New Research Suggests: What Role Will Therapists Play in the Future?

The computer revolution is coming to psychotherapy: A UCLA study found that patients experiencing depression, stress or a variety of other symptoms were treated effectively using a computer software program supplemented by very brief visits with a therapist.

Patients who used software called the Therapeutic Learning Program (TLP)—developed by psychiatrist Roger Gould to help people confront their underlying problems—showed significant improvement and reported a high level of satisfaction with the treatment.

"The software program is very sophisticated, theoretically sound and user-friend," said UCLA psychologist Marion Jacobs, one of the researchers on the project. "It looks very promising for patients with mild to moderate psychological problems."

The study involved 90 patients—most with mild to moderate psychological problems—who were randomly divided into two groups. In one group, each patient saw a psychotherapist for about 50 minutes each week for 10 weeks. In the other group, each patient used the TLP software program for ten "sessions," supplemented by brief visits with a therapist lasting for 10-15 minutes weekly. Patient evaluations were conducted at the end of treatment, and again six months later to see whether the effects were lasting.

Subjects in both groups showed a significant decrease in depression, anxiety and perceived stress at the end of treatment, Jacobs said.

"The frequency and severity of symptoms reported by subjects in both groups significantly declined at the end of the program," Jacobs said. "At the six-month follow-up, most patients in both groups reported that the treatment had been effective and that they were satisfied with the treatment they received. Patients generally preferred the more intensive interaction with a therapist, but they found the computer-aided treatment equally effective, Jacobs said.

In a self-reported scale from one to five (five represents "very satisfied," four: "satisfied," three: "neutral," two: "dissatisfied," and one: "very dissatisfied"), patients who were treated by a therapist reported a satisfaction score of 4.5, compared with a score of 4.0 from patients who used the TLP software program. On a one-to-five effectiveness scale (five: "very effective," four: "effective," etc.), patients treated by a therapist reported a 4.5, compared with a 4.2 by patients who used the software program—a difference that is not statistically meaningful, Jacobs said.

The computer software helps patients to see patterns in their behavior and helps patients identify what bothers them, what obstacles prevent them from changing their behavior and how they can find alternatives, Jacobs said.

What are the implications of this technology for the future of mental health?

Andrew Christensen, a UCLA professor of psychology who worked on the study, said the role of therapists is likely to change as the therapist's tools become more widely available.

"I very much welcome psychology that is both effective and inexpensive," Christensen said. "The need for mental health services cannot conceivably be met by professional therapists; there are simply far too many people who need help, but cannot afford professional therapy. The fact that alternative treatments are, or soon will be, available that are both cost-effective and successful is an extremely important and encouraging finding—especially given the need for cost constraints in health care.

"The tools of psychology will soon be much more widely available, and I applaud that. The role of therapists is likely to move away from providing one-on-one psychotherapy and toward developing, evaluating and supervising more broad-based treatments such as computer-aided interventions and support groups.

"Some therapists may feel threatened by these changes, but I believe the changes are inevitable and positive developments that therapists can embrace. Therapists will still be needed to, among other things, advise when alternative treatments are appropriate for patients, and to work with patients for whom such treatments are not appropriate. Although these preliminary results for computer-assisted therapy look promising, we do not yet know how effective software programs will be over the long-term or with people whose psychological difficulties are more severe."

Christensen said the public will demand the "democratization of psychology." He noted that millions of Americans already belong to self-help groups and read the estimated 2,000 self-help books that are published annually.

What will therapy look like in 20 years as technology speeds up the trend toward self-help?

Jacobs laughed at the question, and answered, "Try five years. The people who read self-help books and join self-help support groups will want self-help software. Computer-assisted therapy is not the answer for everyone, but it will play an increasingly large role in mental health care."

This study has been published in Professional Psychology: Research and Practice 2001, Vol. 32, No.1, 92-96.