For comparison: how does human-based therapy work?
This will probably sound like bullshit if you don’t know anyone who’s experienced it, but most of the effect of therapy comes from an interpersonal exchange based around shared goals, not from techniques. There’s plenty of science to back that up (one of many summary articles here – effect sizes are in figure 1).
Some of the process does look like getting tools put in front of you to deal with specific situations better than you would on your own. Sometimes those tools do help. If you need to bring yourself back from a stressful experience, some ways of doing that are probably better than others. If you have specific experiences that lodged themselves in your brain and don’t seem to want to come out, you might be able to guide yourself through working through them, even if that process is also often easier with someone else helping. Those are just a few examples. Besides therapists like myself sometimes failing to adequately explain how therapy is supposed to work, it also seems to be a common complaint that therapists can be unwilling to provide much structure, direction, and yes, tools, even when directly asked. The science though suggests that the tools are not usually doing the bulk of the work of helping you improve your life, even if they’re helpful in some cases and valid to ask for.
It’s hard to predict exactly what the rest of the helping interpersonal exchange that’s not the tools is going to look like moment to moment between any two people. It’s also much, much harder for some people to sink into it than others. It can also seriously hurt if it doesn’t work right, which anecdotally seems to be a major contributor to instances where therapy does harm. In spite of the risks and limitations, this is where most of the generative potential of therapy comes from. No one’s figured it out in advance exactly what it would look like for you to gain from experimenting with trusting someone in a way you haven’t before, saying something you haven’t been able to give voice to, or exposing yourself to a response you’ve been closed off to before. What is predictable about it though is that if you keep showing up, ride feelings of discomfort as they come up, and put genuine effort into trying to find new ways to come back to therapy after misunderstanding or difficult sessions especially when your therapist is holding up their side of that deal, you’ll probably grow from it. The tolerance to interpersonal discomfort and new contact with parts of yourself that are harder to develop in everyday interaction will shine through in the rest of your life outside of therapy.
What AI-assisted therapy might do well or poorly
Even people like those leading /r/therapygpt are generally not promoting an LLM as a therapist, delivering therapy in the traditional sense, and I’m not either. But since people are going to them for help, let’s think about what they seem to be good or bad at out of what therapists actually do.
Take a look again at the chart from Wampold’s article I linked in a previous post about how big common and specific effects are in therapy:
Current LLMs actually seem to be pretty good at many of these, particularly empathy (of course no one’s describing the LLM itself as actually experiencing empathy, but that may not always matter if you’re hearing the words you know you can benefit from hearing).
The specific ways that LLMs can be good at this kind of thing and over what time scale depends strongly on the input they were trained on. One of the most commonly used training sets called “Common Crawl” intentionally consumes wide swaths of the Internet without censorship (more background). Earlier LLMs built on this kind of dataset were notorious for reproducing the kinds of toxicity and hatred that have always been easy to find in any Internet comment section – not what I want when I’m trying to feel better about myself or anything else. A bunch of more recent forces in LLM development have been pushing this in a more positive direction though. One of those is performance testing LLMs for traits like emotional intelligence and proneness to feeding mental health deterioration. With some attention being paid to this, a way to measure improvement, and a recognition that people value LLMs in part because of how well they do as conversational partners, many of the big companies involved have also started incorporating datasets that can be curated to train LLMs to respond more empathetically, and processes to incorporate guardrails that try to stop the model from producing toxic and harmful responses.
My impression is that this has helped quite a bit compared to the LLM behavior I was reading about a year or two ago.
None of the current discussion around these models will tell you though about what pieces of human verbal exchange are missing almost entirely from online content and so would almost certainly be missing from any output an LLM would ever give you. Some of the common and specific factors mentioned in therapy research above have a time scale to them. Meaningful moments of empathetic exchange, of coming back together and revisiting the point of treatment after strong disagreements can have a very different tone, shape and content when months into a therapeutic process than they did at the start. Public-facing datasets curated from freely licensed posts people have made online will not represent either side of those exchanges, even though they’re the ones that often make the biggest difference in the effect therapy has on a person’s life.
Current discussion of LLMs also usually assumes that their input and outputs both reflect a “view from nowhere”, an average of human experience that misses nothing and misrepresents nothing, even though writing from some groups is way more likely to end up online and in a training set than others’. There are exceptions, like the Common Corpus deliberately including words from cultural heritage projects. The overwhelming majority of less deliberately curated input though is going to reflect the same biases you’d get in a user-base like reddit’s: more male, more west coast, more STEM-educated, spending more time on screens than average, less religious, valuing knowledge work over manual labor or artistic output, playing more video games and watching more anime, and so on. And for whatever it’s worth: with way more info about cognitive-behavioral therapy than any other perspective on mental health.
I’m adding next to zero to the range of qualities found in human therapists or to any online conversation, so don’t take me to be saying I’m any better than anyone else who fits that description. If in some ways you’re like me or them, then maybe that’s OK or even a good thing if you want your LLM output to be responding only from a perspective like yours and not challenging you with someone else’s. It’s probably good for the sense of immediate support and empathy someone like me would get from the LLM’s default tone and knowledge, and bad for someone else’s.
None of this should turn you off of ever using an LLM for anything with therapy-like benefits. What it should do is inform how you use it and what you expect to get out of it. When what you want is an immediately available sounding board that can reply to something you can describe in a relatively brief conversation, many LLMs will have been trained to give good results. That’s probably also true for therapy-adjacent tasks like giving summaries or general recommendations for coping skills, or maybe even prompting for ideas about ways to handle a conversation or situation in a different way someone else has already thought of but that you haven’t been exposed to yet. The LLM’s helpfulness, performance and knowledge will tend to drop off as you get more into specifics that you share with relatively small groups of people, or as those issues take on a wider time scale in your life to where you’d have a hard time describing all the intersecting aspects of what you’re dealing with even over many hours of conversation.
If you do want to try to work on rare, more complex, longer running issues with an LLM’s help, you might do better by offsetting some of its weaknesses with your own strengths. If you know in advance that what it’s been fed may to it not be very representative of the connections and time scale between interconnected issues in your life, it may work better to pick one more specific topic at a time and then do some reflection in between LLM chats to figure out for yourself how the pieces connect. Rely on your own gut feelings and be in touch with our own uncertainties about social situations you might be bringing to an LLM chat for help.