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Comment by tkk23 | Hacker News Reader

>Others engage in therapy with an artificially intelligent (and usually feminized) chatbot. Disturbingly, these digital apps are largely unregulated and have questionable standards of care.

What alternatives are there? Therapists don't scale. If half of society could improve their life with therapy, and a therapist can treat 30 people per month over 10 years, then 1% of society have to become therapists. More therapists than teachers would be needed.

I believe that this is a huge opportunity. Like medicine, people will be willing to pay anything to be happy. The biggest problem apart from developing a cure will be getting heard. The market will be flooded with enticing apps and a most likely bitter medicine will be a tough sell.

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This has become much more clear in the last couple years. Demand shot way up and is far outstripping supply. Then you get into the issue of how so many patients aren't a good match for the first therapist they try, so they have to jump through all the hoops and fill out all the forms to try another one, which also may not be a good match (all while potentially on the edge of some kind of breakdown)... I went through at least five before I found one I felt was effective for me, and my experience is not uncommon.

Personally, I think we need to lower the barrier of entry for people to become therapists, and streamline the whole patient intake process. It's not like the quality is all that great with existing barriers, there are PhDs out there actively harming patients-- one kept trying to push Jesus on me when part of what I was dealing with was childhood religious trauma and the difficulties of restructuring my world view as a nonbeliever, an absolute breach of ethics.

We need to make it easier for people to try out multiple therapists until they find one that's a good match for them, and part of that is increasing the supply of therapists. Unfortunately I'm not sure a chatbot is ever going to quite do it except for in the simplest & most clear cut cases, the mental tangles we can get into really require general intelligence to grapple with.

Therapist have a huge amount of influence and power over their patients. Do you really think lowering the bar is a good idea? Try and imagine the end result. Maybe it's me, but I shudder thinking of it.

The real problem, IMHO, is we've built an inhumane economic system that causes tremendous stress over the psyche of the individual. Instead of optimizing for wellbeing,we optimize for GDP, this is a pretty poor proxy. A more humane and tolerant society, with less hyper stimulating culture could reduce the need for more therapists. But of course this is an ideal, I don't know how to get there, but it seems to me unleashing therapists into the wild, while streamlining out the ethical and self regulation that come with the guild structure is a terrible idea.

I agree in principle, but in the mean time we need triage. The current system has reached a breaking point.

> Do you really think lowering the bar is a good idea?

How much lower can the bar go? The "ethical and self regulation" you describe is all too often nonexistent. If my experiences - and many others I've read about - are any indication, the situation couldn't be much worse. There are certified professionals doing everything from actively pushing religion to making a cynical game out of how fast they can pigeonhole your 'symptoms' into a checklist so they can prescribe the currently most marketed drug for that DSM entry. Then they tell you to report back in two months.

Just having someone to talk your shit out with regularly who doesn't judge too much and has knowledge of practical solutions for common stressors would be a vast improvement over the 'care' all too many are currently receiving. The guidelines for providing simpler care like this can be clear & concise, and we have better tools now for filtering out bad actors. I see more reasons to continue advocating for such an approach than not at this point.

Not to mention that the dating game of filling out all the paperwork for the third time may be what pushes someone from on-edge but stable for the day into a breakdown.

Instead of scaling therapy/drugs up, maybe we improve community instead. Humans often just need to vent and otherwise connect with each other. OTOH, work is often considered a dangerous place to do that and we spend most (or at least a significant portion) of our waking lives there. This means we need to build community outside of work. Among other things, that in turn negates at least one of long commutes or long hours.

We already have therapist alternatives in the form of parasocial relationships and pseudo-personalized entertainment. There's even one prominent livestreamer who acts as a collective psychiatrist and does public sessions with other streamers, which is the most 2022 thing I've heard of in the last few weeks.

AI chatbots are just the natural conclusion.

Therapists just play the role close family fulfill in most of East and South Asia. That scales very well but requires a societal monoculture that I’m not sure the west is capable of.

Mental health is terrible in east asia (at least in Korea), where mental health issues are highly stigmatized, mental healthcare is not covered under insurance (it's all in your head), familial and cultural narcissism is rife, the suicide rates are staggeringly high (especially among children and the elderly), and highly disordered behaviour (drug abuse, eating disorders) are considered as part of the culture, so I'm not sure these are good examples?

No they don’t. East and South Asian family relationships can be quite fraught. People don’t talk about their feelings. Parents put tremendous pressure on their children to study in school. Then they pressure them to quickly get married and have kids right after school. I have met plenty of people from both India and China who have expressed a lot of alienation from their families.

It’s all economic pressure in the end.

Tactically not talking about your feelings is a good thing. Nothing coming out of psychology has been replicated or validated i.e. a bunch of invalidated opinions. The most important thing is to prevent alienation and isolation and Asia does that better than anyone else.

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