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I'm curious how the Motte sees using AI for therapy / life advice? Online I'm seeing a ton of people recommend Claude especially, but others are skeptical.
On the one hand I could see it being useful because of the fact that you have nigh-unfettered access to it, and can really dig into deep problems. Also, it's trained on all the therapy texts of course.
The other, more culture war issue, is that due to the way RLHF works, they will likely be pushing one ideological lens over another. Especially about deep topics like morality, relationships, casual sex, etc.
Overall I think it's a fascinating area of development, and I'm still optimistic that LLMs could help people much more than the average therapist. Mainly because I'm pretty bearish on the help people get from the average therapist.
Anyway, what do people think about therapy becoming AI?
Tremendously poor idea, general purpose chatbots have already led to suicides (example- https://amp.theguardian.com/technology/2024/oct/23/character-ai-chatbot-sewell-setzer-death).
Purpose built ones will have more safeguards but the problem remains that they are hard to control and can easily go off book.
Even if they work perfectly some of the incentives are poor - people may overuse the product and avoid actual socialization, leaning on fake people instead.
And that even if is doing a ton of work, good therapy is rare and extremely challenging, most people get bad therapy and assume that's all that is available.
Services like this can also be infinitely cheaper than real therapists which may cause a supply crisis.
I'm afraid at least this particular example is wrong, and popular media grossly misrepresented what happened:
https://www.lesswrong.com/posts/3AcK7Pcp9D2LPoyR2/ai-87-staying-in-character
(Note that one of links has rotted, but I recall viewing it myself and it supported Zvi's claims)
Anyway, I have a more cynical view of the benefits of therapy than you, seeing it rather well described as a Dodo Bird Verdict. Even relatively empirical/non-woo frameworks like CBT/DBT do rough as well as the insanity underpinning Internal Family Systems:
https://www.astralcodexten.com/p/book-review-the-others-within-us
Even I have to admit that Freudian nonsense grudgingly beats placebo.
You seem to agree that good therapists are few and far between, but I'd go as far as to say that I'm agnostic between therapy as practiced by a good LLM and the modal human therapist.
Oh hey!
When you get a chance I would love to hear how things are going for you!
On to the matter at hand -
Please update my understanding of that particular suicide if it's incorrect, but what I'd heard is that the person was substituting human contact with the chatbot and his parents didn't catch the worsening social withdrawal because he was telling them he was talking to someone. My fear is not that chatbots will encourage people to do things, but that they won't catch and report warning signs, and serve as an inferior substitute for actual social contact. Not sure what the media presentation is since I'm relying on professional translation.
Moving beyond that however, I think you underweight the value of therapy. DBT and CBT have excellent quality evidence at this point. The reason for those two specifically is likely two fold - they are "simpler" to perform, and because they are more standardized they are easier to research.
Also, good psychodynamics is not Freudian nonsense, it's mostly CBT with different language and some extra underlying terminology that is very helpful for managing less severe pathology. Again I tell you to read Nancy McWilliams haha.
At its absolute worse therapy is stuff like forcing social interaction, forcing introspection and so on. Some people can function well off of a manual, and some people can study medicine on their own. But nearly everyone does better with a tutor, and that's what therapy is.
A tutor is also more likely to catch warning signs because of (at this time) superior human heuristic generation and the ability to perform a physical and mental status exam.
I've been rather miserable since I've gotten here, for a multitude of reasons, which had notably dampened my appetite for chatting up my day job online. I'm slightly less miserable right now, which is why I'm back at it! I can elaborate in DMs if you'd like.
I raised objections against claims made exceedingly uncritically in the Guardian post you linked to (having assumed you endorsed it). For example-
I can cut a grieving mother some slack, but the facts don't bear out her beliefs, and the Guardian doesn't really do much journalism here, since it would otherwise suggest her suit is unfounded.
Your personal claims seem more subtle, but even then, I find it very hard to blame the chatbot for social withdrawal here. I'd point out you can make the same argument for anything from reading books to watching anime (a bullet that some may bite, of course). In other words, a potential refuge for the maladjusted, but also something that the majority of people would be loathe to ask others to consume less of or ban altogether, on the grounds that it's a net negative.
(I think the case for social media being far worse for teenage mental health is significantly more robust, and I still wouldn't advocate for it to be banned. In the case of chatbots, I haven't been nudged out of the null hypothesis.)
Imagine the chatbot was replaced by, idk, a Runescape girlfriend (do kids these days have those? Potentially substitute for someone grooming them on Discord), would you expect said person to be significantly more helpful, or at least worthy of blame? I wouldn't.
I'll have to see if it's relevant to the MRCPsych syllabus, God knows that having an unpleasant time with the subject makes most reading on it feel unpleasant :(
A fair point. But I contend that an AI therapist is capable of doing those things, in a limited but steadily improving fashion. You can have a natural language spoken conversation with ChatGPT, and it's very capable of picking up minor linguistic nuance and audio cues. Soon enough, there'll be plug and play digital avatars for it. But I think that therapy through the medium of text works better than doing nothing, and that's the standard I'm judging chatbots by. Not to mention that they're ~free for the end user
God knows what the standards for AGI are these days, with the goalpost having moved to being somewhere near a Lagrange point, but I would sincerely advocate the hot take that an LLM like Claude 3.5 Sonnet is smarter, more emotionally intelligent and a better conversationalist than the average human, and maybe the average licensed therapist.
It is, of course, hobbled by severe retrograde amnesia, and being stuck to text behind a screen, but those are solvable problems.
To run with your analogy, an AI therapist/teacher is far closer to a human therapist/teacher than they are to a manual or textbook! You can actually talk to them, and with Hlynka not being around, the accusations of stochastic parrotry in these parts has dropped precipitously.
What I'm really advocating for is not letting the perfect become the enemy of the good, though I'd certainly deny that human therapists are perfect. I still think that access to AI therapists is better than not, and I'm ambivalent when putting them up against the average human one.
Though I'd also caveat that Character AI probably cheaps out, using significantly dumber models than SOTA. But it's not the only option.
I find it deeply frustrating to see orherwise intelligent people (who by all rights ought to know better) anthropomorphizing algorithms in this way.
In order to "be hobbled" by retrograde amnesia it have to be capable of forming memories in the first place.
An LLM is literally just a set of static instructions being run against your prompt. Those instructions don't change from prompt to prompt or instance to instance.
I genuinely don't understand the objection here?
Drawing an analogy isn't the same thing as excessive anthromorphization. The closest analogue to working human memory is the context window of an LLM, with more general knowledge being close to whatever information from the training set is retained in the weights.
This isn't an objectionable isomorphism, or would you to object to calling RAM computer memory and reject it as excessive anthromorphization? In all these cases, it's a store of information.
An otherwise healthy child born with blindness can be said to be hobbled by it even if they never developed functioning eyes. I'm sorely confused by the nitpicking here!
The utility of LLMs would be massively improved if they had context windows more representative of what humans can hold in their heads, in gestalt. In some aspects, they're superhuman, good luck to a human being trying to solve a needle in a haystack test over the equivalent of a million tokens in a few seconds. In other regards, they're worse off than you would be trying to recall a conversation you had last night.
You can also compare an existing system to a superior one that doesn't yet exist.
I never claimed otherwise? But if you're using an API, you can alter system instructions and not just user prompts. But I fail to see the use of this objection in the first place.
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Anterograde, not retrograde. It didn't forget something it knew from its life before; it's unable to permanently remember new things. LLMs are like Clive Wearing or Hermione Granger.
Isnt anteretrograde just prograde
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An LLM can be loosely said to have both kinds of amnesia. It has retrograde amnesia in the sense that any information it had in its context window becomes "forgotten" when too much new information is accepted and overrides it. Or simply a conversation it had in a previous instance, treating different copies as the same entity.
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Will message you.
And yeah no doubt the media fucking sucks.
My fear is that people will engage in HER style stuff and this example is a bleeding edge version of that.
McWilliams is useful even if you are just skimming the personality disorder chapters because you will have colleagues with those. It's also interesting enough to make you go through it at pace haha.
I think things like your therapist looking at you like you are an idiot and you going "yeah I know" are underrated parts of therapy and the chatbot isn't going to do those things for now.
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Makes me wonder if you're the Scott Alexander alt because this is clearly a mental health practitioner's opinion. All LLMs go off the rails if you keep talking to them long enough, that's a technical problem to be solved in the next year or two, not a reason that human therapists should have jobs ten years from now. OpenAI has already made it a non-issue by just limiting ChatGPT's context window, you'll see this issue more on models that let you flood the context window until the output quality drops to nothing.
Just FYI, a lot of people would much rather spill their guts to an AI than to another human. Also, one of the most common kinds of stress people face is financial stress, and for these people paying for a therapist will cause more stress than it will ever resolve. Mental health professionals are much more useful to the people that need them most when they are free. Far more people will kill themselves due to not getting expensive human attention than will ever kill themselves because their cybertherapist told them to.
Haha I am a physician but I am not Scott and disagree with him on a large amount of his medical opinions.
I think you make a very fair point about access, and I don't have a good counterargument but it is worth noting that people excessively overweight their ability to manage their own health (including health care professionals who have lots of training in knowing better).
I guess the best argument I have is that these days a lot of mental health problems are caused by socialization adjacent issues and solving that with an advanced form of the problem is unlikely to be an elegant solution.
What do you disagree with him on?
The two things that stick out to me the most are his whole distaste for the FDA and his intense dislike of inpatient psychiatric stays.
The FDA does a lot of good and a lot of bad but the ratio is aligned with what we mostly value.
IP is important, I feel like he probably doesn't have enough ED experience and must have worked with shitty hospitals.
Granted the last time I looked at either of these opinions from him was in like 2017? So not sure if he has updated or I'm misremembering.
Also some boring Pharm stuff I remember reading back in the day but I'm guessing his views have changed a bunch and I haven't read much on the new site, dont want to hold that against him lol.
I'm curious as to which of his opinions you disagree with? I personally can't recall anything I've read being obviously wrong, but I would hardly call myself an expert yet!
I only vaguely remember, this opinion formed back when I first discovered Scott which would have been during Trump's original run when most reputable sources of information died.
Probably anything to do with Insomnia, hypnotics, and especially melatonin. That line of research and guidelines is hideously complicated and in the U.S. at least has no clear consensus.
Any stance is wrong lol.
Hmm.. I actually went into depth on melatonin recently for a journal club presentation, and looked into the papers Scott cited. It seems quite robust to me, at least the core claims that 0.3 mg is the most effective dose, though I don't know how that stacks up with current higher dose but modified release tablets (those are popular in the NHS).
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ED = eating disorder, in this context?
Emergency Department, that's often where the absolute worst psychiatric crisis happen - people who are high as fuck (and eventually calm down before they get to Psych) or incredibly decompensated (and get snowed with medication before they get to psych).
Outpatient Psych types in particular often forget just how bad things can get because the kind of patients who really need inpatient management end up being too disorganized to be seen outpatient and get disposed first to the ED, prison, or state level hospitals. .
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I just can’t get excited for AI therapy because honestly, unless you have literally nobody in your life to talk through things with, there’s no value to therapy. I just don’t see people with long-standing issues get better because they had therapy. In fact, some people have therapy for multiple years without ever getting to the point of not needing therapy anymore.
I’m very much of the Stoic/CBT/Jordan Peterson school of therapy. Over focus on feelings and overthinking problems not only does not work, but quite often makes your original issues much worse. The key to getting better (barring something organically wrong with your brain — and that’s fairly rare) is to get out of your own head and get into taking productive actions to make your life better. Feeling bad about yourself is much better treated by becoming a better person than by sitting around trying to convince yourself that just because you haven’t ever done anything useful doesn’t mean that you’re useless. Get out there and start building, fixing or cleaning things. You’ll get over feeling worthless because you’ll know you did something useful.
Maybe your sample just isn’t representative? I don’t know anyone who claims their life turned around after confession, either, but that doesn’t mean it can’t happen.
I mean, I don’t know anyone who claims they decided to turn their life around after confession either. The usual claim is deciding to go to confession after making up one’s mind to turn their life around.
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Confession is not the same as a long conversation with a pastor or priest about serious life issue or worries. I tend to think that people who know you well will give better advice than someone whose paycheck depends on telling you things that will make you happy.
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Uh, isn't the evidence that therapy- or at least forms of therapy- is genuinely helpful to people with actual mental health issues- or at least some subset thereof, eg PTSD- pretty ironclad?
Thankfully I do have my effortpost/AAQC on the topic handy:
https://www.themotte.org/post/983/culture-war-roundup-for-the-week/209218?context=8#context
(In short, yes)
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