The clinical practice of and the research on psychotherapy has had an ambivalent, if not a tumultuous relationship with technology. The practice of psychotherapy is by its nature a private and confidential interaction, most often between two people (the therapist and the patient), working in a room with no observers. To psychoanalysts, this privacy was sacrosanct and could only be understood from the perspective of the analyst—the ultimate human interpreter of the therapeutic transaction.

In the 1950s, Carl Rogers and colleagues, acutely interested in what actually transpired in therapy and what characterized effective therapy, used reel-to-reel tape recorders to capture the audio transaction of therapy. These recordings provided material for observers (that is, others besides the participants) a view of psychotherapy previously unavailable.

The use of audio recordings was a stunning change for the field; nevertheless, most information about the course of therapy as well as the outcome were obtained from self-report of the therapist and the patient, or by the use of human raters observing video or audio tapes of sessions. The limitation of ratings, whether by participants or observers, was recognized by many in the field. Accordingly, psychotherapy researchers began to employ physiological measures (e.g., galvanic skin response) and neuro assessments (MRI studies of psychotherapy). There have been various studies involving various measures of verbal and nonverbal behavior, technologically assessed—and although interesting, the results have had minimal, if any, effect, on the practice of psychotherapy or in the training of therapists. But the situation is changing…

A number of forces have created an explosion of software solutions.

First, of course, technology has permeated all aspects of modern life. Second, there is excess demand for addressing mental health concerns, due to increasing prevalence of mental concerns and a relative dearth of licensed therapists. Third, COVID induced restrictions required electronic mediated delivery of mental health services. Finally, given these various forces, there is pressure to make mental health services more efficient and more effective.

There are now over 10,000 mental health apps for smart phones—generating revenue in excess of 500 million dollars in 2022 alone. Most of which have no established beneficial effects, nor are they regulated by the FDA and the data from these apps are not governed by HIPAA. A sizable portion of traditional psychotherapy is delivered through billion dollar tech companies offering video administered treatment. Increased effort is being made by systems of care (e.g., national health services, health plans, or insurance companies) to offer precision mental health by using big data and machine learning to match patients to a particular therapist or treatment (type of psychotherapy or even psychotherapy versus some other form of treatment, such as an app or other alternative).

There is little evidence that these technical solutions are improving mental health. Certainly, at the population level the prevalence of mental health concerns has not been decreasing, despite the technological advances and money invested. Yet, software solutions are needed.

How Skillsetter’s Technology Is Changing Mental Health Services

At Skillsetter we have taken a different approach to improving mental health services, by utilizing what is know about psychotherapy and interpersonal skills and using technology to facilitate the process.

First, we know that psychotherapy is remarkably effective—as effective as medications for most mental disorders, and longer lasting without side-effects. Second, the type of psychotherapy delivered does not make a difference, but what does make a difference is the therapist themselves.

Some therapists, regardless of what approach they take to psychotherapy, are more effective across a range of clients, than other therapists. It is clear that the more effective therapists have a sophisticated set of interpersonal skills that are used in challenging therapeutic interactions. Yet, the evidence is clear that therapists do not improve over the course of their careers.

The objective at Skillsetter is to use technology to assist in the training of therapists so that they will have the necessary interpersonal skills to be effective therapists over the course of their careers. Using deliberate practice, a proven method to achieve expertise, Skillsetter is an electronic platform for the deliberate practice of the interpersonal skills necessary to be an effective therapist.