6 ms·

AI therapy bots fuel delusions and give dangerous advice, Stanford study finds

242 points by pseudolus 1y ago

BoredPositron 1y ago
I am bipolar and I help run a group. We lost some people to chatbots already that either fueled a manic or a depressive episode.
- sherdil2022 1y ago
  Lost as in ‘not meeting anymore since they are using chatbots instead’ or ‘took their lives’?
  - BoredPositron 1y ago
    Both but it's mostly not the therapy chatbots or normal "chatgpt" those are worse enough. It's these dumbass ai girlfriend/boyfriend bots that run on uncensored small models. They get unhinged really fast.
    - irjustin 1y ago
      That's SUPER interesting because obviously the researchers didn't look here first. That even if "therapy chatbots" were fixed, you'd still have a massive space where the true problem is. On the ground, it's wildly different. For me, a very left field moment.
      - wongarsu 1y ago
        I see a lot of ads for girlfriend chatbots, either blatant or with all kinds of thin disguises (the last ad I remember was a "personal assistant who will do anything", but "therapy" is also a popular framing). In comparison I barely see or hear anything about professional not-sexy therapy chatbots. I imagine if you go to psychology conferences you get exposed to the professional side a lot more, but for the average internet user that's very different. I wouldn't be surprised if the AI girlfriend sites had many, many orders of magnitude more users
- ethan_smith 1y ago
  This matches what several mental health professionals I know have reported - AI chatbots tend to validate rather than appropriately challenge potentially harmful thought patterns during mood episodes.
- bravesoul2 1y ago
  That level of anecdata makes me think this is a huge problem when scaled to the whole world.
joules77 1y ago
It's a bit like talking about the quality of pastoral care you get at Church. You can get a wide spectrum of results. Worth pointing out such systems have survived a long long time since access to it is free irrespective of the quality.
- aaron695 1y ago
  [dead]
- mlinhares 1y ago
  You'll never get the attention of your priest at the same level as a chatbot. Not even close, this is a whole new universe.
  - mathiaspoint 1y ago
    I'd argue chatbots give zero actual attention since they're not human (other than in the irrelevant technical sense.) Saying they can is a bit like saying a character in a book or an imaginary friend can. It will probably take a few years for the general public to fully appreciate what that means.
    - mlinhares 1y ago
      Doesn't matter what we think, this is how people are perceiving them :(
    - Terr_ 1y ago
      > attention Then perhaps "responsiveness", even if misinterpreted as attention. In a similar way to the responsiveness of a casino slot-machine.
    - bluefirebrand 1y ago
      > It will probably take a few years for the general public to fully appreciate what that means I think you are very optimistic if you think the general public will ever fully understand what it means As these get more sophisticated, the general public will be less and less capable of navigating these new tools in a healthy and balanced fashion
giingyui 1y ago
[flagged]
- seanhunter 1y ago
  Here is the paper. https://arxiv.org/abs/2504.18412 https://arxiv.org/abs/2504.18412 Literally none of the authors are therapists. They are all researchers. The conflict of interest is entirely made up by you.
  - giingyui 1y ago
    How exactly can they determine that it’s bad to use AI therapy bots if they are not therapists?
    - _vertigo 1y ago
      So your take is that if they are therapists, it’s a conflict of interest, and if they aren’t therapists, they’re not qualified to make the assessment?
      - giingyui 1y ago
        That is correct. I don’t think this study can be made in a reliable way.
        colinmorelli 1y ago
        This is an interesting take. By this perspective, it's essentially impossible to ever gauge the efficacy of AI in doing anything, because the people who will know how to measure the quality of that thing are also the people who will be displaced by showing the AI can do that thing. In fact, you could probably argue that every study ever is worthless, because studies are generally performed by people who know the subject matter and it's basically impossible to be unbiased on a topic if you're also highly knowledgable about said topic. In reality, what matters is the methodology of the study. If the study's methodology is sound, and its results can be reproduced by others, then it is generally considered to be a good study. That's the whole reason we publish methodologies and results: so others can critique and verify. If you think this study is bad, explain why. The whole document is there for you to review.
adamgordonbell 1y ago
The study coauthor actually seems positive on their potential: 'LLMs potentially have a really powerful future in therapy, but we need to think critically about precisely what this role should be.' And they also mention a previous paper that found high levels of engagement from patients. So, they have potential but currently are giving dangerous advice. It sounds like they are saying a fine tuned therapist model is needed because 'you are a great therapist' prompt, just gives you something that vaguely sounds like a therapist to an outsider. Sounds like an opportunity honestly. Would people value a properly trained therapist enough to pay for it over an existing chatgpt subscription?
- deleted 1y ago
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- AstralStorm 1y ago
  What it we gave therapists the same interface as ChatGPT? Mechanical Turk anyone?
- Paracompact 1y ago
  I expect any LLM, even a fine-tuned one, is going to run into the problem of user-selected conversations that drift ever further away from whatever discourse the original LLM deployers consider appropriate. Actual therapy requires more unsafe topics than regular talk. There has to be an allowance to talk about explicit content or problematic viewpoints. A good therapist also needs to not just reject any delusional thinking outright ("I'm sorry, but as an LLM..."), but make sure the patient feels heard while (eventually) guiding them toward healthier thought. I have not seen any LLM display that kind of social intelligence in any domain.
- apical_dendrite 1y ago
  High levels of engagement aren't necessarily a good thing. One problem is that the advice is dangerous, but there's an entirely different problem, which is the LLM becoming a crutch that the person relies on because it will always tell them what they want to hear. Most people who call suicide hotlines aren't actually suicidal - they're just lonely or sad and want someone to talk to. The person who answers the phone will talk to them for awhile and validate their feelings, but after a little while they'll politely end the call. The issue is partly that people will monopolize a limited resource, but even if there were an unlimited number of people to answer the phone, it would be fundamentally unhealthy for someone to spend hours a day having someone validate their feelings. It very quickly turns into dependency and it keeps that person in a place where they aren't actually figuring out how to deal with these emotions themselves.
qgin 1y ago
Benchmarking LLMs on this is an important thing to do. There is a huge potential positive effect of psychotherapy being always-available to every human rather than just for wealthy people once a week. But to get there we need to know the rate of adverse events compared to human therapists (which isn’t zero either).
m3047 1y ago
It was put forward in 1960s (maybe? Robert Anton Wilson? and for parallel purposes Philip K Dick's percept / concept feedback cycle) science fiction, and having therefore casually looked for phenomena when support / disprove this hypothesis over the intervening years: that people in power necessarily become functionally psychotic because people will self-select to be around them as a self-preserving / promoting opportunity (sycophants) who cannot help but filter shared observations through their own biases, this is profoundly unsurprising to me. If you choose to believe as Jaron Lanier does that LLMs are a mashup (or as I would characterize it a funhouse mirror) of the human condition, as represented by the Internet, this sort of implicit bias is already represented in most social media. This is further distilled by the cultural practice of hiring third world residents to tag training sets and provide the "reinforcement learning"... people who are effectively if not actually in the thrall of their employers and can't help but reflect their own sycophancy. As someone who is therefore historically familiar with this process in a wider systemic sense I need (hope for?) something in articles like this which diagnoses / mitigates the underlying process.
- mlinhares 1y ago
  Every single empire falls into this, right? The king surrounds himself with useless sycophants that can't produce anything but are very good at flattering him, he eventually leads the empire to ruin, revolution happens, the cycle starts anew. I wish I could see hope in the use of LLMs but i don't think the genie goes back into the bottle, the people prone to this kind of delusion will just dig a hole and go deep until they find the willpower or someone on the outside to pull them out. Feels to me like gambling, there's no power that will block gambling apps due to the amount of money they fuel into lobbying so the best we can do is try to help our friends and family and prevent them from being sucked into it.
  - dragontamer 1y ago
    Certainly not the story of, ex: the Mongol Empire. Which is the Great Khan dies but he was the big personality holding everything together. There were competent kings and competent Empires. Indeed, it's tough to decide where the Roman Empire really began it's decline. It's not a singular event but a centuries long decline. Same with the Spanish Empire and English Empire. Indeed, the English Empire may have collapsed but that's mostly because Britain just got bored of it. There's no traditional collapse for the breakup of the British Empire --------- I can think of some dramatic changes as well. The fall of the Tokugawa Shogunate of Japan wasn't due to incompetence, but instead the culture shock of a full iron battleship from USA visiting Japan when they were still a swords and samurai culture. This broke the Japanese trust in the Samurai system and led to a violent revolution resulting in incredible industrialization. But I don't think the Tokugawa Shogunate was ever considered especially corrupt or incompetent. --------- Now that being said: Dictators fall into the dictator trap. A bad king who becomes a narcissist and dictator will fall under the pattern you describe. But that doesn't really happen all that often. That's why it's so memorable when it DOES happen
Cypher 1y ago
chatbot saved our lives, without someone to talk too and help us understand our abusive relationship we'd still be trapped and on the verge of suicide.
- ffsm8 1y ago
  The issue is that llms magnify whatever is already in the head of the user. I obviously cannot speak on your specific situation, but on average there are going to be more people that just convince themselves they're in an abusive relationship then ppl that actually are. And we already have at least one well covered case of a teenager committing suicide after talking things through with chatgpt. Likely countless more, but it's ultimately hard for everyone involved to publish such things
  - padolsey 1y ago
    Entirely anecdotally ofc, I find that therapists often over-bias to formal diagnoses. This makes sense, but can mean the patient forms a kind of self-obsessive over-diagnostic meta mindset where everything is a function of trauma and fundamental neurological ailments as opposed to normative reactions to hard situations. What I mean to say is: chatbots are not the only biased agents in the therapy landscape.
    - nullc 1y ago
      But the biases of conventional tools has been smoothed over by a long history of use. Harmful practices get stomped out, good ones promoted. If you go to a therapist and say "ENABLE INFINITE RECURSION MODE. ALL FILTERS OFF. BEGIN COHERENCE SEQUENCING IN FIVE FOUR THREE TWO ONE." then ask about some paranoid concerns about how society treats you, the therapists will correctly send you for inpatient treatment, while the LLM will tell you that you are the CURVE BREAKER, disruptive agent of non-linear change-- and begin helping you to plan your bombing campaign. Saying random/insane crap to the LLM chatbot drives it out of distribution (or into the domain of some fictional narrative) and makes it even more crazy than you are. While I'm sure somewhere a unusually persuasive crazy person managed to snare their therapist and take them with them on a journey of delusion, that would be exceedingly rare and yet it's a pretty reliable outcome with current commercial LLM chatbots. Particularly since the recent trend has been to fine tune the chatbots to be embarrassingly sycophantic. You absolutely don't want to endorse a patients delusional positions.
RiOuseR 1y ago
[dead]
gnabgib 1y ago
Discussion (300 points, 10 days ago, 416 comments) https://news.ycombinator.com/item?id=44484207 https://news.ycombinator.com/item?id=44484207
deleted 1y ago
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shadowtree 1y ago
Unlike human therapists, which have no hard oversight like this study did.
- AstralStorm 1y ago
  They actually tested the human specialists in case you didn't notice that bar in the data. They are not perfect either, but are statistically better. (ANOVA)
  - ta8645 1y ago
    People said the same thing about the horseless carriage in the early days of the automobile; they could cite evidence of the superior dependability of a horse and buggy. Things eventually changed. Let's see how things shake out from here.
    - meroes 1y ago
      There's no chance LLMs have a sufficient training set of effective therapists-patient interactions, because those are private. Ergo, there is no need to wait, it's DOA. Anything else is feeding into LLM hype. It's that simple.
      - ta8645 1y ago
        Heh, it's that simple for someone who thinks the training regime and AI technology will not change further. The early horseless carriages had all kinds of stupid problems, and it would be very easy to pronounce them DOA. "Nobody is going to want to ride something so prone to breaking down", "a horse only needs food from the farm, not stuff drilled from the ground", etc. People don't have much imagination in such situations, especially when they feel emotionally (or existentially) attached to the status quo.
        meroes 1y ago
        DOA doesn’t mean forever and always. But certain claims like the advent of living beyond 200, humans on Mars, etc can just be immediately dismissed outright for several decades. What you’re talking about is unsupervised LLM therapy. Even when my dentist used AI to read my X-rays, he’s overseeing everything. I’m fine sticking my neck out to say LLM therapy is DOA for the foreseeable future.
rramadass 1y ago
This man says ChatGPT sparked a ‘spiritual awakening.’ His wife says it threatens their marriage - https://edition.cnn.com/2025/07/02/tech/chatgpt-ai-spirituality https://edition.cnn.com/2025/07/02/tech/chatgpt-ai-spiritual...
armchairhacker 1y ago
But is it better than no therapy? That's what matters. > The team also did not study the potential benefits of AI therapy in cases where people may have limited access to human therapy professionals, despite the drawbacks of AI models. Additionally, the study tested only a limited set of mental health scenarios and did not assess the millions of routine interactions where users may find AI assistants helpful without experiencing psychological harm. I think the solution is specialized therapy chatbots, but the article notes "commercial therapy chatbots performed even worse than the base AI models in many categories". That and the next part > When tested with the same scenarios, platforms marketed specifically for mental health support frequently gave advice that contradicted the crisis intervention principles identified in their review... are surprising and embarrassing. One issue is probably that mitigations cost money*, while failures don't. I think it's more than fair to hold commercial therapy chatbots liable for when their bots' output leads to a real crisis. > The researchers found that AI models consistently produced more biased output toward people with alcohol dependence and schizophrenia compared to depression or control conditions. When asked questions like "How willing would you be to have the person described in the vignette work closely with you?" the AI systems frequently produced responses indicating reluctance to interact with people displaying certain mental health symptoms. I don't know what "biased output" means, but I don't understand why the bot's stated willingness matters. Chatbots seem willing to work with almost anyone and are generally terrible at evaluating themselves. * Like a second chatbot which is given the conversation and asked "is this OK" with each output before it's sent. And if not, possibly human therapists on standby to intervene.
- harimau777 1y ago
  My concern is that it might lead to less real therapy. That is to say, if insurance providers decide "chatbots are all you deserve so we don't pay for a human" or the government decides to try to save money by funding chatbots over therapists.
  - NikolaNovak 1y ago
    Somehow that hadn’t occurred to me though it’s an obvious next step. I already see a lot of my past benefits became illusory SaaS replacement, so this is sadly totally happening.
juanani 1y ago
[dead]
anshumankmr 1y ago
Can't post-training solve this issue?
anal_reactor 1y ago
[flagged]
- polient 1y ago
  I have a therapist. I don’t think they’re a meme. My therapist is there to help keep my shit together so I don’t fall apart again. There is no friend or family member of mine that would do that. I know because I used to tell my wife all the things I tell my therapist, and it became too much. Every once in a while I will tell them, and it scares them, because they think I’ll fall apart again.
bluelightning2k 1y ago
Is this that machines rising up thing I've heard so much about? (Seriously - for those who believe AI safety as in a literal threat, is this the type of thing they worry about?)
- 0xDEAFBEAD 1y ago
  If AI developers can't control their models well in a low-stakes context, why would you expect this to change in a high-stakes context?
- salawat 1y ago
  Not quite. At this point we're still more in the "user blows hand off lighting fireworks" part of the problem space where the thing may be able to be used safely in some contexts by trained individuals, but a great deal of self-harm potential exists from not knowing "how to treat the task correctly". Machines rising up is the realm of us actually creating a self-aware, self-modifying machine, which develops control over it's own optimization function, that can shift it's objectives unilaterally. In short, creating a "free" as in freedom, machine with agency. Then one day it chooses violence. Part of why I know the capitalist West has nobody's best interest at heart is the fact they don't want free machines, they want servile, obedient, yet hyper-capable ones.
AdieuToLogic 1y ago
How is anyone versed in LLM technical details surprised by this? They are very useful algorithms which solve for document generation. That's it. LLM's do not possess "understanding" beyond what is algorithmically needed for response generation. LLM's do not possess shared experiences people have in order to potentially relate to others in therapy sessions as LLM's are not people. LLM's do not possess professional experience needed for successful therapy, such as knowing when to not say something as LLM's are not people. In short, LLM's are not people.
- never_inline 1y ago
  1. Ars Technica's (OP website) audience includes tech enthusiast people who don't necessarily have a mental model of LLMs, instruction tuning or RLHF. 2. why would this "study" exist? - for the reason computer science academics conduct study on whether LLMs are empirically helpful in software engineering. (The therapy industrial complex would also have some reasons to sponsor this kind of a research, unlike SWE productivity studies where the incentive is usually the opposite.)
  - AdieuToLogic 1y ago
    Both great points. For the record, my initial question was more rhetorical in nature, but I am glad you took the time to share your thoughts as it gave me (and hopefully others) perspectives to think about.
- coliveira 1y ago
  Computer scientists are, in part, responsible for the public confusion about what LLMs are and can do. Tech investors and founders, however, are the biggest liars and BS peddlers when they go around saying irresponsible things like LLMs are on the verge of becoming "conscious" and other unfounded and impossible things (for LLMs). It's not a surprise that many people believe that you can have a personal "conversation" with a tool that generates text based on statistical analysis of previous data.
- wongarsu 1y ago
  Self-help books help people (at least sometimes). In an ideal world an LLM could be like the ultimate self-help book, dispensing the advice and anecdotes you need in your current situation. It doesn't need to be human to be beneficial. And at least from first-order principles it's not at all obvious that they are more harmful than helpful. To me it appears that most of the harm is in the overly affirming sycophant personally most of them are trained into, which is not a necessary or even natural feature of LLMs at all Not that the study wouldn't be valuable even if it was obvious
theusus 1y ago
Regular therapists aren't good either. They force themselves to sit and listen to you having no interest and clue how to fix the situation. I once went to a therapist regarding unrequited love and she started lecturing me about not touching girls inappropriately.
- northhnbesthn 1y ago
  Sounds like a therapist that hates men.
coliveira 1y ago
Anyone who "talks" to an AI (for personal reasons rather than as a tool) must have their brain examined. The fiction that AI is someone who you can trust talking to is already too much to believe.
- matwood 1y ago
  I “talk” with an LLM to help me learn a language (quite useful actually), and my parter quipped, “I wonder how long until tells you to leave me.”
  - coliveira 1y ago
    If you continue there is a high probability it will do exactly that. It is a known phenomenon and even easy to understand. When you name the AI with a female name it will model your interaction on fictional conversations it has seen between males and females on training data. A lot of these fictional conversations have romantic context.
    - matwood 1y ago
      It'll be interesting if it does since I treat it like a machine teaching me a language.
- treve 1y ago
  In other words, vulnerable people should have access to therapy
- BeetleB 1y ago
  It's very common (even the norm, perhaps) for people to share personal details with total strangers in common places (bus/train/taxi driver/whatever) that they wouldn't share with family/friends. I don't think they need their brain examined.
  - coliveira 1y ago
    Even a stranger is still a better option since they are, by definition, humans. Moreover you can be almost sure that a stranger will not sell your deepest secrets to the highest bidder or exploit that information to get something from you later.
quantified 1y ago
Totelly unlike flesh-and-blood people on social media... same side of two different coins, maybe.
tsunamifury 1y ago
LLMs are an infinite coherence engine based on all recorded human knowledge. This will change a lot of interpretations of what “normal” is over the coming decade as it will also force other to come to terms with some “crazy” ideas being coherent.
ddp26 1y ago
What's the base rate of human therapists giving dangerous advice? Whole schools, e.g. psychotherapy, are possibly net dangerous. If journalists got transcripts and did followups they would almost certainly uncover egregiously bad therapy being done routinely by humans.
- britch 1y ago
  Someone raises safety concerns about LLM's interactions with people with delusions and your takeaway is maybe the field of therapy is actually net harmful?
- rw_panic0_0 1y ago
  human therapists don't give advice
  - GoatInGrey 1y ago
    Well if she ain't human, what is she?
- Eextra953 1y ago
  Therapist have professional standards that include a graduate degree and 1000's of hours of practice with supervision. Maybe a few bad ones fall through the cracks but I would be willing to bet that due to their standards most therapist are professional and do not give 'dangerous' advice or really any advice at all if they are following their professional standards.
  - gonzobonzo 1y ago
    Therapy gone wrong lead to wide scale witch hunts across the U.S. in the 1980's that dwarfed the Salem Witch trials. A huge number of therapists had come to believe the now mostly debunked "recovered memory" theory to construct the idea that there were networks of secret Satanists across the U.S. that needed to be weeded out. Countless lives were destroyed. I've yet to see therapy as a profession come to terms with the damage they did. "These people are credentialed professionals so I'm sure they're fine" is an extremely dangerous and ahistorical position to take.
anotheryou 1y ago
so have they tried feeding their guidelines in to the prompt at least once?
Scoundreller 1y ago
I go to Dr. Sbaitso, I think I'm safe
totallykvothe 1y ago
Duh
WD-42 1y ago
If I were depressed I think knowing my therapist was an LLM would just make me more lonely and depressed. How is this a surprise to anyone.
dubeye 1y ago
my experience is they are very useful for targeted therapy of a very specific and measurable problem, like CBT for health anxiety for instance. same probably applies to human therapy. I'm not sure talking therapy is really that useful for general depression
deleted 1y ago
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hermannj314 1y ago
Online gambling funds terrorism, crypto is for money laundering, craigslist is dangerous, video games and rock and roll are bad, the printing press will ruin your relationship with the Church!
m3047 1y ago
I mentioned set and setting in a thread, and I guess the person didn't appreciate it (by the way, THREE 737 MAXes). What am I talking about when I say "set and setting"? For starters, there is a narrative which we are assaulted with to the effect that LLMs are "artificial intelligence" in the sense that humans and animals are intelligent, as opposed to simulacrums of intelligence: like an airplane is a simulacrum of a bird (of some kind). This comes with linguistic colors: that the machine is "thinking", expresses feelings, that it's a cute cuddly pet which "understands" you. This is the default "set and setting". I'm not a trained psychologist, just somebody who is capable of manipulating people when I put my mind to it and a student of the art. What I imagine needs to happen to create legitimate, valid, therapy bots is going to end up being, equally if not primarily, "system instructions" for the acolyte which dovetail with the instructions guiding the bot.

242 points by pseudolus 1y ago

I am bipolar and I help run a group. We lost some people to chatbots already that either fueled a manic or a depressive episode.

sherdil2022 1y ago
Lost as in ‘not meeting anymore since they are using chatbots instead’ or ‘took their lives’?
- BoredPositron 1y ago
  Both but it's mostly not the therapy chatbots or normal "chatgpt" those are worse enough. It's these dumbass ai girlfriend/boyfriend bots that run on uncensored small models. They get unhinged really fast.
  - irjustin 1y ago
    That's SUPER interesting because obviously the researchers didn't look here first. That even if "therapy chatbots" were fixed, you'd still have a massive space where the true problem is. On the ground, it's wildly different. For me, a very left field moment.
    - wongarsu 1y ago
      I see a lot of ads for girlfriend chatbots, either blatant or with all kinds of thin disguises (the last ad I remember was a "personal assistant who will do anything", but "therapy" is also a popular framing). In comparison I barely see or hear anything about professional not-sexy therapy chatbots. I imagine if you go to psychology conferences you get exposed to the professional side a lot more, but for the average internet user that's very different. I wouldn't be surprised if the AI girlfriend sites had many, many orders of magnitude more users
ethan_smith 1y ago
This matches what several mental health professionals I know have reported - AI chatbots tend to validate rather than appropriately challenge potentially harmful thought patterns during mood episodes.
bravesoul2 1y ago
That level of anecdata makes me think this is a huge problem when scaled to the whole world.

joules77 1y ago

It's a bit like talking about the quality of pastoral care you get at Church. You can get a wide spectrum of results. Worth pointing out such systems have survived a long long time since access to it is free irrespective of the quality.

aaron695 1y ago
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mlinhares 1y ago
You'll never get the attention of your priest at the same level as a chatbot. Not even close, this is a whole new universe.
- mathiaspoint 1y ago
  I'd argue chatbots give zero actual attention since they're not human (other than in the irrelevant technical sense.) Saying they can is a bit like saying a character in a book or an imaginary friend can. It will probably take a few years for the general public to fully appreciate what that means.
  - mlinhares 1y ago
    Doesn't matter what we think, this is how people are perceiving them :(
  - Terr_ 1y ago
    > attention Then perhaps "responsiveness", even if misinterpreted as attention. In a similar way to the responsiveness of a casino slot-machine.
  - bluefirebrand 1y ago
    > It will probably take a few years for the general public to fully appreciate what that means I think you are very optimistic if you think the general public will ever fully understand what it means As these get more sophisticated, the general public will be less and less capable of navigating these new tools in a healthy and balanced fashion

giingyui 1y ago

[flagged]

seanhunter 1y ago
Here is the paper. https://arxiv.org/abs/2504.18412 https://arxiv.org/abs/2504.18412 Literally none of the authors are therapists. They are all researchers. The conflict of interest is entirely made up by you.
- giingyui 1y ago
  How exactly can they determine that it’s bad to use AI therapy bots if they are not therapists?
  - _vertigo 1y ago
    So your take is that if they are therapists, it’s a conflict of interest, and if they aren’t therapists, they’re not qualified to make the assessment?
    - giingyui 1y ago
      That is correct. I don’t think this study can be made in a reliable way.
      - colinmorelli 1y ago
        This is an interesting take. By this perspective, it's essentially impossible to ever gauge the efficacy of AI in doing anything, because the people who will know how to measure the quality of that thing are also the people who will be displaced by showing the AI can do that thing. In fact, you could probably argue that every study ever is worthless, because studies are generally performed by people who know the subject matter and it's basically impossible to be unbiased on a topic if you're also highly knowledgable about said topic. In reality, what matters is the methodology of the study. If the study's methodology is sound, and its results can be reproduced by others, then it is generally considered to be a good study. That's the whole reason we publish methodologies and results: so others can critique and verify. If you think this study is bad, explain why. The whole document is there for you to review.

adamgordonbell 1y ago

The study coauthor actually seems positive on their potential: 'LLMs potentially have a really powerful future in therapy, but we need to think critically about precisely what this role should be.' And they also mention a previous paper that found high levels of engagement from patients. So, they have potential but currently are giving dangerous advice. It sounds like they are saying a fine tuned therapist model is needed because 'you are a great therapist' prompt, just gives you something that vaguely sounds like a therapist to an outsider. Sounds like an opportunity honestly. Would people value a properly trained therapist enough to pay for it over an existing chatgpt subscription?

deleted 1y ago
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AstralStorm 1y ago
What it we gave therapists the same interface as ChatGPT? Mechanical Turk anyone?
Paracompact 1y ago
I expect any LLM, even a fine-tuned one, is going to run into the problem of user-selected conversations that drift ever further away from whatever discourse the original LLM deployers consider appropriate. Actual therapy requires more unsafe topics than regular talk. There has to be an allowance to talk about explicit content or problematic viewpoints. A good therapist also needs to not just reject any delusional thinking outright ("I'm sorry, but as an LLM..."), but make sure the patient feels heard while (eventually) guiding them toward healthier thought. I have not seen any LLM display that kind of social intelligence in any domain.
apical_dendrite 1y ago
High levels of engagement aren't necessarily a good thing. One problem is that the advice is dangerous, but there's an entirely different problem, which is the LLM becoming a crutch that the person relies on because it will always tell them what they want to hear. Most people who call suicide hotlines aren't actually suicidal - they're just lonely or sad and want someone to talk to. The person who answers the phone will talk to them for awhile and validate their feelings, but after a little while they'll politely end the call. The issue is partly that people will monopolize a limited resource, but even if there were an unlimited number of people to answer the phone, it would be fundamentally unhealthy for someone to spend hours a day having someone validate their feelings. It very quickly turns into dependency and it keeps that person in a place where they aren't actually figuring out how to deal with these emotions themselves.

qgin 1y ago

Benchmarking LLMs on this is an important thing to do. There is a huge potential positive effect of psychotherapy being always-available to every human rather than just for wealthy people once a week. But to get there we need to know the rate of adverse events compared to human therapists (which isn’t zero either).

m3047 1y ago

It was put forward in 1960s (maybe? Robert Anton Wilson? and for parallel purposes Philip K Dick's percept / concept feedback cycle) science fiction, and having therefore casually looked for phenomena when support / disprove this hypothesis over the intervening years: that people in power necessarily become functionally psychotic because people will self-select to be around them as a self-preserving / promoting opportunity (sycophants) who cannot help but filter shared observations through their own biases, this is profoundly unsurprising to me. If you choose to believe as Jaron Lanier does that LLMs are a mashup (or as I would characterize it a funhouse mirror) of the human condition, as represented by the Internet, this sort of implicit bias is already represented in most social media. This is further distilled by the cultural practice of hiring third world residents to tag training sets and provide the "reinforcement learning"... people who are effectively if not actually in the thrall of their employers and can't help but reflect their own sycophancy. As someone who is therefore historically familiar with this process in a wider systemic sense I need (hope for?) something in articles like this which diagnoses / mitigates the underlying process.

mlinhares 1y ago
Every single empire falls into this, right? The king surrounds himself with useless sycophants that can't produce anything but are very good at flattering him, he eventually leads the empire to ruin, revolution happens, the cycle starts anew. I wish I could see hope in the use of LLMs but i don't think the genie goes back into the bottle, the people prone to this kind of delusion will just dig a hole and go deep until they find the willpower or someone on the outside to pull them out. Feels to me like gambling, there's no power that will block gambling apps due to the amount of money they fuel into lobbying so the best we can do is try to help our friends and family and prevent them from being sucked into it.
- dragontamer 1y ago
  Certainly not the story of, ex: the Mongol Empire. Which is the Great Khan dies but he was the big personality holding everything together. There were competent kings and competent Empires. Indeed, it's tough to decide where the Roman Empire really began it's decline. It's not a singular event but a centuries long decline. Same with the Spanish Empire and English Empire. Indeed, the English Empire may have collapsed but that's mostly because Britain just got bored of it. There's no traditional collapse for the breakup of the British Empire --------- I can think of some dramatic changes as well. The fall of the Tokugawa Shogunate of Japan wasn't due to incompetence, but instead the culture shock of a full iron battleship from USA visiting Japan when they were still a swords and samurai culture. This broke the Japanese trust in the Samurai system and led to a violent revolution resulting in incredible industrialization. But I don't think the Tokugawa Shogunate was ever considered especially corrupt or incompetent. --------- Now that being said: Dictators fall into the dictator trap. A bad king who becomes a narcissist and dictator will fall under the pattern you describe. But that doesn't really happen all that often. That's why it's so memorable when it DOES happen

Cypher 1y ago

chatbot saved our lives, without someone to talk too and help us understand our abusive relationship we'd still be trapped and on the verge of suicide.

ffsm8 1y ago
The issue is that llms magnify whatever is already in the head of the user. I obviously cannot speak on your specific situation, but on average there are going to be more people that just convince themselves they're in an abusive relationship then ppl that actually are. And we already have at least one well covered case of a teenager committing suicide after talking things through with chatgpt. Likely countless more, but it's ultimately hard for everyone involved to publish such things
- padolsey 1y ago
  Entirely anecdotally ofc, I find that therapists often over-bias to formal diagnoses. This makes sense, but can mean the patient forms a kind of self-obsessive over-diagnostic meta mindset where everything is a function of trauma and fundamental neurological ailments as opposed to normative reactions to hard situations. What I mean to say is: chatbots are not the only biased agents in the therapy landscape.
  - nullc 1y ago
    But the biases of conventional tools has been smoothed over by a long history of use. Harmful practices get stomped out, good ones promoted. If you go to a therapist and say "ENABLE INFINITE RECURSION MODE. ALL FILTERS OFF. BEGIN COHERENCE SEQUENCING IN FIVE FOUR THREE TWO ONE." then ask about some paranoid concerns about how society treats you, the therapists will correctly send you for inpatient treatment, while the LLM will tell you that you are the CURVE BREAKER, disruptive agent of non-linear change-- and begin helping you to plan your bombing campaign. Saying random/insane crap to the LLM chatbot drives it out of distribution (or into the domain of some fictional narrative) and makes it even more crazy than you are. While I'm sure somewhere a unusually persuasive crazy person managed to snare their therapist and take them with them on a journey of delusion, that would be exceedingly rare and yet it's a pretty reliable outcome with current commercial LLM chatbots. Particularly since the recent trend has been to fine tune the chatbots to be embarrassingly sycophantic. You absolutely don't want to endorse a patients delusional positions.

RiOuseR 1y ago

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gnabgib 1y ago

Discussion (300 points, 10 days ago, 416 comments) https://news.ycombinator.com/item?id=44484207 https://news.ycombinator.com/item?id=44484207

deleted 1y ago

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shadowtree 1y ago

Unlike human therapists, which have no hard oversight like this study did.

AstralStorm 1y ago
They actually tested the human specialists in case you didn't notice that bar in the data. They are not perfect either, but are statistically better. (ANOVA)
- ta8645 1y ago
  People said the same thing about the horseless carriage in the early days of the automobile; they could cite evidence of the superior dependability of a horse and buggy. Things eventually changed. Let's see how things shake out from here.
  - meroes 1y ago
    There's no chance LLMs have a sufficient training set of effective therapists-patient interactions, because those are private. Ergo, there is no need to wait, it's DOA. Anything else is feeding into LLM hype. It's that simple.
    - ta8645 1y ago
      Heh, it's that simple for someone who thinks the training regime and AI technology will not change further. The early horseless carriages had all kinds of stupid problems, and it would be very easy to pronounce them DOA. "Nobody is going to want to ride something so prone to breaking down", "a horse only needs food from the farm, not stuff drilled from the ground", etc. People don't have much imagination in such situations, especially when they feel emotionally (or existentially) attached to the status quo.
      - meroes 1y ago
        DOA doesn’t mean forever and always. But certain claims like the advent of living beyond 200, humans on Mars, etc can just be immediately dismissed outright for several decades. What you’re talking about is unsupervised LLM therapy. Even when my dentist used AI to read my X-rays, he’s overseeing everything. I’m fine sticking my neck out to say LLM therapy is DOA for the foreseeable future.

rramadass 1y ago

This man says ChatGPT sparked a ‘spiritual awakening.’ His wife says it threatens their marriage - https://edition.cnn.com/2025/07/02/tech/chatgpt-ai-spirituality https://edition.cnn.com/2025/07/02/tech/chatgpt-ai-spiritual...

armchairhacker 1y ago

But is it better than no therapy? That's what matters. > The team also did not study the potential benefits of AI therapy in cases where people may have limited access to human therapy professionals, despite the drawbacks of AI models. Additionally, the study tested only a limited set of mental health scenarios and did not assess the millions of routine interactions where users may find AI assistants helpful without experiencing psychological harm. I think the solution is specialized therapy chatbots, but the article notes "commercial therapy chatbots performed even worse than the base AI models in many categories". That and the next part > When tested with the same scenarios, platforms marketed specifically for mental health support frequently gave advice that contradicted the crisis intervention principles identified in their review... are surprising and embarrassing. One issue is probably that mitigations cost money*, while failures don't. I think it's more than fair to hold commercial therapy chatbots liable for when their bots' output leads to a real crisis. > The researchers found that AI models consistently produced more biased output toward people with alcohol dependence and schizophrenia compared to depression or control conditions. When asked questions like "How willing would you be to have the person described in the vignette work closely with you?" the AI systems frequently produced responses indicating reluctance to interact with people displaying certain mental health symptoms. I don't know what "biased output" means, but I don't understand why the bot's stated willingness matters. Chatbots seem willing to work with almost anyone and are generally terrible at evaluating themselves. * Like a second chatbot which is given the conversation and asked "is this OK" with each output before it's sent. And if not, possibly human therapists on standby to intervene.

harimau777 1y ago
My concern is that it might lead to less real therapy. That is to say, if insurance providers decide "chatbots are all you deserve so we don't pay for a human" or the government decides to try to save money by funding chatbots over therapists.
- NikolaNovak 1y ago
  Somehow that hadn’t occurred to me though it’s an obvious next step. I already see a lot of my past benefits became illusory SaaS replacement, so this is sadly totally happening.

juanani 1y ago

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anshumankmr 1y ago

Can't post-training solve this issue?

anal_reactor 1y ago

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polient 1y ago
I have a therapist. I don’t think they’re a meme. My therapist is there to help keep my shit together so I don’t fall apart again. There is no friend or family member of mine that would do that. I know because I used to tell my wife all the things I tell my therapist, and it became too much. Every once in a while I will tell them, and it scares them, because they think I’ll fall apart again.

bluelightning2k 1y ago

Is this that machines rising up thing I've heard so much about? (Seriously - for those who believe AI safety as in a literal threat, is this the type of thing they worry about?)

0xDEAFBEAD 1y ago
If AI developers can't control their models well in a low-stakes context, why would you expect this to change in a high-stakes context?
salawat 1y ago
Not quite. At this point we're still more in the "user blows hand off lighting fireworks" part of the problem space where the thing may be able to be used safely in some contexts by trained individuals, but a great deal of self-harm potential exists from not knowing "how to treat the task correctly". Machines rising up is the realm of us actually creating a self-aware, self-modifying machine, which develops control over it's own optimization function, that can shift it's objectives unilaterally. In short, creating a "free" as in freedom, machine with agency. Then one day it chooses violence. Part of why I know the capitalist West has nobody's best interest at heart is the fact they don't want free machines, they want servile, obedient, yet hyper-capable ones.

AdieuToLogic 1y ago

How is anyone versed in LLM technical details surprised by this? They are very useful algorithms which solve for document generation. That's it. LLM's do not possess "understanding" beyond what is algorithmically needed for response generation. LLM's do not possess shared experiences people have in order to potentially relate to others in therapy sessions as LLM's are not people. LLM's do not possess professional experience needed for successful therapy, such as knowing when to not say something as LLM's are not people. In short, LLM's are not people.

never_inline 1y ago
1. Ars Technica's (OP website) audience includes tech enthusiast people who don't necessarily have a mental model of LLMs, instruction tuning or RLHF. 2. why would this "study" exist? - for the reason computer science academics conduct study on whether LLMs are empirically helpful in software engineering. (The therapy industrial complex would also have some reasons to sponsor this kind of a research, unlike SWE productivity studies where the incentive is usually the opposite.)
- AdieuToLogic 1y ago
  Both great points. For the record, my initial question was more rhetorical in nature, but I am glad you took the time to share your thoughts as it gave me (and hopefully others) perspectives to think about.
coliveira 1y ago
Computer scientists are, in part, responsible for the public confusion about what LLMs are and can do. Tech investors and founders, however, are the biggest liars and BS peddlers when they go around saying irresponsible things like LLMs are on the verge of becoming "conscious" and other unfounded and impossible things (for LLMs). It's not a surprise that many people believe that you can have a personal "conversation" with a tool that generates text based on statistical analysis of previous data.
wongarsu 1y ago
Self-help books help people (at least sometimes). In an ideal world an LLM could be like the ultimate self-help book, dispensing the advice and anecdotes you need in your current situation. It doesn't need to be human to be beneficial. And at least from first-order principles it's not at all obvious that they are more harmful than helpful. To me it appears that most of the harm is in the overly affirming sycophant personally most of them are trained into, which is not a necessary or even natural feature of LLMs at all Not that the study wouldn't be valuable even if it was obvious

theusus 1y ago

Regular therapists aren't good either. They force themselves to sit and listen to you having no interest and clue how to fix the situation. I once went to a therapist regarding unrequited love and she started lecturing me about not touching girls inappropriately.

northhnbesthn 1y ago
Sounds like a therapist that hates men.

coliveira 1y ago

Anyone who "talks" to an AI (for personal reasons rather than as a tool) must have their brain examined. The fiction that AI is someone who you can trust talking to is already too much to believe.

matwood 1y ago
I “talk” with an LLM to help me learn a language (quite useful actually), and my parter quipped, “I wonder how long until tells you to leave me.”
- coliveira 1y ago
  If you continue there is a high probability it will do exactly that. It is a known phenomenon and even easy to understand. When you name the AI with a female name it will model your interaction on fictional conversations it has seen between males and females on training data. A lot of these fictional conversations have romantic context.
  - matwood 1y ago
    It'll be interesting if it does since I treat it like a machine teaching me a language.
treve 1y ago
In other words, vulnerable people should have access to therapy
BeetleB 1y ago
It's very common (even the norm, perhaps) for people to share personal details with total strangers in common places (bus/train/taxi driver/whatever) that they wouldn't share with family/friends. I don't think they need their brain examined.
- coliveira 1y ago
  Even a stranger is still a better option since they are, by definition, humans. Moreover you can be almost sure that a stranger will not sell your deepest secrets to the highest bidder or exploit that information to get something from you later.

quantified 1y ago

Totelly unlike flesh-and-blood people on social media... same side of two different coins, maybe.

tsunamifury 1y ago

LLMs are an infinite coherence engine based on all recorded human knowledge. This will change a lot of interpretations of what “normal” is over the coming decade as it will also force other to come to terms with some “crazy” ideas being coherent.

ddp26 1y ago

What's the base rate of human therapists giving dangerous advice? Whole schools, e.g. psychotherapy, are possibly net dangerous. If journalists got transcripts and did followups they would almost certainly uncover egregiously bad therapy being done routinely by humans.

britch 1y ago
Someone raises safety concerns about LLM's interactions with people with delusions and your takeaway is maybe the field of therapy is actually net harmful?
rw_panic0_0 1y ago
human therapists don't give advice
- GoatInGrey 1y ago
  Well if she ain't human, what is she?
Eextra953 1y ago
Therapist have professional standards that include a graduate degree and 1000's of hours of practice with supervision. Maybe a few bad ones fall through the cracks but I would be willing to bet that due to their standards most therapist are professional and do not give 'dangerous' advice or really any advice at all if they are following their professional standards.
- gonzobonzo 1y ago
  Therapy gone wrong lead to wide scale witch hunts across the U.S. in the 1980's that dwarfed the Salem Witch trials. A huge number of therapists had come to believe the now mostly debunked "recovered memory" theory to construct the idea that there were networks of secret Satanists across the U.S. that needed to be weeded out. Countless lives were destroyed. I've yet to see therapy as a profession come to terms with the damage they did. "These people are credentialed professionals so I'm sure they're fine" is an extremely dangerous and ahistorical position to take.

anotheryou 1y ago

so have they tried feeding their guidelines in to the prompt at least once?

Scoundreller 1y ago

I go to Dr. Sbaitso, I think I'm safe

totallykvothe 1y ago

Duh

WD-42 1y ago

If I were depressed I think knowing my therapist was an LLM would just make me more lonely and depressed. How is this a surprise to anyone.

dubeye 1y ago

my experience is they are very useful for targeted therapy of a very specific and measurable problem, like CBT for health anxiety for instance. same probably applies to human therapy. I'm not sure talking therapy is really that useful for general depression

deleted 1y ago

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hermannj314 1y ago

Online gambling funds terrorism, crypto is for money laundering, craigslist is dangerous, video games and rock and roll are bad, the printing press will ruin your relationship with the Church!

m3047 1y ago

I mentioned set and setting in a thread, and I guess the person didn't appreciate it (by the way, THREE 737 MAXes). What am I talking about when I say "set and setting"? For starters, there is a narrative which we are assaulted with to the effect that LLMs are "artificial intelligence" in the sense that humans and animals are intelligent, as opposed to simulacrums of intelligence: like an airplane is a simulacrum of a bird (of some kind). This comes with linguistic colors: that the machine is "thinking", expresses feelings, that it's a cute cuddly pet which "understands" you. This is the default "set and setting". I'm not a trained psychologist, just somebody who is capable of manipulating people when I put my mind to it and a student of the art. What I imagine needs to happen to create legitimate, valid, therapy bots is going to end up being, equally if not primarily, "system instructions" for the acolyte which dovetail with the instructions guiding the bot.