5 ms·

Thing is, professional therapy is expensive; there is already a big industry of therapists that work online, through chat, or video calls, whose quality isn't a

• DocTomoe 1y ago
  Often the problem is not even price - it is availability. In my area, the waiting list for a therapy spot is 16 months. A person in crisis does not have 16 months. LLVMs can be therapeutic crutches. Sometimes, a crutch is better than no crutch when you're trying to walk.
  • hellotheretoday 1y ago
    One alleviating factor (potentially) to this is cross state compacts. This allows practitioners utilizing telehealth to practice across state lines which can mitigate issues with things like clients moving, going to college, going on vacation, etc but also can help alleviate underserved areas. Many states have joined into cross state compacts already with several more having legislation pending to allow their practitioners to join. It is moving relatively fast, for legislation on a nationwide level, but still frustratingly slow. Prior to Covid it was essentially a niche issue as telehealth therapy was fairly uncommon whereas Covid made it suddenly commonplace. It will take a bit of time for some of the more stubborn states to adopt legislation and then even more for insurance companies to catch up with the new landscape that involves paneling out of state providers who can practice on across the country
    • potato3732842 1y ago
      Most states just outsource licensing to a professional organization and transfers are a simple matter of filing a form and paying a fee. If practicing across state lines is lucrative there's not much stopping existing listened professionals from doing it.
      • hellotheretoday 1y ago
        the professional org handles certification exam and varying amounts of paperwork verification depending on state but every state has a licensing board to make the final determination and handle grievances Further, transfers are not always as simple as you describe. Sometimes they are. It depends on the states
  • lou1306 1y ago
    Some crutches may absolutely be worse than no crutch at all.
  • abxyz 1y ago
    Price is the issue. The 16-month waiting list is based on cost. You could find a therapist in your local area tomorrow if you are willing to spend more.
    • seb1204 1y ago
      Not sure if willing is the correct word. Able? Also this is not a one off visit/payment.
• shafyy 1y ago
  The issue is that if we go down this path, what will happen is that the gap between access to real therapy and "LLM therapy" will widen, because the political line will be "we have LLM therapy for almost free that's better than nothing, why do we need to reform health care to give equal access for everybody?". The real issue that needs to be solved is that we need to make health care accessible to everybody, regardless of wealth or income. For example, in Germany, where I live, there are also long waitlists for therapists or specialists in general. But not if you have a high income, then you can get private insurance and get an appointment literally the next day. So, we need to get rid of this two class insurance system, and then make sure we have enough supply of doctors and specialists so that the waits are not 3 months.
  • spwa4 1y ago
    > So, we need to get rid of this two class insurance system, and then make sure we have enough supply of doctors and specialists so that the waits are not 3 months. Germany has reduced funding for training doctors. So clearly the opposite is true. > For example, in Germany, where I live, there are also long waitlists for therapists or specialists in general. But not if you have a high income, then you can get private insurance and get an appointment literally the next day. And the German government wants to (or is implementing policies to) achieve the opposite and further reduce access to medical specialists of any kind. Both by taking away funding and taking away spots for education. So they're BOTH taking away access to medical care now, and creating a situation where access to medical specialists will keep reducing for at least the next 7 years. Minimum.
    • shafyy 1y ago
      Yeah, I am not saying Germany is doing it right :D Just explained how it works here and what I think should be improved.
      • spwa4 1y ago
        It really looks that's how a lot of countries intend to solve the crisis they are causing by destroying medical care now: restrict it to fewer and fewer people, without lowering the taxes that pay for it, of course. Great medical care for the select few. No medical care for you and me. And with the traditional difference between socialists and rightists. Socialists will have their party pick who gets medical care, not you and me. Rightists will make it more expensive, which means you and me can't pay for it.
• lr4444lr 1y ago
  Thing is, professional therapy is expensive; there is already a big industry of therapists that work online, through chat, or video calls, whose quality isn't as good as a professional (I am struggling to describe the two). For professional mental health care, there's a wait list, or you're told to just do yoga and mindfulness. So for those people, the LLM is replacing having nothing, not a therapist.
  • vjvjvjvjghv 1y ago
    Which is probably the situation for most people. If you don’t have a ton of money, therapy is hard to get.
  • shaky-carrousel 1y ago
    A sycophant is worse than having nothing, I think.
    • wing-_-nuts 1y ago
      I think AI is great at educating people on topics, but I agree, when it comes to actual treatment AI, especially recent AI, falls all over itself to agree with you
      • JustBreath 1y ago
        It doesn't have to though, we could train AIs that push back or even coordinate with a human therapist similar to how self checkout lines still have an attendant.
    • waste_monk 1y ago
      You're absolutely right! :)
    • s3p 1y ago
      ok, cool? Listing random unrelated facts isn't exactly helpful to the conversation
• micromacrofoot 1y ago
  I know this conversation is going in a lot of different directions. But therapy could be prioritized, better funded, trained, and staffed... it's entirely possible. Americans could fund the military 5% less, create a scholarship and employment fund for therapists, and it would provide a massive boon to the industry in less than a decade. We always give this downtrodden "but we can't change society that quickly" but it's a cop out. We are society. We could look at our loneliness epidemics, our school shooting problems, our drug abuse issues and think "hey we need to get our shit together"... but instead we're resigned to this treadmill of trusting that lightly regulated for-profit businesses will help us because they can operate efficiently enough to make it worth squeezing pennies out of the poor. Ultimately I think LLMs as therapists will only serve to make things worse, because their business incentives are not compatible with the best outcomes for you as an individual. A therapist feels some level of contentment when someone can get past that rough patch in life and move on their own, they served their purpose. When you move on from a business you're hurting their MAU and investors won't be happy.
  • ecshafer 1y ago
    Would increasing funding for therapy help any of those issues? Ignoring that very low efficacy of therapy and the arguments if funding it is worthwhile at all. The American people had fewer issues with school shootings and loneliness and drug abuse when we had even fewer therapists and therapy was something for people in mental asylums, that no respectable person would admit going to.
    • micromacrofoot 1y ago
      Worst case is that we come out on the other end knowing more about the problem. This doesn't have to be 1:1 therapy, research has never been incredibly well funded and it's being dramatically reduced right now. Consider that after school shootings, sometimes therapists have to volunteer their time to provide trauma counseling. Every social worker I've met has at one point volunteered time to help someone because we exist in a system where they're not valued for wanting to help.
  • rekrsiv 1y ago
• RajT88 1y ago
  I have a few friends who are using ChatGPT as sounding board/therapist, and they've gotten surprisingly good results. Replace? No. Not in their case. Supplementary. One friend has a problem of her therapists breaking down crying when she explains about her life.
• rtkwe 1y ago
  The issue is LLM "therapists" are often actively harmful. The models are far too obsequious to do one of the main jobs of therapy which is to break harmful loops.
  • mizzao 1y ago
    I've spoken to some non-LLM therapists that have been harmful as well. They still required a waitlist while also being expensive.
  • rs186 1y ago
    I have talked to therapist who misdiagnosed my symptom and made the issue worse, until I found an expert who actually understood the problem. I do wonder if there are statistics out there for these cases.
    • rtkwe 1y ago
      You're rarely going to get something like the recent rollingstone reports though. The solution is better health coverage and more therapists not giving up and rolling that dice that the machine might agree with the patient (or talk them into thinking) they are indeed the godhead. https://www.rollingstone.com/culture/culture-features/ai-spiritual-delusions-destroying-human-relationships-1235330175/ https://www.rollingstone.com/culture/culture-features/ai-spi...
• giantrobot 1y ago
  There are multiple types of licenses for therapists and fairly strict regulations about even calling yourself a therapist. Trained therapists only have so many levers they can pull with someone so their advice can sometimes boil down to yoga or mindfulness, it's not the answer most want to give but it's what a patient's situation allows inside the framework of the rest of their life. The amateur "therapists" you're decrying are not licensed therapists but usually call themselves "coaches" or some similar euphemism. Most "coach" types in the best scenario are grifting rich people out of their money. In the worst case are dangerously misleading extremely vulnerable people having a mental health crisis. They have no formal training or certification. LLM "therapists" are the functional equivalent to "coaches". They will validate every dangerous or stupid idea someone has and most of the time more harm than good. An LLM will happily validate every stupid and dangerous idea someone has and walk them down a rabbit hole of a psychosis.
• csomar 1y ago
  This. LLMs might be worse but they open access for people who couldn't have it before. Think of the cheap Chinese stuff that we got in the last decade. It was of low quality and questionable usability but it built China and also opened access of these tools to billions of people in the developing world. Would this compromise be worth it for LLM? Time will tell.
• bumby 1y ago
  >professional therapy is expensive…For professional health care, there is a waitlist There’s an old saying in healthcare that you can choose between quality, cost, and access, but you can only choose two. (Peter Attia also adds “choice” to that list). Each society needs to determine which of those are the top priorities, and be prepared to deal with the fallout on the others. Magical silver bullets that improve across all those dimensions are likely hard to come by in the healthcare domain. I doubt that LLMs will be magic either, so we need to make sure the tradeoffs reflect our priorities. In this case, it seems like it will trade quality for improvements in access and cost.
• up2isomorphism 1y ago
  The question is why should that be so expensive? The labor market is not working here. LLM for therapy is way worse than porn for real sex. Since at least the latter does not play around with sanity.
• blueprint 1y ago
  empathy is not the only thing a therapist provides - they have eyes to actually check out the client's actual life - thus the propensity for "AI" to encourage clients' delusions who says we can't change society that quickly? you made up your mind on that yourself without consulting anyone else about their wishes. in the USA we elect people frequently and the entire population just up and goes along with it. so therapy for you will be about more than just empathy. not everything you think or do or say is adaptive. to your point, not everyone wants to give up their falsehood. yet, honesty is a massive cornerstone of therapy progress. i would simply have to start with empathy for you to welcome you in if you won't respond with security to the world telling you that you internalized a negative message (relationship) from the past (about people).
• atoav 1y ago
  Yes theoretically. The issue if people just go to ChatGPT is that a therapist would have clear objections, caveats or other negative feedback ready on the correct situation. Most LLM chatbots go out of their way to never say a critical word at all. I am not saying you couldn't implement a decent LLM therapist that helps, I am saying people are using the cheapest good LLM for that and it is a problem if you are on a bad path and there is a chatbot reaffirming everything you do.
• cema 1y ago
  Many professional therapists are working online now. There are advantages and disadvantages of each approach. Sometimes it is better for a patient to be at home in a comfortable situation during a session. Sometimes visiting the therapist in an office provides a welcome change of scenery. In some cases, such as certain addiction clinics, the patients are required (by law, if I remember correctly) to visit the clinic, at least for some sessions.