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

The impact of 'cultural difference' in the therapeutic space : a self psychology perspective on the finding of understanding

Bibliography: leaves 73-77.This study explored the influence of cultural difference in psychotherapy. This is an issue of particular relevance in South Africa where cross-cultural work is commonly practised. Yet there appears to be a silence surrounding the experiences of therapists who are working cross-culturally. The aim of the study was to explore, from the perspective of the therapist, how a psychoanalytic self psychology approach, allows us to engage and work with difference in the therapeutic space. The method used was a case study analysis of a psychotherapeutic relationship between the researcher, a white therapist-in-training, and a black client. The analysis drew on process notes written after the therapy sessions, and focused on the first year of the therapeutic relationship. The material was analysed using a hermeneutic-psychoanalytic theoretical framework.. Two aspects of the psychoanalytic self psychology approach were identified as potentially useful ways of working with difference: 1) the significance of the role of empathy in therapy and 2) the intersubjective stance which is inherent in self psychology. The case study analysis suggested that by paying attention to empathic processes, it becomes possible for us to track the way in which real and perceived differences between therapist and client can lead to empathic ruptures. The adoption of an intersubjective stance highlights how the therapist-client interaction constitutes the meeting of two subjective worlds which are socio-historically defined, multi-dimensional and fluid. The study suggests that in South Africa, where acknowledging racial difference runs the risk of creating divisions between people, there may be a tendency in therapy, to reframe racial difference as some other kind of difference which is less threatening such as language and/or gender difference. One of the fears behind naming and working with difference which was identified, was the fear of being part of a process that uses racial difference to oppress people. A second fear was that by naming difference, divisions would be created between therapist and client which could threaten a potential connection and jeopardise the therapeutic relationship. The study suggests that only after those unconscious threats and fears have been made conscious, does it become possible to authentically connect cross-culturally and thereafter, to begin to locate the similarities in our experiences

A QUALITATIVE STUDY INTO MODERN PSYCHOANALYTIC JOINING AND MIRRORING THROUGH PSYCHOTHERAPEUTIC EXCHANGES

This dissertation intends to address current deficits in knowledge regarding the modern psychoanalytic interventions of joining and mirroring, including substantial definition issues in the literature and the absence of current writings on the psychotherapeutic interventions of joining and mirroring in practice. The focus of the study was on the ever-dynamic landscape between modern analytically-informed practitioners and their clients in psychotherapeutic exchange(s) that the practitioners believed encompassed joining and/or mirroring interventions. Participants were six experienced practitioners who described their clinical work as being informed by modern psychoanalysis and who have engaged or were currently engaging in individual psychotherapy with a client. Participating practitioners were asked to identify and describe salient moment(s) and/or exchange(s) with a client in individual psychotherapy, with an emphasis on the emotional, behavioral, interpersonal and intrapersonal elements during these moments. Thematic analysis of interviews produced four themes: (1) initiation – an inciting moment; (2) guiding elements; (3) markers of effectiveness; and (4) comparisons between joining and mirroring. The result is a less abstract, vastly updated, and more robust understanding of joining and mirroring interventions as they are utilized in a modern psychoanalytically-informed practice. Less-known aspects of joining and mirroring, which are usually circulated verbally by practitioners, were articulated, thus improving the accessibility and relevance of modern psychoanalytic literature to a wider audience. Research from other fields were integrated to extend the potential efficacy and mechanisms of action underlying joining and mirroring interventions, thereby contributing to a deeper understanding of how the process of therapeutic change can operate through these interventions

Racial Bias and Dance/Movement Therapy: Manifestation of Therapist Bias in Nonverbal Communication and the Therapeutic Relationship

A healthy relationship between a therapist and client is core to the therapeutic process. This therapeutic relationship occurs in the context of the culture at large, and will be affected by the cultural identities of both the therapist and client. With this in mind, it is vital that therapists cultivate cultural humility and become familiar with their own cultural identity and biases, to grow in awareness of their effect on interaction with clients. In dance/movement therapy, the nonverbal and embodied elements of relating are especially important to consider. This thesis focuses on racial identity in the context of cultural realities in the United States, including a review of relevant literature and a heuristic first-person study conducted by the author to explore her own biases relating to race and their manifestation on a body level. Literature and the author’s research suggest that therapist bias is likely to manifest, including nonverbally, and negatively impact the therapeutic relationship unless it is acknowledged and addressed

Conversations on Empathy

In the aftermath of a global pandemic, amidst new and ongoing wars, genocide, inequality, and staggering ecological collapse, some in the public and political arena have argued that we are in desperate need of greater empathy — be this with our neighbours, refugees, war victims, the vulnerable or disappearing animal and plant species. This interdisciplinary volume asks the crucial questions: How does a better understanding of empathy contribute, if at all, to our understanding of others? How is it implicated in the ways we perceive, understand and constitute others as subjects? Conversations on Empathy examines how empathy might be enacted and experienced either as a way to highlight forms of otherness or, instead, to overcome what might otherwise appear to be irreducible differences. It explores the ways in which empathy enables us to understand, imagine and create sameness and otherness in our everyday intersubjective encounters focusing on a varied range of "radical others" – others who are perceived as being dramatically different from oneself. With a focus on the importance of empathy to understand difference, the book contends that the role of empathy is critical, now more than ever, for thinking about local and global challenges of interconnectedness, care and justice

The Dance of Becoming: Pedagogy in Dance/Movement Therapy in the US

The purpose of this study was to begin to define pedagogical theory and practice in the field of dance/movement therapy (DMT). Fourteen DMT educators from American Dance Therapy Association approved programs participated in the study, taking part in individual semi-structured interviews through a phenomenological lens. The participants had taught in the DMT field for at least five years and at most 44 years. Utilizing grounded theory methods, two focus groups were also conducted in which six DMT educators discussed initial qualitative themes from the individual interviews. Through an engaged process, participants were able to participate in the further defining of the study’s themes. Data were analyzed using grounded theory methods of initial and focused coding. The researcher also used member checking, peer review, and a personal research journal to name her own reflexive position within the emerging data. The researcher’s findings centered around six qualitative themes. These themes named the importance of the DMT student’s development of self-awareness including body identity, cultural identity, and professional identity all housed within the experience of embodied learning. Findings also named the importance of educator transparency and modeling in the classroom to create space for student exploration. Recommendations from the study aimed towards creating more opportunities for educators to collaborate and communicate across the field with the goal of creating best practices for DMT education. Also, recommendation for DMT educators centered around clarity of expectations in the embodied self-reflective learning process

AN ANALYSIS OF TALK AND INTERACTIONS IN INITIAL SESSIONS IN THE CONTEXT OF COUNSELING AND FAMILY MEDICINE

This study used conversation analysis, a method that directly investigates language use and interactions at both the thematic level and microanalytic level, to explore the processes of talk and interactions of initial sessions between trainees and their clients/patients in two professions, counselor education and family medicine. The naturally occurring, audio and/or video-recorded data regarding initial sessions conducted by trainees in both professions were used to explore three overarching questions: (1) How are the conversations between trainees and clients developed and maintained in their initial encounters? (2) How are therapeutic relationships and therapeutic discourses developed in initial sessions? (3) How do co-constructed, sequential interactions at the moment produce subsequent actions and interactions such as disclosures, presentation of challenging communications, and vulnerability? The results indicated that while professional practice was contextual and circumstantial, both professions in this study share a number of strategies and talk features with regard to the development of therapeutic relationships, the process of disclosures, and the presentation of unique interactions as a result of co-constructed therapeutic discourses. The study of talk and interaction provides authentic materials of clinical practices and a comprehensive analytic framework for supervision. Future studies regarding clinical encounters, working alliances, and therapeutic discourses that include analyses of talk and interactions will provide additional insight and enrich the methodological repertoires for current studies related to the best practices, effective therapeutic alliances, and communications

Conversations on Empathy

In the aftermath of a global pandemic, amidst new and ongoing wars, genocide, inequality, and staggering ecological collapse, some in the public and political arena have argued that we are in desperate need of greater empathy — be this with our neighbours, refugees, war victims, the vulnerable or disappearing animal and plant species. This interdisciplinary volume asks the crucial questions: How does a better understanding of empathy contribute, if at all, to our understanding of others? How is it implicated in the ways we perceive, understand and constitute others as subjects? Conversations on Empathy examines how empathy might be enacted and experienced either as a way to highlight forms of otherness or, instead, to overcome what might otherwise appear to be irreducible differences. It explores the ways in which empathy enables us to understand, imagine and create sameness and otherness in our everyday intersubjective encounters focusing on a varied range of "radical others" – others who are perceived as being dramatically different from oneself. With a focus on the importance of empathy to understand difference, the book contends that the role of empathy is critical, now more than ever, for thinking about local and global challenges of interconnectedness, care and justice

Picturing the fictitious person: An exploratory study on the effect of images on user perceptions of AI-generated personas

Human-computer interaction (HCI) research is facing a vital question of the effectiveness of personas generated using artificial intelligence (AI). Addressing this question, this research explores user perceptions of AI-generated personas for textual content (GPT-4) and two image generation models (DALL-E and Midjourney). We evaluate whether the inclusion of images in AI-generated personas impacts user perception or if AI text descriptions alone suffice to create good personas. Recruiting 216 participants, we compare three AI-generated personas without images and those with either DALL-E or Midjourney-created images. Contrary to expectations from persona literature, the presence of images in AI-generated personas did not significantly impact user perceptions. Rather, the participants generally perceived AI-generated personas to be of good quality regardless of the inclusion of images. These findings suggest that textual content, i.e., the persona narrative, is the primary driver of user perceptions in AI-generated personas. Our findings contribute to the ongoing AI-HCI discourse and provide recommendations for designing AI-generated personas.© 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).fi=vertaisarvioitu|en=peerReviewed