Design And Evaluation of A Conversational Agent for Mental Health Support: Forming Human-Agent Sociotechnical And Therapeutic Relationships

Many people with mental health disorders face significant challenges getting the help they need, including the costs of obtaining psychological counseling or psychiatry services, as well as fear of being stigmatized. As a way of addressing these barriers, text-based conversational agents (chatbots) have gained traction as a new form of e-therapy. Powered by artificial intelligence (AI) and natural language processing techniques, this technology offers more natural interactions and a “judgment-free zone” for clients concerned about stigma. However, literature on psychotherapeutic chatbots is sparse in both the psychology and human computer interaction (HCI) fields. While recent studies indicate that chatbots provide an affordable and effective therapy delivery method, this research has not thoroughly explained the underlying mechanisms for increasing acceptance of chatbots and making them more engaging. Don Norman (1994) has argued the main difficulties of utilizing intelligent agents are social—not technical—and particularly center around people’s perceptions of agents. In exploring the use of chatbots in psychotherapy, we must investigate how this technology is conceptually understood, and the thoughts and feelings they evoke when people interact with them. This dissertation focuses on two types of relationships critical to the success of utilizing chatbots for mental health interventions: sociotechnical relationships and therapeutic relationships. A sociotechnical relationship concerns technology adoption, usability, and the compatibility between humans and chatbots. A therapeutic relationship encompasses people’s feelings and attitudes toward a chatbot therapist. Therefore, this dissertation asks: What are the optimal design principles for a conversational agent that facilitates the development of both sociotechnical and therapeutic relationships to help people manage their mental health? To investigate this question, I designed an original conversational system with eight gendered and racially heterogeneous personas, and one neutral robot-like persona. Using a mixed-method approach (online experiment and interviews), I evaluated factors related to the adoption and use of conversational agents for psychotherapeutic purposes. I also unpacked the human-agent relational dynamics and evaluated how anthropomorphism and perceived racial similarity impact people’s perceptions of and interactions with the chatbot. These findings contributed to the wider understanding of conversational AI application in mental health support and provided actionable design recommendations

Identifying Therapeutic Alliance Patterns Among a Feasible Clinical Measure to Improve Treatment Outcome

Background: Research has shown a link between therapeutic alliance and treatment outcome, but the definition of alliance and the focus of research has varied across studies. The present study evaluated a possible association between the alliance strength and treatment outcome, which is operationalized by participants’ outcome scores and the difference between their first and last self-reported alliance scores, in a sample of children and adolescents seeking treatment at a community mental health facility. Method: 96 children and 239 adolescents who received mental health treatment at a local community clinic were asked to complete two feasible self-reported measures during each therapeutic session, including the Child Session Rating Scale (CSRS) or the Session Rating Scale (SRS) and the Child Outcome Rating Scale (CORS) or the Outcome Rating Scale (ORS) for the current study. Results: Due to the small number of children participants in the alliance groups, it was not possible to explore the relationship between therapeutic alliance and treatment outcome. However, the adolescent participants who ended therapy with a strong therapeutic alliance had a positive treatment outcome when compared to participants who ended therapy with a poor alliance. Overall, the results were inconclusive for the children sample due to the low number of participants and data collected. The overall results for the adolescent sample did show that therapeutic alliance was a significant predictor of treatment outcome. Conclusions: From these results, we can conclude that therapeutic alliance is an important factor in mental health treatment with young clients. Conversely, the exploratory analyses also suggest that there may be other factors that influence treatment outcome. Possible explanations, such as other stakeholders involved, number of sessions attended, and models/techniques used in treatment, are examined. Implications for practice and suggestions for research are discussed. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/et

Identifying Therapeutic Alliance Patterns Among a Feasible Clinical Measure to Improve Treatment Outcome

Background: Research has shown a link between therapeutic alliance and treatment outcome, but the definition of alliance and the focus of research has varied across studies. The present study evaluated a possible association between the alliance strength and treatment outcome, which is operationalized by participants’ outcome scores and the difference between their first and last self-reported alliance scores, in a sample of children and adolescents seeking treatment at a community mental health facility. Method: 96 children and 239 adolescents who received mental health treatment at a local community clinic were asked to complete two feasible self-reported measures during each therapeutic session, including the Child Session Rating Scale (CSRS) or the Session Rating Scale (SRS) and the Child Outcome Rating Scale (CORS) or the Outcome Rating Scale (ORS) for the current study. Results: Due to the small number of children participants in the alliance groups, it was not possible to explore the relationship between therapeutic alliance and treatment outcome. However, the adolescent participants who ended therapy with a strong therapeutic alliance had a positive treatment outcome when compared to participants who ended therapy with a poor alliance. Overall, the results were inconclusive for the children sample due to the low number of participants and data collected. The overall results for the adolescent sample did show that therapeutic alliance was a significant predictor of treatment outcome. Conclusions: From these results, we can conclude that therapeutic alliance is an important factor in mental health treatment with young clients. Conversely, the exploratory analyses also suggest that there may be other factors that influence treatment outcome. Possible explanations, such as other stakeholders involved, number of sessions attended, and models/techniques used in treatment, are examined. Implications for practice and suggestions for research are discussed. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/et

State v. Capone Clerk\u27s Record v. 2 Dckt. 43124

https://digitalcommons.law.uidaho.edu/idaho_supreme_court_record_briefs/7947/thumbnail.jp

'Between bodies': an implicit relational model

The main aim of this study was to generate a theory of what happens between the body of the therapist and the body of the client in a psychotherapeutic setting. This was achieved through documenting and analysing first-hand therapists’ experiences of their own embodied being in the psychotherapeutic process. A descriptive phenomenological design was adopted using a grounded theory methodology. Participants were experienced psychological therapists, nine of whom were female and three of whom were male. Through use of semi-structured interviews the research captured therapists’ direct experience of their embodied interaction with clients. It was discovered that at any given juncture the body of the therapist registers a considerable amount of intersubjective somatic information. The Core Category of Between Bodies emerged from this analysis and this is divided into five sub-categories. These include (i) Body to Body (ii) Connection (iii) Somatic Experiencing of Other (iv) Embodied Process and (v) Intersubjective Space. Findings describe a theoretically salient Implicit Relational Model of what happens between bodies in the psychotherapeutic encounter. Movement to and between each of the sub-categories is mediated by the embodied processes of the first sub-category Body to Body. These embodied relational processes are co-created and act as a mediator between client and therapist for generating one or more of the sub-categories Connection, Somatic Experiencing of Other, Embodied Process and Intersubjective Space. This research study highlights the importance of exploring and attending to implicit processes. The findings are discussed in relation to current research on neuroscience and infant studies. Such theory will add to knowledge and understanding of the implicit intersubjective field of the therapeutic relationship. It will also help to inform specific recommendations for supervisors, trainers, therapists and researchers

Unawareness of paralysis following stroke: an existential-phenomenological inquiry into the paradox of anosognosia

We inescapably experience the world through our body. Yet as our embodiment itself is the background of all our everyday experience, it appears to be experienced quietly. We tend to take for granted that our body is present in and contributing to all experience, as we also tend to take for granted the feeling that it belongs to us and it is under our control. However, certain neuropsychological disorders that arise after damage to the right hemisphere of the brain serve as a reminder that these feelings and intuitions cannot always be taken for granted. What is more ‘counter-intuitive’ than someone who is unaware of the fact that they can no longer move half their body? Or someone who cannot recognise their own arm or, leg as theirs? These disorders have troubled neurology, philosophy and psychology since the time of Charcot, Janet, Freud and Babinski and continue to represent frequent, largely unmet and poorly studied clinical challenges. The present thesis aims to explore from an interdisciplinary vantage point the way in which the body is experienced in people with such neuropsychological disorders following a stroke. More specifically, it aims to complement current scientific perspectives on these disorders with existential-phenomenological ideas regarding the experience of embodiment in these patients, with particular emphasis on the ‘pre-reflected’ dimensions of embodiment and their derivatives in mental life as highlighted by the philosopher Merleau-Ponty. The empirical part of the thesis involves behavioural and neuroimaging methodologies from the field of neuropsychology, including two case series and one single case study (total N = 14). Three hypotheses inspired by the early writings of Merleau-Ponty on embodiment were explored in these three studies, respectively: (a) whether patients with motor unawareness have a ‘pre-reflective’ awareness of their deficits; (b) whether such forms of pre-reflective awareness may paradoxically contribute to their explicit unawareness and (c) whether insights generated by the above two studies could be translated to a psychophysical intervention that can help a patient recover her explicit awareness of her paralysis. The results of these studies confirmed all three hypotheses, with some theoretical constraints that are discussed in each chapter. More generally, the results of these studies are discussed in relation to both scientific and philosophical theories of body awareness and most importantly in relation to clinical challenges and the scope of existential counselling psychology. I argue that these disorders allow a unique insight into how existential, counselling and psychotherapeutic psychology can position its practice in relation to some of these paradoxical ways of being-in-the-world that are not habitually so ‘visible’, unless revealed by brain damage. These considerations apply particularly to the more general paradox of psychotherapeutic clients who frequently come to therapy consciously hoping to change their habitual ways of being-in-the-world while implicitly, yet with almost equal force, they may hope not to change their commitment to the world

Echoes in Bosnia and Beyond

As the twentieth anniversary of war in Bosnia—Herzegovina looms, many civilian survivors remain traumatised by the events they experienced and/or witnessed. Following the end of the war, the ensuing social and political upheaval and lack of resources have resulted in chronic emotional issues and mental health problems within the civilian population. Ongoing help has come from a British-based charitable organization—Healing Hands Network—which, since 1996, has provided hands-on therapies in and around Sarajevo to clients referred by local organizations, including the Association of Concentration Camp Victims, the Association of Civil War Victims. Women Victims of War and Mothers of Srebrenica. Some clients have received treatments for many years and the Charity has been looking into how the current or perhaps new interventions might help these clients move on