The links for these texts were received on 14th January 2025.

Both texts on AI therapy are on the Mental Health Action website:

Part 1 Machina Ex Deo: AI and the future of NHS Talking Therapies

https://mentalhealthaction.uk/wp-content/uploads/2025/01/ai-part-1-p-atkinson.pdf

Part 2 Machina Ex Deo: State therapy and the hollowing out of intersubjectivity

https://mentalhealthaction.uk/wp-content/uploads/2025/01/ai-part-2-p-atkinson-2.pdf

Both texts focus on what is happening in the UK and have ramifications for other countries who may follow suit. Both come from a critical base of the UK Government’s action and how the UK Government is using treatments for mental health conditions as a cover for eliminating long term sickness, unemployment, disability, and so on. The treatment are Government-defined and implemented by Government employees using Government approved treatments.

These texts are exemplary for their references which are all indexed and accessible.

Julia Evans

The Outline of the texts with some very abbreviated notes/extracts.

PART ONE
Machina ex deo
AI and the future of NHS Talking Therapies
By Paul Atkinson

What sort of social world is being built as a result of data colonialism. What will count as social knowledge in that world, and what older forms of social knowledge may drop out of the picture? Furthermore, what do those changes mean for social inequality and social justice?1

  1. Couldry, N. and Mejias, U. (2019). The costs of connection: how data is colonizing human life and appropriating it for capitalism. Redwood City, California: Stanford University Press, p.115.

An AI therapist can access your cellphone, laptop, personal data, emails, all-day movement, and routine, making it more efficient in understanding you and your problems. Knowing problems in depth gives an AI-therapist advantage over the usual therapist.2

  1. Ahmed, A. (2022). AI therapy: digital solution to address mental health issues. Online at: https://techacute.com/ai-therapy-digital-solution-to-address-mental-health-issues

We made the world uninhabitable for ourselves and it can only be inhabited by robots and androids.3

  1. Bisley, A. (2017). Q & A: author Irvine Welsh on the ‘Trainspotting’ sequel, drugs, and writing. Online at: https://www.macleans.ca/culture/books/qa-author-irvine-welsh-on-the-trainspotting-sequel-drugs-and-writing

SECTION HEADINGS

-Onboarding AI therapy (AIT)

-“What does the app want?”9

  1. Question posed by: Bandinelli, C., and Bandinelli, A. (2021). What does the app want? A psychoanalytic interpretation of dating apps’ libidinal economy. Psychoanal Cult Soc 26, 181–198. Available online at: https://doi.org/10.1057/s41282-021-00217-5

-The march of the machines I

ieso Digital Health

ieso Digital Health is a UK company, providing talking therapy to over 25 NHS trusts.21

  1. See: https://www.iesogroup.com/nhs

-The march of the machines II

Limbic Access and Limbic Care

Limbic Access is a conversational artificial intelligence chatbot which is used “to assist both patients and mental health practitioners with referral, triage, and clinical assessment of mild-to-moderate adult mental illness”.33

  1. Rollwage, M., Habicht, J., Juchems, K., Carrington, B., Hauser, T.U., and Harper, R. (2024). Conversational AI facilitates mental health assessments and is associated with improved recovery rates. BMJ Innovations, Vol. 10, Issue 1-2. Abstract online at: https://innovations.bmj.com/content/10/1-2/4

Trent Psychological Therapies Service

Trent PTS provides NHS behavioural therapies in Derbyshire and Nottinghamshire. It began life as Trent CBT Services Ltd in 2004.37

  1. https://find-and-update.company-information.service.gov.uk/company/05117697

Silvercloud and Wysa

Silvercloud, formerly a Dublin/UK private provider of digital therapy, was taken over in 2021 by Amwell – American Well.39

  1. https://www.silvercloudhealth.com/uk/about-us

-II Ready for the robots

Public/private partnership

Big data

IAPT/NHS Talking Therapies describes itself as an “evidence-based”57 mental health service, offering “NICE-recommended psychological therapies at the appropriate dose matched to the mental health problem, and the intensity and duration of delivery… designed to optimise outcomes”.58

  1. For a critique of ‘evidence-based’ treatments in mental health, see for example: Gregory, A.A. (2023). Debunking 4 myths about evidence-based treatments. Online at: https://www.psychologytoday.com/gb/blog/simplifying-complex-trauma/202305/debunking-4-myths-about-evidence-based-treatments

Also, Shedler, J. (2018). Where is the evidence for “evidence-based” therapy? Psychiatric Clinics of North America, Volume 41, Issue 2, 2018, pp.319-329. Online at: https://doi.org/10.1016/j.psc.2018.02.001

Also, Beichman, J. (2021). Evidence-based medicine, evidence-based practice, NICE, IAPT and CBT: A short history. Online at: https://jaybeichmanwriter.com/2021/12/21/evidence-based-medicine-evidence-based-practice-nice-iapt-and-cbt-a-short-history

  1. Description at: https://www.england.nhs.uk/mental-health/adults/nhs-talking-therapies

The behavioural assembly-line

The emergence of AI therapy is a natural progression of the mechanistic models of therapy developed by the IAPT service over the last 16 years. The neo-Taylorism63 of short-term CBT treatments will morph quite smoothly into the full automation of machine learning and AI agents.

  1. Baumgarten, S. and Bourgadel, C. (2023). Digitalisation, neo-Taylorism and translation in the 2020s. Perspectives, 32(3), pp. 508–523. https://www.tandfonline.com/doi/full/10.1080/0907676X.2023.2285844

PART TWO
Machina ex deo
State therapy and the hollowing out of intersubjectivity
By Paul Atkinson

“Big Data and Cloud Capital2 are fast developing mechanisms of power and monopoly that are hollowing out social life and reconstructing the expectations of interpersonal relationship. They are working to embed neoliberal forms of knowledge and psychological language based in the individualism and utilitarianism of biochemistry, neuroscience, and behaviourism – languages which help colonise and marketise subjective and intersubjective experience.”

  1. Yanis Varoufakis on ‘Cloud Capitalism’ and ‘Technofeudalism’. Interviewed for The Futurists Podcast (Tercek, R., and King, B.) in 2023. View online at: https://youtu.be/X9jt5qh6yyk?si=U2qZAMKT3T_42sJ5 For a critique of ‘Technofeudalism’ see also: Snow, H. (2023). We’re still living under capitalism. Online at: https://jacobin.com/2023/10/cloud-capitalism-technofeudalism-serfs-cloud-big-data-yanis-varoufakis

SECTION HEADINGS

-Homogenising psychotherapy

All services but one

CBT represents one approach within a pluralistic understanding of psyche and its therapy. Especially in the truncated assembly-line version of behaviourism adopted and developed by IAPT, it homogenises and sterilises the field in both theory and practice.6

  1. Bruun, M. K. (2023). ‘A factory of therapy’: accountability and the monitoring of psychological therapy in IAPT. Online at: https://www.tandfonline.com/doi/full/10.1080/13648470.2023.2217773#d1e250

-Deskilling the therapists

A dimension of the hollowing out of NHS Talking Therapies is the deskilling of its workforce.17

  1. For details of the NHS Talking Therapies workforce see NHS Talking Therapies for anxiety and depression workforce census (2023). Online at: https://shorturl.at/VV1Sa

-Machinic unconscious: the ethics of the therapeutic interaction

What we can certainly say is that CBT-based AI therapy developed to provide short-term fixes for NHS patients will not be practising not-knowing.

-Hypocrisy and the political economy of NHS Talking Therapies

From IAPT workforce surveys, we know that high levels of burnout, depression and anxiety are experienced by a significant proportion of its staff.54 This should come as no surprise, however shocking. The service operates like a machine, an assembly line of mental health ‘fixes’ micro-managed more under the ethos of Taylorism than the faux liberalism of the human relations model the book espouses.55 These power relations will be baked in and obscured by AI and the anonymity of machine learning and algorithms.

  1. IAPT Blog. (2019). Hitting a new low. Online at: https://therapymeetsnumbers.com/hitting-a-new-low On the Indeed job review site, the Trent Psychological Therapy Service has been condemned by ex-employees with comments like “Bitter awful feeling in my soul”, “Micromanaged. I was treated like a dog’s body”, “don’t bother”, “Profits before people”, “a proper business taking money from the NHS and treating staff as toilet paper to be used and then thrown away”. Indeed Blog. (2018-2023). Trent PTS Employee Reviews. Online at: https://uk.indeed.com/cmp/Trent-Pts/reviews
  2. Postings, J. (2023). The return of ‘Taylorism’? Online at: https://www.bps.org.uk/psychologist/return-taylorism

-AI, the mental health crisis and the accelerating denial of care

… As we have seen, psychological therapies in primary care since 2008 have become an engine of social reconstruction in the service of maintaining the ailing neoliberal project. IAPT unfolded a factory system of cognitive behavioural education and training on the UK public in the name of mental health care. Its colossal inefficiency and ineffectiveness as a system of care in the service of the social good is disguised by its claims of evidence-base, data harvesting and its abuse of outcome statistics. By hollowing out and narrowing down the human encounter at the heart of therapeutic practice, it has set the stage for its eclipse via AI. If any further evidence were needed of the mechanisation of NHS therapy and the direction of travel driving its development, the replacement of human beings by conversational agents and their algorithms surely oblige. The current provision of short-term CBT will over the next few years be giving way to its natural progeny – CBT therapy by robot.

While relational psychotherapy will become increasingly the privilege of people who can afford the fees of independent practitioners, digitalised denial of care and CBT-speak will become the norm for the majority. Unless those of us who care can do something about it.