6 ms·

And real therapists are good right?

by auspiv 10mo ago

ajuc 10mo ago
Less bad at least.
Arsenik1 10mo ago
They are high-pay LLM wrappers dressed as humans
Dilettante_ 10mo ago
This is the real question. Not to rehash the self-driving cars arguments that have been had to death, but with potential LLM mental healthcare the question "but what if it causes harm in some interactions" is asked much, much more than with human mental healthcare professionals. (And I'm not being theoretical here, I have quite a bit of experience getting incredibly inadequate mental health care.)
airstrike 10mo ago
I hear you, but I feel it's also important to differentiate between the kinds in which humans and LLMs can be quote-unquote "bad". "Good" is too broad and subjective to be a useful metric.
ffuxlpff 10mo ago
It is still debated if therapies even work. The evidence is moving to the direction that they don't.
- jfindper 10mo ago
  Okay, I'll bite. What evidence is there that therapy, in general, doesn't work?
  - tim333 10mo ago
    I remember in my psychology textbook and it said in terms of measured results therapy was better than nothing at all but no better than just chatting to friends. These things are hard to measure of course.
    - dns_snek 10mo ago
      That's a hopeless generalization. People have many different problems and there are many different modalities of psychotherapy that try to address them. Treating less severe forms of anxiety with CBT is going to be a lot more successful than treating deeply rooted personality disorders using any modality. Some problems are more suitable for CBT, and others are more suitable for EMDR, etc. Just chatting to friends isn't enough unless you're just dealing with relatively mild, garden variety loneliness, depression, anxiety, or something similar.
- jodrellblank 10mo ago
  It's not the past anymore, we don't need to debate, we can watch and listen to actual recordings of therapy sessions and the patients going from feeling variously bad to better. Here's Dr David Burns channel with a 4hr video of a session with a woman who is obsessively anxious about her college-age daughter's safety: https://www.youtube.com/watch?v=on2N5DsKHRk https://www.youtube.com/watch?v=on2N5DsKHRk Here's a 2.5 hour session (split into several videos) with a doctor who has a bad relationship with his son and felt like a failure for it: https://www.youtube.com/watch?v=42JDnrD106w https://www.youtube.com/watch?v=42JDnrD106w https://www.youtube.com/watch?v=S5H2YGljhqQ https://www.youtube.com/watch?v=S5H2YGljhqQ https://www.youtube.com/watch?v=bZ9_0j_fmeg https://www.youtube.com/watch?v=bZ9_0j_fmeg https://www.youtube.com/watch?v=eiCrdGVa8Q0 https://www.youtube.com/watch?v=eiCrdGVa8Q0 https://www.youtube.com/watch?v=cARvhlTckaM https://www.youtube.com/watch?v=cARvhlTckaM Here's a couple of hour session with Marilyn who was diagnosed with lung cancer and spiraling with depression, anxiety, shame, loneliness, hopelessness, demoralization, and anger, despite her successful career: https://www.youtube.com/watch?v=S7sQ_zDGsY8 https://www.youtube.com/watch?v=S7sQ_zDGsY8 https://www.youtube.com/watch?v=tyuFN4mbGZQ https://www.youtube.com/watch?v=tyuFN4mbGZQ (there's probably more parts to find through YouTube somehow) And a session with Lee with loneliness and marriage relationship problems: https://www.youtube.com/watch?v=imEMM3r6XL8 https://www.youtube.com/watch?v=imEMM3r6XL8 (probably more parts as well) It's like saying "it is still debated if debugging even works" as if all languages, all debuggers, all programmers, all systems, are the same and if you can find lots of people who can't debug then "debugging doesn't work". But no, you only need a few examples of "therapy working" to believe that it works, and see the whole session to see that it isn't just luck or just the relief of talking, but is a skill and a technique and a debugging of the mind.
  - tredre3 10mo ago
    I agree with you that outright claims of "therapy doesn't work" should be backed by evidence. But a patient feeling better at the end of a single therapy session doesn't prove that therapy works either... - Does the patient feel better between sessions too? Will they keep feeling better after the therapy ends? Aka are they "cured"? - Would the patient feel equally good if they confided in a non-licensed therapist? - Do the techniques (CBT, DBT, ACT, IFS, etc) actually provide tangible benefits versus just listening and providing advice?
chemotaxis 10mo ago
I've known quite a few people who went to therapy and I'm not sure that's even the right question to ask. I don't think they were paying to get helped as much as they were just paying to have someone to talk to. To be clear, there are people who genuinely need help, but for most, a therapist is probably just a substitute for a close friend / life coach. And say what you will about this, a paid professional is, at the very least, unlikely to let you wind yourself up or go down weird rabbit holes... something that LLMs seem to excel at.
- knollimar 10mo ago
  It's tiresome to vent a lot to a close friend and get life advice if your problems are big enough and require gradual work. It's better not to degrade the close friend, and "life coach focused on healthy self awareness" is probably indistinguishable from most good therapy.
jodrellblank 10mo ago
As I sometimes repeat on HN, Dr David Burns started giving his patients a survey at the start and end of every session, to rate how he was doing as the therapist and to rate their feelings, on a scale of 1-5. Reasoning that if he's not good it would show up in patients thinking he's bad, and not feeling any better. And then he could tune his therapy approaches towards the ones which make people feel better and rate him as more understanding and listening and caring. And he criticises therapists who won't do that, therapists who say patients have been seeing them for years with only incremental improvements or no improvements. Yes there's no objective way to measure how angry or suicidal or anxious someone is and compare two people, but if someone is subjectively reporting 5/5 sadness about X at the start of a session and wants help with X, then at some point in the future they should be reporting that number going down or they aren't being helped. And more effective help could mean that it goes down to 1/5 in three sessions instead of down to 4/5 in three years, and that's a feedback loop which (he says) has got him to be able to help people in a single two-hour therapy session, where most therapists and insurance companies will only do a too-short session with no feedback loop.
- SideburnsOfDoom 10mo ago
  > Reasoning that if he's not good it would show up in patients thinking he's bad, and not feeling any better. This is like a questionnaire on how much stronger you feel after working out at a gym: you often don't, you feel tired. Both gym and talking therapy (when done correctly) will push you slightly out of your comfort zone, and aim to let you safely deal with moderate amounts of something that you find really hard. So as to expand your capabilities. "I feel good" immediately after is utterly the wrong metric. Being more capable / feeling better some time later is the more reliable indicator, like progress at a gym. And also this is why an agreeable statistical word generator LLM is not the correct tool for the job.
  - jodrellblank 10mo ago
    No it isn't, it's like a questionnaire on how hungry you are before and after dinner. If you eat carrot air and parsley and your hunger stays the same, dinner was a failure. If you eat bread and soup and your hunger diminishes a bit, it helped but you might need more dinner. > "will push you slightly out of your comfort zone, and aim to let you safely deal with moderate amounts of something that you find really hard." You can listen to some of those sessions and see that this is not what Dr Burns does[1]. His model is: it's not events which make us feel down, it's the thoughts we have about those events. You can see it yourself when you are stressing about something for ages, and someone gives you a bit of information "the surgeon says it all went well" and your worry leaves like a switch was flipped. You don't debug an integer overflow by progressively increasing int32 to int33 to int34, you spend the time understanding the problem and then you quickly change int32 to int64 and the program handles larger numbers instantly. If we can't let go of negative thoughts then we get stuck with lots of them, it's why people repeat certain things like "I hate him", "It's my fault and I deserve to be punished", "I'm a failure", "I'm a loser nobody loves me", "I'm a bad mother", "I'm a coward" or whatever - on mental loop, minute after minute sometimes for years or decades, retriggering the same pattern of negative feelings every time. He sets up an environment where the patient is willing and able to work with him (empathy) and guides the patient to see the reasons why they can't let go of those thoughts and how they could let go, and with a click of understanding the thought leaves, and that's a moment of near-instant transformation not a progressive overload, and that specific thought is fixed, and then they do another and another until the patient is happy they have been helped with the thing they wanted help with. [1] mostly, sometimes for anxiety he does use exposure therapy

And real therapists are good right?

by auspiv 10mo ago

And real therapists are good right?

ajuc 10mo ago

Less bad at least.

Arsenik1 10mo ago

They are high-pay LLM wrappers dressed as humans

Dilettante_ 10mo ago

This is the real question. Not to rehash the self-driving cars arguments that have been had to death, but with potential LLM mental healthcare the question "but what if it causes harm in some interactions" is asked much, much more than with human mental healthcare professionals. (And I'm not being theoretical here, I have quite a bit of experience getting incredibly inadequate mental health care.)

airstrike 10mo ago

I hear you, but I feel it's also important to differentiate between the kinds in which humans and LLMs can be quote-unquote "bad". "Good" is too broad and subjective to be a useful metric.

ffuxlpff 10mo ago

It is still debated if therapies even work. The evidence is moving to the direction that they don't.

jfindper 10mo ago
Okay, I'll bite. What evidence is there that therapy, in general, doesn't work?
- tim333 10mo ago
  I remember in my psychology textbook and it said in terms of measured results therapy was better than nothing at all but no better than just chatting to friends. These things are hard to measure of course.
  - dns_snek 10mo ago
    That's a hopeless generalization. People have many different problems and there are many different modalities of psychotherapy that try to address them. Treating less severe forms of anxiety with CBT is going to be a lot more successful than treating deeply rooted personality disorders using any modality. Some problems are more suitable for CBT, and others are more suitable for EMDR, etc. Just chatting to friends isn't enough unless you're just dealing with relatively mild, garden variety loneliness, depression, anxiety, or something similar.
jodrellblank 10mo ago
It's not the past anymore, we don't need to debate, we can watch and listen to actual recordings of therapy sessions and the patients going from feeling variously bad to better. Here's Dr David Burns channel with a 4hr video of a session with a woman who is obsessively anxious about her college-age daughter's safety: https://www.youtube.com/watch?v=on2N5DsKHRk https://www.youtube.com/watch?v=on2N5DsKHRk Here's a 2.5 hour session (split into several videos) with a doctor who has a bad relationship with his son and felt like a failure for it: https://www.youtube.com/watch?v=42JDnrD106w https://www.youtube.com/watch?v=42JDnrD106w https://www.youtube.com/watch?v=S5H2YGljhqQ https://www.youtube.com/watch?v=S5H2YGljhqQ https://www.youtube.com/watch?v=bZ9_0j_fmeg https://www.youtube.com/watch?v=bZ9_0j_fmeg https://www.youtube.com/watch?v=eiCrdGVa8Q0 https://www.youtube.com/watch?v=eiCrdGVa8Q0 https://www.youtube.com/watch?v=cARvhlTckaM https://www.youtube.com/watch?v=cARvhlTckaM Here's a couple of hour session with Marilyn who was diagnosed with lung cancer and spiraling with depression, anxiety, shame, loneliness, hopelessness, demoralization, and anger, despite her successful career: https://www.youtube.com/watch?v=S7sQ_zDGsY8 https://www.youtube.com/watch?v=S7sQ_zDGsY8 https://www.youtube.com/watch?v=tyuFN4mbGZQ https://www.youtube.com/watch?v=tyuFN4mbGZQ (there's probably more parts to find through YouTube somehow) And a session with Lee with loneliness and marriage relationship problems: https://www.youtube.com/watch?v=imEMM3r6XL8 https://www.youtube.com/watch?v=imEMM3r6XL8 (probably more parts as well) It's like saying "it is still debated if debugging even works" as if all languages, all debuggers, all programmers, all systems, are the same and if you can find lots of people who can't debug then "debugging doesn't work". But no, you only need a few examples of "therapy working" to believe that it works, and see the whole session to see that it isn't just luck or just the relief of talking, but is a skill and a technique and a debugging of the mind.
- tredre3 10mo ago
  I agree with you that outright claims of "therapy doesn't work" should be backed by evidence. But a patient feeling better at the end of a single therapy session doesn't prove that therapy works either... - Does the patient feel better between sessions too? Will they keep feeling better after the therapy ends? Aka are they "cured"? - Would the patient feel equally good if they confided in a non-licensed therapist? - Do the techniques (CBT, DBT, ACT, IFS, etc) actually provide tangible benefits versus just listening and providing advice?

chemotaxis 10mo ago

I've known quite a few people who went to therapy and I'm not sure that's even the right question to ask. I don't think they were paying to get helped as much as they were just paying to have someone to talk to. To be clear, there are people who genuinely need help, but for most, a therapist is probably just a substitute for a close friend / life coach. And say what you will about this, a paid professional is, at the very least, unlikely to let you wind yourself up or go down weird rabbit holes... something that LLMs seem to excel at.

knollimar 10mo ago
It's tiresome to vent a lot to a close friend and get life advice if your problems are big enough and require gradual work. It's better not to degrade the close friend, and "life coach focused on healthy self awareness" is probably indistinguishable from most good therapy.

jodrellblank 10mo ago

As I sometimes repeat on HN, Dr David Burns started giving his patients a survey at the start and end of every session, to rate how he was doing as the therapist and to rate their feelings, on a scale of 1-5. Reasoning that if he's not good it would show up in patients thinking he's bad, and not feeling any better. And then he could tune his therapy approaches towards the ones which make people feel better and rate him as more understanding and listening and caring. And he criticises therapists who won't do that, therapists who say patients have been seeing them for years with only incremental improvements or no improvements. Yes there's no objective way to measure how angry or suicidal or anxious someone is and compare two people, but if someone is subjectively reporting 5/5 sadness about X at the start of a session and wants help with X, then at some point in the future they should be reporting that number going down or they aren't being helped. And more effective help could mean that it goes down to 1/5 in three sessions instead of down to 4/5 in three years, and that's a feedback loop which (he says) has got him to be able to help people in a single two-hour therapy session, where most therapists and insurance companies will only do a too-short session with no feedback loop.

SideburnsOfDoom 10mo ago
> Reasoning that if he's not good it would show up in patients thinking he's bad, and not feeling any better. This is like a questionnaire on how much stronger you feel after working out at a gym: you often don't, you feel tired. Both gym and talking therapy (when done correctly) will push you slightly out of your comfort zone, and aim to let you safely deal with moderate amounts of something that you find really hard. So as to expand your capabilities. "I feel good" immediately after is utterly the wrong metric. Being more capable / feeling better some time later is the more reliable indicator, like progress at a gym. And also this is why an agreeable statistical word generator LLM is not the correct tool for the job.
- jodrellblank 10mo ago
  No it isn't, it's like a questionnaire on how hungry you are before and after dinner. If you eat carrot air and parsley and your hunger stays the same, dinner was a failure. If you eat bread and soup and your hunger diminishes a bit, it helped but you might need more dinner. > "will push you slightly out of your comfort zone, and aim to let you safely deal with moderate amounts of something that you find really hard." You can listen to some of those sessions and see that this is not what Dr Burns does[1]. His model is: it's not events which make us feel down, it's the thoughts we have about those events. You can see it yourself when you are stressing about something for ages, and someone gives you a bit of information "the surgeon says it all went well" and your worry leaves like a switch was flipped. You don't debug an integer overflow by progressively increasing int32 to int33 to int34, you spend the time understanding the problem and then you quickly change int32 to int64 and the program handles larger numbers instantly. If we can't let go of negative thoughts then we get stuck with lots of them, it's why people repeat certain things like "I hate him", "It's my fault and I deserve to be punished", "I'm a failure", "I'm a loser nobody loves me", "I'm a bad mother", "I'm a coward" or whatever - on mental loop, minute after minute sometimes for years or decades, retriggering the same pattern of negative feelings every time. He sets up an environment where the patient is willing and able to work with him (empathy) and guides the patient to see the reasons why they can't let go of those thoughts and how they could let go, and with a click of understanding the thought leaves, and that's a moment of near-instant transformation not a progressive overload, and that specific thought is fixed, and then they do another and another until the patient is happy they have been helped with the thing they wanted help with. [1] mostly, sometimes for anxiety he does use exposure therapy