3 ms·

At a reactive level I agree; at a practical level, I disagree. I think a better long term goal would be LLMs approved for therapy - that know when a human is ne

At a reactive level I agree; at a practical level, I disagree. I think a better long term goal would be LLMs approved for therapy - that know when a human is needed. My wife is a therapist, an MFT, and having peeked behind the scenes of both her schooling and the others in her practicum, I was aghast and how amateur and slapshot it all appeared. I'm someone who needs and will need therapy for life - I can have bouts of horrible OCD, that when I'm in it, is just awful - I've found someone good, but she's expensive. My point - if you hold therapists on a pedestal, check out the number of legs on that thing.

supersour 1y ago
yes, I definitely agree here. We've known for a long while that 1:1 therapy isn't the only way to treat depression, even if we aim to use psychotherapy methods like CBT/DBT. David Burns released his CBT guide "Feeling Good" in 1980, which he labels as a new genre of "Bibliotherapy". His book is shown to have clinically significant effects on depression remission. Why can an LLM not provide a more focused and interactive version of this very book? Now, I agree with you and the article's argument that one cannot simply throw a gpt-4o at a patient and expect results. The LLM must be trained to both be empathetic and push back against the user when necessary, forcing the user to build nuance in their mental narrative and face their cognitive distortions.
- BobaFloutist 1y ago
  1:1 therapy isn't the only way to treat depression, but it's still unmatched for personality disorders, and can be a huge force multiplier with medication for OCD, GAD, MDD, Schizophrenia, ADHD, and, yes, depression. The problem is that because therapy is as much art as science, the subset of skilled, intelligent therapists is much smaller than the set of all therapists, and the subset of skilled, intelligent therapists with experience and knowledge of your particular disorder and a modality that's most effective for you is tiny, making it frustratingly hard to find a good match.
genewitch 1y ago
LCSW requirements in Louisiana: Complete 5760 hours of clinical experience Complete 3840 hours of supervised clinical experience Complete 96 hours of BACS supervision Take the LCSW test ($260) Pay the application fee to LASWBE ($100) Complete 20 hours of continuing education yearly And first you have to get the MSW master's degree, and test to become licensed, and have professional insurance. That 96 hours "BACS" is ~$100 per hour, max 1 hour per week, and has to be completed in <4 years. The "slapshot" education is because all this is "soft science" - the real education is in on-the-job training. hence requiring over 5000 hours of clinical experience. I also have stuff to say about other comments, but suffice to say "neither your experience, nor your cohort's experience, are universal". Feeding patient files and clinical notes into a training set violates so many ethical and legal rules; but barring that, you gotta train those 8000+ hours worth, for each cohort, in each geographical or political region. What works in Louisiana may not be as effective in DTLA or SEATAC. What works in emergency mental health situations won't work on someone burnt out from work, or experiencing compassion fatigue. Being a mental health professional in a hospital environment is different than in a clinical environment is different than in private practice. That's what the 8000 hours of training trains, for the environment it will be used in. Sure, someone could pull a meta and just violate ethics and do it anyhow, but what will they charge to use it? How will the "LLM" keep track of 45 minutes worth of notes per session? Do you have any idea how much writing is involved? treatment plans, session notes, treatment team notes, nevermind the other overheads. LLM can barely function as an "artist" of any sort, but we want to shoehorn in mental health? c'mon.
- bigmattystyles 1y ago
  I agree with almost everything you said - especially, about LLMs not being nearly ready yet. I didn't phrase that very well. The practicum and supervision, did seem very intense and thorough and I will admit that since that involved actual clients, what my wife could/should/did share about it was nearly nil so my visibility into it was just as nil. The part I disagree with is: >> Feeding patient files and clinical notes into a training set violates so many ethical and legal rules I know it's unrealistic but I wonder if completely anonymized records would help or if that would remove so much context as to be useless. I guess I would allow for my anonymized enough medical records to be available for training 100 years after my death, though I get that even that is a timebomb with genetics. And yes, obviously my comment was a personal anecdote.

supersour 1y ago

yes, I definitely agree here. We've known for a long while that 1:1 therapy isn't the only way to treat depression, even if we aim to use psychotherapy methods like CBT/DBT. David Burns released his CBT guide "Feeling Good" in 1980, which he labels as a new genre of "Bibliotherapy". His book is shown to have clinically significant effects on depression remission. Why can an LLM not provide a more focused and interactive version of this very book? Now, I agree with you and the article's argument that one cannot simply throw a gpt-4o at a patient and expect results. The LLM must be trained to both be empathetic and push back against the user when necessary, forcing the user to build nuance in their mental narrative and face their cognitive distortions.

BobaFloutist 1y ago
1:1 therapy isn't the only way to treat depression, but it's still unmatched for personality disorders, and can be a huge force multiplier with medication for OCD, GAD, MDD, Schizophrenia, ADHD, and, yes, depression. The problem is that because therapy is as much art as science, the subset of skilled, intelligent therapists is much smaller than the set of all therapists, and the subset of skilled, intelligent therapists with experience and knowledge of your particular disorder and a modality that's most effective for you is tiny, making it frustratingly hard to find a good match.

genewitch 1y ago

LCSW requirements in Louisiana: Complete 5760 hours of clinical experience Complete 3840 hours of supervised clinical experience Complete 96 hours of BACS supervision Take the LCSW test ($260) Pay the application fee to LASWBE ($100) Complete 20 hours of continuing education yearly And first you have to get the MSW master's degree, and test to become licensed, and have professional insurance. That 96 hours "BACS" is ~$100 per hour, max 1 hour per week, and has to be completed in <4 years. The "slapshot" education is because all this is "soft science" - the real education is in on-the-job training. hence requiring over 5000 hours of clinical experience. I also have stuff to say about other comments, but suffice to say "neither your experience, nor your cohort's experience, are universal". Feeding patient files and clinical notes into a training set violates so many ethical and legal rules; but barring that, you gotta train those 8000+ hours worth, for each cohort, in each geographical or political region. What works in Louisiana may not be as effective in DTLA or SEATAC. What works in emergency mental health situations won't work on someone burnt out from work, or experiencing compassion fatigue. Being a mental health professional in a hospital environment is different than in a clinical environment is different than in private practice. That's what the 8000 hours of training trains, for the environment it will be used in. Sure, someone could pull a meta and just violate ethics and do it anyhow, but what will they charge to use it? How will the "LLM" keep track of 45 minutes worth of notes per session? Do you have any idea how much writing is involved? treatment plans, session notes, treatment team notes, nevermind the other overheads. LLM can barely function as an "artist" of any sort, but we want to shoehorn in mental health? c'mon.

bigmattystyles 1y ago
I agree with almost everything you said - especially, about LLMs not being nearly ready yet. I didn't phrase that very well. The practicum and supervision, did seem very intense and thorough and I will admit that since that involved actual clients, what my wife could/should/did share about it was nearly nil so my visibility into it was just as nil. The part I disagree with is: >> Feeding patient files and clinical notes into a training set violates so many ethical and legal rules I know it's unrealistic but I wonder if completely anonymized records would help or if that would remove so much context as to be useless. I guess I would allow for my anonymized enough medical records to be available for training 100 years after my death, though I get that even that is a timebomb with genetics. And yes, obviously my comment was a personal anecdote.