Comment by grammarsaint | Hacker News Reader

Comment by grammarsaint | Hacker News Reader

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I think LLMs have a lot of therapeutic potential, but I am worried about how easily they can cause harm in this area. CBT is the gold standard treatment for many problems, but applying it correctly requires some nuance and an accurate diagnosis of the problem.

Consider a teenager who is fixated on the idea that they're a "bad person" because they're having homosexual thoughts. You might think they need positive affirmations or exercises to challenge their fears with evidence. But these symptoms are sometimes a manifestation of OCD. If so, using CBT to "argue away" the fear could end up reinforcing the OCD cycle and causing more and more self-doubt. For this person, the better treatment would be a different CBT tool: exposure. It may seem odd, but they would be better served with exercises such as repeatedly thinking sexual thoughts and then telling themselves, "I might be a horrible person because of this." (The purpose is to desensitize them to the idea - eventually, they will just get bored.) Needless to say, this type of treatment needs to be implemented with care.

I think it's beyond the capabilities of LLMs to reliably distinguish problems like this. So then, I think the systems have to be designed so that their output is at least harmless for all people, and that sounds really hard.

That's an interesting point, but I'll reiterate this tool is explicitly described as not being a replacement for therapy.

> I think LLMs have a lot of therapeutic potential, but I am worried about how easily they can cause harm in this area

At the end of the day, no one can be 100% responsible for someone else. The agency lies with the patient. Even human therapists come with their own beliefs that seep into their practice, which while well-intentioned may not align with the goals of the patient. It is up to the patient to understand their own values and decide whether therapy with a given therapist/therapy method is effective in improving their life.

In your example above, I'm not sure the harm risk is so high. In fact, with your example of exposure, since LLMs tend to regurgitate the same flavor of response over and over, they might actually deliver the same effect of desensitization.

I fall into the OCD thinking category, and found LLMs helpful precisely for the fact they have endless patience (whereas I feel the need to hold back after a certain number of times talking to friends/therapist about the same issue)

Best one can do is be upfront with the aims/design of the tool, and let people decide

Those are all great points.

I hope my comment didn’t come across as a criticism of your project. I was really just going off on a tangent - I’ve heard a number of people discuss building LLM therapist bots, and so I’ve had these concerns in the back of my mind.

Your project looks awesome, and I think “assisted journaling” may be one of the best ways to frame this technology’s potential. I especially like how the app tends to follow up with questions that lead the user to continue exploring their feelings (rather than offering opinions or conclusions). Also: kudos on the clever name.

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