.

The counselor’s role

In the future, it is likely that counselors will be involved in assessment, with clients having initial contact with a live counselor at electronic portals. Or there might be physical centers (triage clinics or schools) where individuals go to have their problems explored and their issues assessed. Once problems are defined collaboratively, clients will likely be referred to exchanges to access services via electronic means.

Counselors will no longer necessarily be needed to provide ongoing, face-to-face treatment. Instead, computerized surrogate counselors, programmed by protocol, will instruct clients on matters of relevance to the contracted counseling service and defined problems. For example, protocol treatments for conditions such as anxiety disorders or depression might be packaged and presented to clients. Career decision-making assistance will be provided in a similar manner. Guidance for addressing marital, family or other relationship problems will be available. Just about any social, vocational or psychological issue will be amenable to treatment through surrogates aligned with counseling technological conglomerates that compete for clients in the electronic marketplace.

Highly trained counselors will be needed to serve as programmers and statisticians (or to work with others in these positions) to design credible and ethical means of electronic intervention for specified problems. These counselors will need some clinical savvy, and they will require training in assessing and evaluating the effectiveness of protocol treatments. They will have to be experts in developing empirically supported approaches and, with the help of their computer “friends,” will have unlimited information at their disposal for both designing and assessing counseling services. The “whole” of human knowledge potentially will be digitized and accessible to counseling technological conglomerates.

The human element

What will happen to the human element if essentially robotic or virtual surrogates take the place of live counselors? Some futurists doubt whether robots could ever replace the human capacity to think creatively and respond to all possible contingencies. Skeptics point out that, to date, there has been limited accomplishment even at the famed AI laboratory at MIT, where robots currently perform no more intelligently than insects. Yet even critics acknowledge that progress in this area is happening fast. And the development of nanotechnology may significantly advance the game.

Nanotechnology is the mechanical manipulation of matter at the atomic or molecular level. Certainly, if robots cannot be made to fully mimic humans, perhaps humans can be made to mimic machines.

As Kurzweil stated in 2005 in The Singularity Is Near, “With the advent of full-scale nanotechnology in the 2020s, we will have the potential to replace biology’s genetic-information repository in the cell nucleus with a nanoengineered system that would maintain the genetic code and simulate the actions of RNA, the ribosome and other elements of the computer in biology’s assembler. … Reengineering the computer of life using nanotechnology could eliminate any remaining obstacles and create a level of durability and flexibility that goes beyond the inherent capabilities of biology.”

The prospect of enhancing the human machine may redefine the human element. In effect, problems such as anxiety, autism, schizophrenia and other debilitating mental conditions may be treated not only by external means but also by internal organic modifications that affect the function of human cells and human behavior. Doctors would not be injecting pharmaceuticals; they would be injecting nanobots capable of modifying, enhancing and repairing human structure.

Beyond the development of intelligent machines directing behavior, AI raises the question of machine-guided human modification, especially by nanotechnology. Counselors may be integral to any decision-making process involving whether an individual should undergo such modification or consent to treatments by machines designed to enhance human functioning (e.g., emotional, intellectual, perceptual or behavioral). Whether counselors are modified themselves may be a question of the limits of the human element.

Implications

Practice: Practice obviously will vary by setting. School personnel, for example, will likely do triage — identifying clients’ concerns and then connecting those clients to the services of a counseling technological conglomerate that is paid for, and provided by, school or other agency funding. Career counselors may initially enter client data into service provider portals to facilitate decision-making.

Rather than targeting systems or relationships or attending to client narratives, the techno-human counseling paradigm likely will return counseling (at least initially) to a focus on the individual, just as traditional face-to-face forms of therapy began. The focus on the individual might be psychomedical, meaning that conglomerate practices could employ medical professionals and mental health professionals to design protocol treatments for specific problems. Some treatments might involve medication as a primary or adjunctive treatment. For example, depression may be treated with medication in combination with surrogate counseling services using some standardized procedures, with differential treatment programmed into the service package depending on variables that emerge throughout the process.

Payment will likely occur in electronic currencies not necessarily linked to classic currency. Electronic currencies will allow for a quick and easy transaction without the involvement of traditional banking and without banking or credit card fees. Transactions may be less traceable and more confidential.

Counselor education: Counselor education is likely to be affected significantly. J.R. Suler of Rider University has been leading the embrace of Internet-based surrogate programs in teaching psychotherapy. Not only has he introduced psychotherapy to students using programs such as ELIZA, but he has also attempted to answer a significant question: Can computers do psychotherapy all on their own with little or no assistance from a human? He answers by describing what he calls the “ultimate computerized psychotherapist,” a wish list of what an ideal program would entail, including a humble persona, reflectiveness, the ability to convey unconditional positive regard, the ability to facilitate cognitive restructuring and the capacity to convey universal truisms. Suler’s work is basis for an argument that computerized psychotherapy is likely to expand and will need to be addressed in counselor education.

As the teaching of counseling will doubtlessly change, the role of counselors and counselor educators will need to follow. Counselor educators will have to be able to train counselors to work with counseling technological conglomerates because larger network service providers may subsume the individual practice of counseling. The “live” counseling screening role may also become prominent because counselors will likely be front line in defining what interventions should be accessed electronically.

Ethics and control: But who will “police” the conglomerates or other providers? Who will ensure that the services provided are safe, fair, ethical and actually translate to the user’s improved status on some criterion? The marketplace will likely be crowded by charlatans and quacks who advertise electronically and seek a quick return. A need will exist for ethical guidelines and some level of control over those who advertise professional credentials or offer services for a fee.

As providers become corporate entities, the day when only individual professional counselors are “certified” may pass. It is hard to imagine that an isolated counselor will be capable of fulfilling the many roles necessary to provide competent and credible services over electronic media, including programming, statistics, clinical knowledge, accounting and website building/monitoring. There will likely be a need for professional organizations to certify counseling technological conglomerates as meeting high standards of professionalism and ethical practice. Credentialing of websites and electronic portals may become necessary, and it will be incumbent on professional associations to anticipate the needs of the public in this regard. If current professional associations do not keep pace with the changes deriving from technological advances, new organizations will emerge to fill the void. Those organizations may or may not have a connection to the long history of mental health practices that preceded them.

Ethical standards will need to be stringent in requiring services that are empirically supported or otherwise effective on some outcome measure. Without measurable outcomes, counseling may deteriorate to friendly interchange at a cost, with only the influence of the technological relationship in effect. Whether the technological relationship will be as effective as the live therapeutic relationship in producing outcomes will be grist for the research mill. In 2008, a comprehensive review and meta-analysis of Internet-based psychotherapy by Azy Barak, Liat Hen, Meyran Boniel-Nissim and Na’ama Shapira, published in the Journal of Technology in Human Services, supported the use of Internet-based interventions. After reviewing 64 empirical articles covering the treatment of 9,764 clients, Barak and colleagues concluded that “the findings of this meta-analysis … provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity.” They wrote that a “comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness.” On the basis of this meta-analysis, there appears to be empirical support for providing Internet-based interventions, although this is an area that likely will require further research.

Providers will need to be held to the highest professional standard to ensure that services are delivered in a timely, cost-effective and just manner. Rules for billing, as well as means for addressing ethical or professional complaints, will have to be communicated to clients prior to a commitment to services. Professional associations may find the need to set up arbitration panels to address client complaints and concerns.

State governments may be faced with licensing technological conglomerates to provide counseling services within state boundaries. Likewise, state governments might have to develop methods to police entities that provide such services from outside the state or even outside the country. A tax on counseling services could one day be instituted to provide monitoring and to support the establishment of mechanisms of control. Otherwise, unregulated services could endanger clients and the public welfare in general.

In the meantime, standards of practice for face-to-face counseling by live, technologically unassisted or unaltered counselors could become obsolete. Regardless, the practice of counseling is likely to change drastically.

Conclusion

Depending on one’s viewpoint, this futuristic portrayal of counseling in the age of intelligent machines may be either exciting or frightening. At this point, the technological singularity is only an ideal — a vision yet to be fulfilled. Regardless of the validity of the technological singularity, counseling services have already evolved to the point that some problems can effectively be addressed through electronic means. And, of course, a whole new set of ethical and professional problems arise as a result. Unless counselors consider the possibility of further dramatic developments, the counseling profession may be relegated to the likes of ancient healers, with techniques surpassed by technologically advanced, efficient, ethical and effective methods.

The techno-human counseling paradigm might emerge as a truly unique framework from which professional counselors can practice. It will be paradigmatic in that it will likely “change the rules of the game” of counseling, creating a new profession of sorts, because counselors will need to align with conglomerate practices to serve clients through an ever-changing, evolving and advancing technological medium.

It is not easy to predict if or when the paradigm will be fully engaged, but there are hints to its emergence in present-day culture. People are becoming more attuned to, and more dependent on, technology in everyday living. Education and counseling are areas that will be amenable to modification using technology. It seems inevitable that counseling will be affected. Whether the technological singularity creates a world of artificial intelligence that surpasses human biological capacity is open to question, but professional counselors cannot assume that the counseling profession will be insulated in any way from such a development.

 

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R. Rocco Cottone is a professor in the Department of Counseling and Family Therapy at the University of Missouri-St. Louis. Contact him at cottone@umsl.edu.

Letters to the editor: ct@counseling.org