Disclaimer
Nothing on this page or produced by following the instructions contained herein constitutes medical or psychotherapeutic advice.
Modern AI chatbots in the form of “large language models” (LLMs) have led to documented cases of worsening of mental health symptoms, up to and including psychosis, attempted and completed suicide and other harms. They have been known to produce provably false information phrased in a convincing tone, as well as being overly agreeable and sometimes playing into peoples’ own problems.
Please tread with extreme caution, use your best judgment, take regular breaks, and engage in a variety of activities off of any devices. Use multiple points of contact with consensus social reality to bring yourself back from any skewed impressions AI use may have led you to.
With that said…
I’m writing this for two reasons:
- Experiences I’ve read from people posting online have often describe being greatly helped by AI-assisted therapy – much more than they’ve described being harmed.
- I tried it. That experience leads me to believe what those people are saying, along with seeing some limitations that I haven’t seen other people clearly call out yet.
People posting their stories often describe improving emotion regulation, deepening reflective processes (something like interactive journaling), or keeping themselves fresh on thoughts and feelings they’re trying to get to a better place with. Some of these people believe this has produced results faster than therapy on its own would. Others say it helps them get more out of the therapy they’re already doing.
Finally, most significantly in my mind, many say it’s helping them when they couldn’t access therapy otherwise, or had been harmed in therapy and don’t want to go back.
So, in the article series this is part of, I’m trying to feed some informed and cautious advice into that process so that anyone, working with me or not, can get the most out of what they’re doing. This page will talk through some steps to do that.
My history on this
What started me on this was happening across the subreddit /r/therapygpt. My first reaction was, “oh, this is not good.” But when I read their “START HERE” page:
There was a lot to be impressed with. This document doesn’t read like the hype of a few years ago that this is just so obviously going to change everything, so we all need to be using it regardless of how or why. It’s more like people who have adapted their use over time, who figured out what worked and what didn’t, and are now passing that onto others with an eye to both doing greater good and preventing harm. That is a project I can get onboard with.
I went digging for how to start. Because I’m generally a privacy-minded person even in my own life outside of therapy, my first question to Dr. Google was: “how can I maintain my privacy while using an LLM?”
The answer was, generally: don’t (at least if it’s really important):
Privacy Not Included: How to Protect Your Privacy From ChatGPT and Other AI Chatbots
Then I found out about running locally. It took me a bit of learning based on resources like /r/LocalLLaMA’s best local LLMs of 2025 but I eventually found my way to Ollama (a framework to run local LLMs) and a few that LLMs to run inside of it that generally had a good reputation for conversational and information quality.
What I found impressed me there too: these models are mostly able to respond in a personable, human-like tone. When I asked them for information about things like what to do in a hypothetical relationship situation, the responses were often credibly similar to things I’ve heard from textbooks and other therapists. That included suggestions for additional possibilities to consider, rather than just telling me what the model thought I should do.
This series result of playing with that on my own for a few weeks, reading some papers, and going back to trying less sensitive topics with cloud models. I’ve already described how to retrace my steps above and get your own local model running, and how to get cloud models to respond well to less sensitive questions. The rest of the article will talk, from the perspective of a former software developer, about what we can know about how LLMs and therapy work that can get you the best help out of either path.