5 ms·

*Shitty start-up LLMs should not replace therapists. There have never been more psychologists, psychiatrists, counsellors and social worker, life coach, therap

*Shitty start-up LLMs should not replace therapists. There have never been more psychologists, psychiatrists, counsellors and social worker, life coach, therapy flops at any time in history and yet mental illness prevalence is at all time highs and climbing. Just because you're a human and not an llm doesn't mean you're not a shit therapist, maybe you did your training at the peak of the replication crisis? Maybe you've got your own foibles that prevent you from being effective in the role? Where I live, it takes 6-8 years and a couple hundred grand to become a practicing psychologist, it really is only an option for the elite, which is fine if you're counselling people from similar backgrounds, but not when you're dealing with people from lower socioeconomic classes with experiences that weren't even on your radar, and that's only if, they can afford the time and $$ to see you. So now we have mental health social workers and all these other "helpers" who's just is to do their job, not fix people. LLM "therapy" is going to and has to happen, the study is really just a self reported benchmarking activity, " I wouldn't have don't it that way" I wonder what the actual prevalence of similar outcomes is for human therapists? Setting aside all of the life coach and influencer dribble that people engaged with which is undoubtedly harmful. LLMs offer access to good enough help at cost, scale and availability that human practitioners can only dream of.

esseph 1y ago
What if they're the same levels of mental health issues as before? Before we'd just throw them in a padded prison. Welcome Home, Sanitarium "There have never been more doctors, and yet we still have all of these injuries and diseases!" Sorry, that argument just doesn't make a lot of sense to me for a whole, while, lot of reasons.
- HenryBemis 1y ago
  It is similar to "we got all these super useful and productive methods to workout (weight lifting, cardio, yoga, gymnastics, martial arts, etc.) yet people drink, smoke, consume sugar, sit all day, etc. We cannot blame X or Y. "It takes a village". It requires "me" to get my ass off the couch, it requires a friend to ask we go for a hike, and so on. We got many solutions and many problems. We have to pick the better activity (sit vs walk)(smoke vs not)(etc..) Having said that, LLMs can help, but the issue with relying on an LLM (imho) is that it you take a wrong path (like Interstellar's TARS the X parameter is too damn high) you can be detailed, while a decent (certified doc) therapist will redirect you to see someone else.
- DharmaPolice 1y ago
  >What if they're the same levels of mental health issues as before? Maybe but this raises the question of how on Earth we'd ever know we were on the right track when it comes to mental health. With physical diseases it's pretty easy to show that overall public health systems in the developed world have been broadly successful over the last 100 years. Less people die young, dramatically less children die in infancy and survival rates for a lot of diseases are much improved. Obesity is clearly a major problem, but even allowing for that the average person is likely to live longer than their great-grandparents. It seems inherently harder to know whether the mental health industry is achieving the same level of success. If we massively expand access to therapy and everyone is still anxious/miserable/etc at what point will we be able to say "Maybe this isn't working".
  - esseph 1y ago
    Answer: Symptom management. There's a whole lot of diseases and disorders we don't know how to cure in healthcare. In those cases, we manage symptoms. We help people develop tools to manage their issues. Sometimes it works, sometimes it doesn't. Same as a lot of surgeries, actually.
    - heisenbit 1y ago
      As the symptoms in mental illness tend to lead to significant negative consequences (loss of work, home, partner) which then worsen the condition further managing symptoms can have great positive impact.
- theothertimcook 1y ago
  Psychology has succeeded in creating new disorders while fields like virology, immunology and oncology are eradicating and improving mortality rates. It was these professions and their predecessors doing the padded cell confinement, labotomising and etc.
spondylosaurus 1y ago
> it really is only an option for the elite, which is fine if you're counselling people from similar backgrounds, but not when you're dealing with people from lower socioeconomic classes with experiences that weren't even on your radar A bizarre qualm. Why would a therapist need to be from the same socioeconomic class as their client? They aren't giving clients life advice. They're giving clients specific services that that training prepared them to provide.
- koakuma-chan 1y ago
  > They're giving clients specific services that that training prepared them to provide. And what would that be?
  - spondylosaurus 1y ago
    Cognitive behavioral therapy, dialectic behavioral therapy, EMDR, acceptance and commitment therapy, family systems therapy, biofeedback, exposure and response prevention, couples therapy...?
    - asdf6969 1y ago
      So they just follow instructions from a book? Why can’t an LLM do that? Advice is so situational that I just don’t really believe a therapist would ever understand most of their clients problems. If you’re having a hard time understanding my perspective, imagine a white American therapist giving an Indian American immigrant advice on how to deal with family issues. They will probably never deeply understand the situation.
- QuadmasterXLII 1y ago
  they don’t need to be from the same class, but without insurance traditional once a week therapy costs as much as rent, and society wide, insurance can’t actually reduce price
  - p_ing 1y ago
chrisweekly 1y ago
Respectfully, while I concur that there's a lot of influencer / life coach nonsense out there, I disagree that LLMs are the solution. Therapy isn't supposed to scale. It's the relationship that heals. A "relationship" with an LLM has an obvious, intrinsic, and fundamental problem. That's not to say there isn't any place at all for use of AI in the mental health space. But they are in no way able to replace a living, empathetic human being; the dismal picture you paint of mental health workers does them a disservice. For context, my wife is an LMHC who runs a small group practice (and I have a degree in cognitive psychology though my career is in tech). This ChatGPT interaction is illustrative of the dangers in putting trust in a LLM: https://amandaguinzburg.substack.com/p/diabolus-ex-machina https://amandaguinzburg.substack.com/p/diabolus-ex-machina
- wisty 1y ago
  > Therapy isn't supposed to scale. It's the relationship that heals. My understanding is that modern evidence-based therapy is basically a checklist of "common sense" advice, a few filters to check if it's the right advice ("stop being lazy" vs "stop working yourself to death" are both good advice depending on context) and some tricks to get the patient to actually listen to the advice that everyone already gives them (e.g. making the patient think they thought of it). You can lead a horse to water, but a skilled therapist's job is to get it to actually drink. As far as I can see, the main issue I see with a lot of LMMs would be that they're fine tuned to agree with people and most people who benefit from therapy are there because they have some terrible ideas that they want to double down on. Yes, the human connection is one of the "tricks". And while a LLM could be useful for someone who actually wants to change, I suspect a lot of people will just find it too easy to "doctor shop" until they find a LLM that tells them their bad habits and lifestyle are totally valid. I think there's probably some good in LLMs but in general they'll probably just be like using TikTok or Twitter for therapy - the danger won't be the lack of human touch but that there's too much choice for people who make bad choices.
  - sonofhans 1y ago
    Your understanding is wrong. What you’re describing is executive coaching — useful advice for already high-functioning people. Ask a real practitioner and they’ll tell you most real therapy is exactly the thing you dismiss as a trick: human connection.
mattdeboard 1y ago
LLMs are about as good at "therapy" as talking to a friend who doesn't understand anything about the internal, subjective experience of being human.
- josephg 1y ago
  And yet, studies show that journaling is super effective at helping to sort out your issues. Apparently in one study, journaling was rated as effective than 70% of counselling sessions by participants. I don’t need my journal to understand anything about my internal, subjective experience. That’s my job. Talking to a friend can be great for your mental health if your friend keeps the attention on you, asks leading questions, and reflects back what you say from time to time. ChatGPT is great at that if you prompt it right. Not as good as a skilled therapist, but good therapists and expensive and in short supply. ChatGPT is way better than nothing. I think a lot of it comes down to promoting though. I’m untrained, but I’ve both had amazing therapists and I’ve filled that role for years in many social groups. I know what I want chatgpt to ask me when we talk about this stuff. It’s pretty good at following directions. But I bet you’d have a way worse experience if you don’t know what you need.
  - shinryuu 1y ago
    How would you prompt it, or what directions would you ask it to follow?
    - josephg 1y ago
      "I'm still processing this issue. Ask me some follow up questions to help me think more about this" "Reflect back what you heard me say, in your own words." "Use an IFS based approach to guide me through this" "I want to sit in this emotion to process it. Stop trying to affirm me. Help me stay in what I'm feeling." ... Stuff like that.
  - deleted 1y ago
    [deleted]
- munificent 1y ago
bovermyer 1y ago
This should not be considered an endorsement of technology so much as an indictment of the failure of extant social systems. The role where humans with broad life experience and even temperaments guide those with narrower, shallower experience is an important one. While it can be filled with the modern idea of "therapist," I think that's too reliant on a capitalist world view. Saying that LLMs fill this role better than humans can - in any context - is, at best, wishful thinking. I wonder if "modern" humanity has lost sight of what it means to care for other humans.
lucasyvas 1y ago
> LLMs offer access to good enough help at cost, scale and availability that human practitioners can only dream of. No
yakattak 1y ago
I've tried both, and the core component that is missing is empathy. A machine can emulate empathy, but its just platitudes. An LLM will never be able to relate to you.
munificent 1y ago
> There have never been more psychologists, psychiatrists, counsellors and social worker, life coach, therapy flops at any time in history and yet mental illness prevalence is at all time highs and climbing. The last time I saw a house fire, there were more firefighters at that property than at any other house on the street and yet the house was on fire.
- theothertimcook 1y ago
  Virology, immunology, and Oncology eradicated entire illnesses and reduced cancer mortality by double digits. Psychology, nearly crashed the peer review system, now recognises excessive use of Xbox as a mental illness.
deleted 1y ago
[deleted]
dbspin 1y ago
>psychologists, psychiatrists, counsellors and social worker Psychotherapy (especially actual depth work rather than CBT) is not something that is commonly available, affordable or ubiquitous. You've said so yourself. As someone who has an undergrad in psychology - and could not afford the time or fees (an additional 6 years after undergrad) to become a clinical psychologist - the world is not drowning in trained psychologists. Quite the opposite. > I wonder what the actual prevalence of similar outcomes is for human therapists? Theres a vast corpus on the efficacy of different therapeutic approaches. Readily googlable. > but not when you're dealing with people from lower socioeconomic classes with experiences that weren't even on your radar You seem to be confusing a psychotherapist with a social worker. There's nothing intrinsic to socioeconomic background that would prevent someone from understanding a psychological disorder or the experience of distress. Although I agree with the implicit point that enormous amounts of psychological suffering are due to financial circumstances. The proliferation of 'life coaches', 'energy workers' and other such hooey is a direct result. And a direct parallel to the substitution of both alternative medicine and over the counter medications for unaffordable care. I note you've made no actual argument for the efficacy of LLM's beyond - they exist and people will use them... Which is of course true, but also a tautology.
- theothertimcook 1y ago
  Youre right you can pretty much run that line backwards for scarcity/availability Shrink, Psych, Social, Counsellor. I was shocked how many psychiatrists deal almost exclusively with treatment and titration of ADHD medication, some are 100% remote via zoom. I've been involved with the publishing of psychology research, my faith in that system is low, see replication crisis comments, beyond that, working in/around mental health I hear of interactions where psychologists or MH social workers have "prescribed" bible study and alike so anecdotal evidence combined with my own experiences over the years. Re: socioeconomic backgrounds, you said so yourself, many cannot afford to go route of clinical psych, increasingly the profession has become pretty exclusive and probably not for the better. Agree regarding the snake oilers but you can't discount distrust and disenfranchisement of/from the establishment nd institutions. 'This way up' is already offering self-paced online CBT, I see LLMs as an extension of that, if only for the simple fact that a person can open a new tab and start the engagement without a referral, appointment, transport, cost, or even really any idea if how the process works. Infact, I'm certain it is already happening based on reading the chatgpt subreddit, as for efficacy I don't think we'll ever really know, I know that I personally would be more comfortable being totally honest with a text box thank a living breathing human so who knows.i appreciate your insights though.

esseph 1y ago

What if they're the same levels of mental health issues as before? Before we'd just throw them in a padded prison. Welcome Home, Sanitarium "There have never been more doctors, and yet we still have all of these injuries and diseases!" Sorry, that argument just doesn't make a lot of sense to me for a whole, while, lot of reasons.

HenryBemis 1y ago
It is similar to "we got all these super useful and productive methods to workout (weight lifting, cardio, yoga, gymnastics, martial arts, etc.) yet people drink, smoke, consume sugar, sit all day, etc. We cannot blame X or Y. "It takes a village". It requires "me" to get my ass off the couch, it requires a friend to ask we go for a hike, and so on. We got many solutions and many problems. We have to pick the better activity (sit vs walk)(smoke vs not)(etc..) Having said that, LLMs can help, but the issue with relying on an LLM (imho) is that it you take a wrong path (like Interstellar's TARS the X parameter is too damn high) you can be detailed, while a decent (certified doc) therapist will redirect you to see someone else.
DharmaPolice 1y ago
>What if they're the same levels of mental health issues as before? Maybe but this raises the question of how on Earth we'd ever know we were on the right track when it comes to mental health. With physical diseases it's pretty easy to show that overall public health systems in the developed world have been broadly successful over the last 100 years. Less people die young, dramatically less children die in infancy and survival rates for a lot of diseases are much improved. Obesity is clearly a major problem, but even allowing for that the average person is likely to live longer than their great-grandparents. It seems inherently harder to know whether the mental health industry is achieving the same level of success. If we massively expand access to therapy and everyone is still anxious/miserable/etc at what point will we be able to say "Maybe this isn't working".
- esseph 1y ago
  Answer: Symptom management. There's a whole lot of diseases and disorders we don't know how to cure in healthcare. In those cases, we manage symptoms. We help people develop tools to manage their issues. Sometimes it works, sometimes it doesn't. Same as a lot of surgeries, actually.
  - heisenbit 1y ago
    As the symptoms in mental illness tend to lead to significant negative consequences (loss of work, home, partner) which then worsen the condition further managing symptoms can have great positive impact.
theothertimcook 1y ago
Psychology has succeeded in creating new disorders while fields like virology, immunology and oncology are eradicating and improving mortality rates. It was these professions and their predecessors doing the padded cell confinement, labotomising and etc.

spondylosaurus 1y ago

> it really is only an option for the elite, which is fine if you're counselling people from similar backgrounds, but not when you're dealing with people from lower socioeconomic classes with experiences that weren't even on your radar A bizarre qualm. Why would a therapist need to be from the same socioeconomic class as their client? They aren't giving clients life advice. They're giving clients specific services that that training prepared them to provide.

koakuma-chan 1y ago
> They're giving clients specific services that that training prepared them to provide. And what would that be?
- spondylosaurus 1y ago
  Cognitive behavioral therapy, dialectic behavioral therapy, EMDR, acceptance and commitment therapy, family systems therapy, biofeedback, exposure and response prevention, couples therapy...?
  - asdf6969 1y ago
    So they just follow instructions from a book? Why can’t an LLM do that? Advice is so situational that I just don’t really believe a therapist would ever understand most of their clients problems. If you’re having a hard time understanding my perspective, imagine a white American therapist giving an Indian American immigrant advice on how to deal with family issues. They will probably never deeply understand the situation.
QuadmasterXLII 1y ago
they don’t need to be from the same class, but without insurance traditional once a week therapy costs as much as rent, and society wide, insurance can’t actually reduce price
- p_ing 1y ago

chrisweekly 1y ago

Respectfully, while I concur that there's a lot of influencer / life coach nonsense out there, I disagree that LLMs are the solution. Therapy isn't supposed to scale. It's the relationship that heals. A "relationship" with an LLM has an obvious, intrinsic, and fundamental problem. That's not to say there isn't any place at all for use of AI in the mental health space. But they are in no way able to replace a living, empathetic human being; the dismal picture you paint of mental health workers does them a disservice. For context, my wife is an LMHC who runs a small group practice (and I have a degree in cognitive psychology though my career is in tech). This ChatGPT interaction is illustrative of the dangers in putting trust in a LLM: https://amandaguinzburg.substack.com/p/diabolus-ex-machina https://amandaguinzburg.substack.com/p/diabolus-ex-machina

wisty 1y ago
> Therapy isn't supposed to scale. It's the relationship that heals. My understanding is that modern evidence-based therapy is basically a checklist of "common sense" advice, a few filters to check if it's the right advice ("stop being lazy" vs "stop working yourself to death" are both good advice depending on context) and some tricks to get the patient to actually listen to the advice that everyone already gives them (e.g. making the patient think they thought of it). You can lead a horse to water, but a skilled therapist's job is to get it to actually drink. As far as I can see, the main issue I see with a lot of LMMs would be that they're fine tuned to agree with people and most people who benefit from therapy are there because they have some terrible ideas that they want to double down on. Yes, the human connection is one of the "tricks". And while a LLM could be useful for someone who actually wants to change, I suspect a lot of people will just find it too easy to "doctor shop" until they find a LLM that tells them their bad habits and lifestyle are totally valid. I think there's probably some good in LLMs but in general they'll probably just be like using TikTok or Twitter for therapy - the danger won't be the lack of human touch but that there's too much choice for people who make bad choices.
- sonofhans 1y ago
  Your understanding is wrong. What you’re describing is executive coaching — useful advice for already high-functioning people. Ask a real practitioner and they’ll tell you most real therapy is exactly the thing you dismiss as a trick: human connection.

mattdeboard 1y ago

LLMs are about as good at "therapy" as talking to a friend who doesn't understand anything about the internal, subjective experience of being human.

josephg 1y ago
And yet, studies show that journaling is super effective at helping to sort out your issues. Apparently in one study, journaling was rated as effective than 70% of counselling sessions by participants. I don’t need my journal to understand anything about my internal, subjective experience. That’s my job. Talking to a friend can be great for your mental health if your friend keeps the attention on you, asks leading questions, and reflects back what you say from time to time. ChatGPT is great at that if you prompt it right. Not as good as a skilled therapist, but good therapists and expensive and in short supply. ChatGPT is way better than nothing. I think a lot of it comes down to promoting though. I’m untrained, but I’ve both had amazing therapists and I’ve filled that role for years in many social groups. I know what I want chatgpt to ask me when we talk about this stuff. It’s pretty good at following directions. But I bet you’d have a way worse experience if you don’t know what you need.
- shinryuu 1y ago
  How would you prompt it, or what directions would you ask it to follow?
  - josephg 1y ago
    "I'm still processing this issue. Ask me some follow up questions to help me think more about this" "Reflect back what you heard me say, in your own words." "Use an IFS based approach to guide me through this" "I want to sit in this emotion to process it. Stop trying to affirm me. Help me stay in what I'm feeling." ... Stuff like that.
- deleted 1y ago
  [deleted]
munificent 1y ago

bovermyer 1y ago

This should not be considered an endorsement of technology so much as an indictment of the failure of extant social systems. The role where humans with broad life experience and even temperaments guide those with narrower, shallower experience is an important one. While it can be filled with the modern idea of "therapist," I think that's too reliant on a capitalist world view. Saying that LLMs fill this role better than humans can - in any context - is, at best, wishful thinking. I wonder if "modern" humanity has lost sight of what it means to care for other humans.

lucasyvas 1y ago

> LLMs offer access to good enough help at cost, scale and availability that human practitioners can only dream of. No

yakattak 1y ago

I've tried both, and the core component that is missing is empathy. A machine can emulate empathy, but its just platitudes. An LLM will never be able to relate to you.

munificent 1y ago

> There have never been more psychologists, psychiatrists, counsellors and social worker, life coach, therapy flops at any time in history and yet mental illness prevalence is at all time highs and climbing. The last time I saw a house fire, there were more firefighters at that property than at any other house on the street and yet the house was on fire.

theothertimcook 1y ago
Virology, immunology, and Oncology eradicated entire illnesses and reduced cancer mortality by double digits. Psychology, nearly crashed the peer review system, now recognises excessive use of Xbox as a mental illness.

deleted 1y ago

[deleted]

dbspin 1y ago

>psychologists, psychiatrists, counsellors and social worker Psychotherapy (especially actual depth work rather than CBT) is not something that is commonly available, affordable or ubiquitous. You've said so yourself. As someone who has an undergrad in psychology - and could not afford the time or fees (an additional 6 years after undergrad) to become a clinical psychologist - the world is not drowning in trained psychologists. Quite the opposite. > I wonder what the actual prevalence of similar outcomes is for human therapists? Theres a vast corpus on the efficacy of different therapeutic approaches. Readily googlable. > but not when you're dealing with people from lower socioeconomic classes with experiences that weren't even on your radar You seem to be confusing a psychotherapist with a social worker. There's nothing intrinsic to socioeconomic background that would prevent someone from understanding a psychological disorder or the experience of distress. Although I agree with the implicit point that enormous amounts of psychological suffering are due to financial circumstances. The proliferation of 'life coaches', 'energy workers' and other such hooey is a direct result. And a direct parallel to the substitution of both alternative medicine and over the counter medications for unaffordable care. I note you've made no actual argument for the efficacy of LLM's beyond - they exist and people will use them... Which is of course true, but also a tautology.

theothertimcook 1y ago
Youre right you can pretty much run that line backwards for scarcity/availability Shrink, Psych, Social, Counsellor. I was shocked how many psychiatrists deal almost exclusively with treatment and titration of ADHD medication, some are 100% remote via zoom. I've been involved with the publishing of psychology research, my faith in that system is low, see replication crisis comments, beyond that, working in/around mental health I hear of interactions where psychologists or MH social workers have "prescribed" bible study and alike so anecdotal evidence combined with my own experiences over the years. Re: socioeconomic backgrounds, you said so yourself, many cannot afford to go route of clinical psych, increasingly the profession has become pretty exclusive and probably not for the better. Agree regarding the snake oilers but you can't discount distrust and disenfranchisement of/from the establishment nd institutions. 'This way up' is already offering self-paced online CBT, I see LLMs as an extension of that, if only for the simple fact that a person can open a new tab and start the engagement without a referral, appointment, transport, cost, or even really any idea if how the process works. Infact, I'm certain it is already happening based on reading the chatgpt subreddit, as for efficacy I don't think we'll ever really know, I know that I personally would be more comfortable being totally honest with a text box thank a living breathing human so who knows.i appreciate your insights though.