Therapy by computer: DIY analysis is looming over the technological horizon, reports Alex Spillius

PERHAPS it makes sense that two of the boom businesses of the Nineties, computers and therapy, should come together. It may not sound the most natural of matches, but neither did nightclubs and sportswear until the late Eighties. But the day may not be far off when patients suffering from a variety of mental problems ranging from stress to suicidal tendencies will have the option of starting their treatment by taking a disk home from their doctor, logging on to happiness and clicking 'continue' for complete contentment.

A team from the Institute of Psychiatry at London's Maudesley Hospital is already piloting a program designed to help patients suffering from anxiety. The Maudesley is also carrying out a trial using virtual reality to combat common phobias, such as the fear of spiders, snakes and heights. Patients strap on a helmet-cum-screen and are gradually exposed to images of their particular nemesis.

Computers are also being used in medical diagnosis. Dr David Bihari, the director of Guy's Hospital's intensive care unit, was recently criticised for threatening to make life or death clinical decisions using the US 'Domesday' computer which flashes up a coffin symbol for any patient likely to survive less than 90 days.

Meanwhile King's College Hospital in London is about to test a service whereby patients can ring in their symptoms for a nurse to tap into a computer which will then recommend appropriate treatment.

Reactions to these developments depend on our levels of technophobia. Those in the vanguard of medical technology see it as progress, but emphasise that such techniques are not designed to replace the human element in medicine, but to augment it, while the computer-illiterate among us are likely to mutter something about George Orwell being merely 10 years early with 1984. The truth is somewhere between the two.

A doctor's surgery in Kennington, south London, is an unlikely setting for this brave new world, but it is here that the Institute of Psychiatry's anxiety program is being tested.

Dr Richard Parkin, who has written much of the program, explains: 'The buzz words are clarification and patient empowerment. I hope it will help people to clarify why they are feeling as they are, to think in more psychological terms about their problems, and plan a strategy to overcome them.'

The program, which has a working title of WorryTel, takes about an hour and a quarter to complete for anyone familiar with using a mouse. It starts with a rough assessment of your problems, using multiple choice questions. 'How have you been feeling about yourself lately? Better, the same, or worse than usual?'

Then it gets more specific. 'Have you made any plans to kill yourself lately?' 'How much have you had to drink in the last week?' (Answer in my case: 47 units. 'Well above the British Medical Association's recommended limit,' tutted WorryTel, 'make an effort to cut your intake or you run a high risk of alcohol dependency.')

It then asks you to pick one to five bad feelings out of a list of around 30. 'How do you feel: anxious, bored, angry, frustrated, jealous, confused . . . ' Then came the important bit. Pick a particular anxiety such as fear of public places, answer a few more questions, and WorryTel prints out a set of exercises and goals to combat your problem. I was advised to 'walk alone in an area near home for half an hour twice a week' among other things. Other problems may mean you should ask your GP about counselling, or you should contact Rape Crisis, Gingerbread, or another emergency agency.

The program is surprisingly user-friendly, though Dr Parkin is well aware that people will see it as dry and artificial. 'I have my doubts about it, but I think it has enormous potential. Say someone has been physically abused, they are scared, don't know what to do for help, don't want to talk to someone else about it. They might use this as a first port of call. If WorryTel can say 'please go to your doctor about the predicament you are in', I hope that might be enough to make them do something.'

The brains behind WorryTel, Professor Isaac Marks, is probably the country's leading exponent of behavioural therapy, a controversial method which places considerable demands on patients, setting them rigid programmes of readjustment. One prominent psychiatrist, who consulted Professor Marks to tackle his snake phobia, and within four days had snakes crawling all over him, says: 'Marks is very famous and we all need him to challenge us but for most therapists his approach is very rigid.'

Computers are becoming ever faster and ever cleverer, as the world chess champion Garry Kasparov discovered to his intense displeasure this week when he was beaten by Pentium Genius 2, the latest chess software. But chess has set parameters, which human emotions do not. Even so, Dr Kenneth Colby, emeritus Professor of Psychiatry at UCLA, California, is convinced his therapy program, the Good Mood Program, can converse meaningfully with patients.

'We think it's the best conversation program. We have had a 96 per cent positive user evaluation,' he said from his Malibu home. This reporter will have to count himself in the four per cent minority. It is tempting to apply the technological prefix of the day to Dr Colby's invention and describe it as 'virtual therapy'. However, there is no way one could mistake a discussion with his program for a session with a real therapist, though compared with a course of therapy, Dr Colby's dollars 99-dollar course is bargain-basement cheap. My dialogue with it went like this:

Me: I am having problems with my (mythical) marriage.

Computer: you believe you are the source of a great deal of trouble.

Me: I think I am partly to blame, but perhaps my wife should also take some of the blame.

Computer: it must be very painful to feel such guilt.

Me: who said I was feeling guilty?

Computer: your assurance falls as your self-esteem falls.

Me: certainly my self-esteem is low.

Computer: you are at peace with your self-esteem?

Me: not quite.

Computer: what makes you not cherish yourself?

Me: the feeling that something I am very committed to may not work out.

Computer: you can't seem to come to the point of finding solutions.

Me: no.

Computer: I apologise. Please continue in spite of my limitations.

Me: what can I do to make my wife love me more?

Computer: what seems to hinder you the most?

Me: I get the feeling she doesn't love me any more.

Computer: you bask in your wife's affection.

Me: I would like to.

'Sure there is room for improvement,' said Dr Colby. 'The main weakness is understanding English. It needs more words and more idiom.' The program, which has taken him 10 years to develop, recognises 90,000 words and gives its responses immediately. Dr Colby is aiming the Good Mood Program at those who 'don't get help, can't afford therapy, or don't know how to find it'. Noble intentions, but isn't there a big difference between talking to a therapist and talking to a computer?

'No. It is myself. I wrote the program. You are talking to me indirectly. Don't confuse the medium with the message.' He claims the value of the human element and voice intonation has 'never been shown to have been of any relevance to therapeutic outcome'.

It was all too much for Judy Cooper, a practising psychotherapist and spokeswoman for the British Association of Psychotherapists. 'I think it's very frightening. It's a sad statement on modern times to respond to human dilemmas in this manner. Therapy should be more widely available but I don't think a computer is the answer - the human relationship is such an important part of therapy. The computer's comments are stereotyped and disconnected. But at least it claims to recognise its limitations, which some human therapists perhaps don't'