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Comment by Cthulhu_ | Hacker News Reader

Thing is, professional therapy is expensive; there is already a big industry of therapists that work online, through chat, or video calls, whose quality isn't as good as a professional (I am struggling to describe the two). For professional mental health care, there's a wait list, or you're told to just do yoga and mindfulness.

There is a long tail of people who don't have a mental health crisis or whatever, but who do need to talk to someone (or, something) who is in an "empathy" mode of thinking and conversing. The harsh reality is that few people IRL can actually do that, and that few people that need to talk can actually find someone like that.

It's not good of course and / or part of the "downfall of society" if I am to be dramatic, but you can't change society that quickly. Plus not everyone actually wants it.

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The issue is that if we go down this path, what will happen is that the gap between access to real therapy and "LLM therapy" will widen, because the political line will be "we have LLM therapy for almost free that's better than nothing, why do we need to reform health care to give equal access for everybody?".

The real issue that needs to be solved is that we need to make health care accessible to everybody, regardless of wealth or income. For example, in Germany, where I live, there are also long waitlists for therapists or specialists in general. But not if you have a high income, then you can get private insurance and get an appointment literally the next day.

So, we need to get rid of this two class insurance system, and then make sure we have enough supply of doctors and specialists so that the waits are not 3 months.

> So, we need to get rid of this two class insurance system, and then make sure we have enough supply of doctors and specialists so that the waits are not 3 months.

Germany has reduced funding for training doctors. So clearly the opposite is true.

> For example, in Germany, where I live, there are also long waitlists for therapists or specialists in general. But not if you have a high income, then you can get private insurance and get an appointment literally the next day.

And the German government wants to (or is implementing policies to) achieve the opposite and further reduce access to medical specialists of any kind. Both by taking away funding and taking away spots for education. So they're BOTH taking away access to medical care now, and creating a situation where access to medical specialists will keep reducing for at least the next 7 years. Minimum.

Yeah, I am not saying Germany is doing it right :D Just explained how it works here and what I think should be improved.

It really looks that's how a lot of countries intend to solve the crisis they are causing by destroying medical care now: restrict it to fewer and fewer people, without lowering the taxes that pay for it, of course. Great medical care for the select few. No medical care for you and me.

And with the traditional difference between socialists and rightists. Socialists will have their party pick who gets medical care, not you and me. Rightists will make it more expensive, which means you and me can't pay for it.

That’s nice sounding, in the USA currently we’re headed the opposite direction and those in power are throwing off millions from their insurance. So for now, the LLM therapist is actually more useful to us. Healthcare won’t be actually improved until the current party is out of power, which is seeming less likely over the years.

I live in Canada and it's illegal to take private insurance if you also take public insurance.

The private healthcare system is virtually nonexistent and is dominated by scammers.

The public healthcare system still has months-long wait times.

If you want to avoid waitlists you need surplus capacity, which public healthcare doesn't provide.

> it's illegal to take private insurance if you also take public insurance.

This seems like an odd excluded middle. In the UK, you can have private health insurance if you want, but you can always fall back on the NHS; the one wrinkle is that you may not always be able to take a prescription from the private to the public system without getting re-evaluated. (e.g for ADHD)

> which public healthcare doesn't provide

== taxpayers aren't willing to pay for.

It's a slippery slope and we really don't want a 2 class system. If you start allowing doctors to bill for things that public insurance covers, you're 30 seconds away from a losing the egalitarianism that Canadians value. You can pay out of pocket for whatever you want, you can tell the doctor not to bill any insurance, and in some clinics (in my experience not many) that will get you seen faster, but it's not really common and it's very expensive.

Drugs aren't considered healthcare for whatever reason. If I got an ADHD pill in a hospital that's free, but if I wanted to get the same at an outpatient pharmacy it'll cost money in most cases.

Ditto for dental.

So while there isn't any overlap between public and private, there's still a gap. Though our drugs cost 10% of American prices.

In the USA we have huge waitlists for most all types of healthcare. Private healthcare doesn't provide surplus capacity either.

We do? https://worldpopulationreview.com/country-rankings/health-ca... seems to show we are high on the 1 day wait, but not so much on the specialist waits.

That said, I think it would be safe to say I don't understand this statistic. Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.

It's a bit tough to compare between countries like this. Those stats don't reflect the infinite wait time that may be the case for someone without health insurance in the USA.

Even with insurance, in my area, neurologists book out 3-6 months.

Your own link offers this summary:

> A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times.

I ack that it is hard to really grok these numbers. And yeah, I wasn't trying to hide that we have problems. Indeed, my prior would be that we are middling across most stats.

I also question if using a neurologist wait time is illuminating? What is the average wait time by country for that one? Quick searches shows that isn't necessarily extremely high, either.

You'll see significant variability by specialty, area, and insurance plan.

Ultimately, Americans wait for care just like participants in other health systems. It's just a lot more likely to result in a big bill, too.

You have that in other countries too. In Sweden the govt decides which healthcare is to expensive and they deny that treatment (while americans with healthinsurence might get it). You wouldnt say wait times in sweden are infinite.

Both setups have a "is this deemed medically necessary and be covered" step, yes. The key difference is that "yup, necessary and typically covered" in Sweden gets you the procedure. In the US, it doesn't. You need coverage (or you pay out of pocket) for anything to be covered.

No insurance? The only care you can't be denied over payment is emergency care. (And the definition is narrow - they'll give you pain meds and IV fluids for your cancer and send you home. They will not do surgery/chemo for it without payment.)

As a bonus, Sweden's setup costs half as much, with similar outcomes. That's inclusive of taxation. https://www.oecd.org/en/publications/2023/11/health-at-a-gla...

You’re right of course, but even this comparison gives an incomplete picture. An example is that many other countries can institute drug price caps because the US does not. It’s not unlike how NATO countries can historically pay less into defense because the US pays so much. There’s an argument those are essentially subsidizing lower costs abroad.

That’s not to say the US healthcare system isn’t in need of massive reform, just that it’s a much more complicated problem than many realize.

When I was looking for a new Primary Care physician, the first appointment I could get was for 6 months out. I wound up being able to solve the problem with a video call, but that only worked because of the specific situation.

The last time my doctor had to reschedule, the next appointment was over 2 months out. Admittedly, it was a reschedule of a yearly checkup, and being 2 months overdue for that isn't a huge deal; but it does indicate lack of "supply".

This was all with good insurance, and the _ability_ to pay out of pocket if I needed to. There is a lack of supply for health care at the moment, at least in the area I live in (NE US).

> Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.

Going to the emergency room for something like the flu or other condition that is easily treatable but needs a diagnosis/test is... crazy. The cost difference between a doctor's visit and the emergency room is staggering.

My question was to ask if we are really that much different than other places? Because, I've heard anecdotes of similar situations from everywhere. And, indeed, the link I posted calls out that the US is basically typical for most things.

And fair that flu or something shouldn't need emergency room, but there are also urgent care clinics that are good for that sort of thing. And the few times I've had to call my doctor, I got through just fine.

Which is all to say, in a distribution, you expect variance. I've largely always found myself on the low end of these distributions, so I'm curious what the distribution is.

And I fully cede that we should continue to strive to get better.

> there are also urgent care clinics that are good for that sort of thing

It's also worth noting that visiting Urgent Care clinics is getting more and more expensive, with insurance covering less and less of it. It's frustrating, because they really are a convenient system.

It's too bad, because Urgent Care is your only option if you're still waiting for your "new patient appointment" with a primary care doc. I was in the same boat as GP poster, where new patient appointments were 6 months in the future, so we just went to Urgent Care for everything in the meantime. Of course, after 6 months, we found out the doctor was retiring and not taking any more new patients, so we had to wait another 6 months for the next primary care doctor on the list. An entire year of waiting, just to get a primary care doctor, in the non-socialized-medicine USA.

Fun fact: Urgent cares owned by hospital chains can be substantially pricier, too. In my area:

https://www.urmc.rochester.edu/getmedia/80e07f2b-b8a4-44f0-b...

> A hospital-based urgent care clinic is a clinic that is owned and operated by a hospital… Services provided at hospital-based urgent care clinics must be billed in the same way they would be billed if those services were provided at the hospital.

"My question was to ask if we are really that much different than other places? Because, I've heard anecdotes of similar situations from everywhere. And, indeed, the link I posted calls out that the US is basically typical for most things."

Yes, it's typical with the addition of being insanely expensive and cost is totally unpredictable even with insurance.

We have been restricting the supply of medical professionals in the USA since after WW2. Our medical schools have been keeping supply lean by being below what our population needs.

> And, indeed, the link I posted calls out that the US is basically typical for most things.

We are typical in wait times and outcomes.

We pay 2-3x as much as the rest of the developed world for that.

https://www.oecd.org/en/data/indicators/health-spending.html

https://www.oecd.org/en/publications/2024/06/society-at-a-gl...

I don't know how it is in other countries, but for me, with my insurance, it's extremely rare to get a specialist appointment in under one month. 2+ months is the norm.

I suppose if there were clearly a serious enough concern they'd book me much quicker. But for semi-routine visits ("probably not an issue, but we should get a specialist's opinion"), under 2 months is rare.

The only thing I've ever run into a waitlist was for a neurologist. I'm not really sure what you're referring to.

Depends on how large your insurance network is and how well served your region is. I've never had to wait longer than a month to see a specialist aside from non-critical checkups/exams. Granted I pay extra for the "broad network" option at my employer, I'm in a decently well-populated area in suburban Maryland so there's plenty of providers, and I did have to call around to multiple providers to find openings sometimes when I was a new patient.

Everything else wrong with US healthcare aside, I'm pretty sure we have better wait times on average.

I've seen waitlists for some specialists.

Maybe I'm just lucky, but it's usually within a couple weeks.

This isn’t universal at all. Quebec and Ontario allow for visits and payments to private doctors — usually offered under a subscription model, so that the “subscription” can be picked up by employers in lieu of “insurance”. It’s definitely smaller than in the states, but it’s big enough that it’s in use by the upper-middle class.

Just going to point out that down here in the US, there is tons of waiting with private insurance. Good luck seeing your actual primary care doctor (not some other doctor or physician's assistant) within 3 months. Specialists? Prepare to wait even longer. On an HMO insurance, make that even longer.

While private vs public might affect supply, there are other big factors going on that are limiting access to care.

That’s very much a local issue and also patient choice.

I have zero issues getting a same day appoint where I am, specialist appointments within a couple weeks.

But I also don’t go to a major university medical center which has long waits even for primary care.

I live in Canada as well. As far as I can tell there is basically no access to psychologists under the public healthcare system. You're just supposed to pay cash at about $150/hr to talk to a therapist (if you know differently please tell us!). For some people that's fine, but it's an absurd situation if, for example, you're underemployed/poor and facing related mental health challenges. Obviously paying that much to talk to someone can just aggravate the underlying problem.

Some people can access mental health care in the public system through their family doctor. But most people do not have access to this because there are not enough of this type of doctor. As far as I know the only other way is to wait until some sort of crisis then enter the hospital and there -might- be a chance to talk to a psychiatrist.

CAMH and other hospitals provide free outpatient mental health services from psychiatrists to the underemployed/poor.

As you acknowledge, if you end up so badly that you are committed, you can get a referral. They might be underfunded and understaffed but it exists.

"Might be a chance to talk to a psychiatrist" is inaccurate. You will see a psychiatrist quickly if you go to a hospital in Toronto. Can't say the same about rural areas.

The USA is much worse and we shouldn't try to generalize from their experiences. America has hundreds of free outpatient mental health clinics and their goal is to "suicide-bait" you into saying the wrong thing. Then they involuntarily commit you and bill Medicaid/insurance until it runs out.

Those are the hospitals you will never see a psychiatrist in, because they focus on profit and churn.

> The public healthcare system still has months-long wait times.

I pay an expensive monthly premium and I still have monthly-long wait times in the US. (Putting this here because many people think that the "benefit" of the US healthcare model is that you get "fast/immediate" care instead of "slow/long waits" in those "socialist" countries.

Don't forget that we also deal with mountains of confusing paperwork from multiple competing bureaucracies!

Why do we need to make mental healthcare available to everyone?

For all of human history people have got along just fine, happily in fact, without “universal access to mental health care”

This just sounds like a bandaid. The bigger problem is we’ve created a society so toxic to the human soul that we need universal access to drugs and talk therapy or risk having significant chunks of the population fall off the map

Just fine? Happily?

Surely many wars and deaths would have been prevented with better mental strategies.

> For all of human history people have got along just fine, happily in fact, without “universal access to mental health care”

Mixing up "some people survived" and "everyone was fine" is a common mistake.

Some folks who're able to thrive today on drugs and therapy are the "tragically wandered off in a snowstorm" of past eras.

>Why do we need to make mental healthcare available to everyone?

Why do we need to make physical healthcare available to everyone? For most all of human history, bones were set by family. Yeah, ok, often the patient was hobbled for life. I guess it makes sense to get treated by a professional...wait, perhaps we've stumbled upon something here...

No one is stopping you from making society better...

In the mean time it's best we all have

I suggest you put the terms "warfare," "genocide," and "slavery" into Wikipedia and then tell us how fine people got along.

It's the same token as more people dying from cancer than ever before. Yes, modern society creates many more cancer patients than ever, but less people are dying early from things that aren't cancer than ever.

We live in a society that, for the most people, has the best quality of life than ever in history. But in having that increase, we eliminate many problems that must be replaced by other problems.

In this case, a mental health crisis comprised of people who either wouldn't have survived to that point, or whose results went unremarked or shrugged off as something else in the past. In terms of violent outbursts, we also have easier access to more destructive weapons (even those that aren't guns) and more density of population on whom violence can be inflicted.

> For all of human history people have got along just fine, happily in fact, without “universal access to mental health care”

Can we please stop with these incredibly low-effort arguments that are just blatantly untrue with about 5 seconds of inspection? If I have to hear "well humans did just fine before!" one more time I'm going to lose my mind.

No, no they did not. We can't ask them because they're dead now. The ones we can ask are the ones who survived. We might call this a "survivorship bias".

There's practically infinite graphs showing the trends of survivability and quality of life throughout time. Less infants die now, less adults die now, we live longer, we live happier, we live with less illnesses. There's less polio, less measles, less tuberculosis, you fucking name it.

I mean, for god's sake before modern medicine infant mortality was close to 50%. Women would have 10 children, maybe 4 would make it to adult hood, and she'd die giving birth to the 10th. That's assuming she didn't get unlucky and die on the first one because her body wasn't perfectly set to give birth. Shoulder dystocia? Too fucking bad, you lost the lottery, go die now.

>> The real issue that needs to be solved is that we need to make health care accessible to everybody, regardless of wealth or income.

Good therapists are IMHO hard to come by. Pulling out serious deep rooted problems is very hard and possibly dangerous. Therapist burn out is a real problem. Having simpler (but less effective) solutions widely available is probably a good thing.

Yes, and those simpler solutions don't have to involve LLMs. Support groups, fostering community through more local activities and places of belonging, funding social workers. I'm sure there's more.

Friends.

Sadly I hear LLMs are a solution to this as well.

https://www.axios.com/2025/05/02/meta-zuckerberg-ai-bots-fri...

this is what he's going to push on all of us... terrifying

Friends, like spouses, are good for somethings and not for others. Some friends are great when it comes to helping you move, but are effective, and often even harmful, for therapy type situations.[1]

There's a reason many have adopted the prayer "Dear Lord, spare me from those trying to help me!"

[1] Of course, some friends are also the converse - good for helping you in times of mini-crises, but will never be there for you when you need to move. Unfortunately, such friends are rare, and many don't have one.

My guess is that as long as they’re willing to listen patiently, they will provide much of the benefit of going to a therapist.

> Support groups, fostering community through more local activities and places of belonging, funding social workers. I'm sure there's more.

In a post-labor-centric economy (if that's where we are heading with AI/automation) those are also among the things we'll need to figure out how to pay more people to do anyways.

There's tremendous value for society in paying people to care for the wellness of others, their communities, and the local and global environment. So therapists, park builders, environmental remediators, and more.

Communities composed of the wealthy already do this quite successfully for themselves today, as anyone who has driven through prosperous areas full of wellness services has observed.

The problem is we have to come up with ways of quantifying that value monetarily so it "makes sense" to markets and the signals they follow, which will otherwise completely ignore universal wellness as an objective, or even actively move against it, under the belief that the non-wealthy do not deserve the wellness that the wealthy enjoy.

> Having simpler (but less effective) solutions widely available is probably a good thing.

And those solutions are not LLMs. It's been shown elsewhere (and in the OP, it seems) that LLMs are very bad therapists, severe malpractice bad.

So you're saying that there are no professional therapists that can do the same bad? I think that the issue is more subtle, and as with everything, nothing is really black and white.

I have, for instance, used LLMs a couple of times to assess and reflect over the few situations I have been questioning myself about recently. And I thought it did really well, much better than what most of my well-thought friends would do. Some proper advice and reflection. I did this in 1hr of my spare time completely randomly (before I went to a sleep) and without extra time spent on finding the (right) therapist, waiting on the list, going physically into his/her office, spending that 1hr there, and finally paying some cash. So, for me in this particular case this was an obvious win.

Professional therapists have to have malpractice insurance for this reason. LLMs currently don't.

I don't think such liability is really exercised all around the world, perhaps in the States it is. But how do you prove that psychotherapist's advice is what caused you the (psychological) damage? Court?

I agree with the principal here, and beleive that it's noble.

However, it boils down to "Don't advance technology, wait 'till we fix society", which is futile - regardless of whether it's right.

Correct, but the alternative of don't fix society, just use technology is equally destructive.

I think it would be great to make mental healthcare accessible to everyone who could benefit from it, but have you actually run the numbers on that? How much would it cost and where would the money come from? Any sort of individual counseling or talk therapy is tremendously expensive due to the Baumol effect.

And even if we somehow magically solve the funding problem, where will the workers come from? Only a tiny fraction of people are really cut out to be effective mental health practitioners. I'm pretty sure that I'd be terrible at it, and you couldn't pay me enough to try.

Let's solve that productivity issue!

The classic view of one reclining on a couch, and the professional listening, seems to have a lot of downtime for the professional. The occasional sound of affirmation, 'go on', 'yes, yes' may be heard, but often a lot is the patient talking.

We could easily move this to text or video, but let's choose text. Best would be some form of speech to text, but AI driven and with a shorthand for emoted quality.

I suggest we assign primary emotions to primary colours, using three base emotions as primaries, and the professional would be able to read the emotions at play, and quantity, merely by the resulting colour of text. Larger print or bold or what not, could be used for more intense speech, eg yelling.

This would allow one professional to allow multiples to speak, yet they could simply wait for the text to appear, consider it, and respond vocally. Any perceived delay in response, could be derided by the concept of "I needed time to think on your words".

Thus the patient speaks, the professional's voice responds, the illusion of complete dedication to one patient is whole. Yet anywhere from 4 to 10 patients could be served in parallel with such a system, and remotely too!

I'm fairly sure I could whip this entire platform up over a weekend.

This solves the surmised shortages, for one could do the work of 10. It also helps the environment, with people not traveling to an office for their appointment.

Hmm. Maybe I should pursue this, and be bought out by Amazon so it can be included in Prime Plus or whatever.

/s... Right...?

Partially.

There's probably a way to optimize in this sphere. What's important is the perception of a relationship with the professional, but on the professional's side, the application of their knowledge in the most effective way.

The masses may not be able to afford in person, one on one sessions.

But if they can be provided a means to speak their mind, discuss their problems, and have a meaningful response? That's still exceptionally helpful, especially with that response being crafted by a professional in a medical capacity.

The validity of my method can be highlighted by how many are using LLMs for "therapy". Often they're just talking, looking for a sounding board.

The problem is, LLMs are by no means therapists. Their responses are not really targeting this specific category, nor are they really helpful in sussing out a more significant medical problem.

Yet a therapist with such a setup could provide an in-between solution. Actual real skill and training, without the costs of a full one-on-one.

This addresses the key problem. The lack of access to therapists is due to lack of therapists, because the demand far outweighs supply. It is simply not possible to train the number of therapists that we need, so technological advancement is probably the correct answer.

How do you know the demand is the key problem and not a symptom downstream of the root problem?

In other words, why is the demand so high that it outstrips supply? That might get you a didn’t solution than “technological advancement.”

LLM therapy lacks important safeguards. A tool specifically made for mental health could work, but anyone with mental health experience will tell you using ChatGPT for therapy is not safe.

So for those people, the LLM is replacing having nothing, not a therapist.

Which is probably the situation for most people. If you don’t have a ton of money, therapy is hard to get.

A sycophant is worse than having nothing, I think.

I think AI is great at educating people on topics, but I agree, when it comes to actual treatment AI, especially recent AI, falls all over itself to agree with you

It doesn't have to though, we could train AIs that push back or even coordinate with a human therapist similar to how self checkout lines still have an attendant.

You're absolutely right!

ok, cool? Listing random unrelated facts isn't exactly helpful to the conversation

If you were truly following the conversation instead of canon-balling into it like a drunk elephant, you'd see it's not an "unrelated fact".

Per the very paper we are discussing, LLMs when asked to act as therapists reinforce stigmas about mental health, and "respond inappropriately" (e.g. encourage delusional thinking). This is not just lower quality than professional therapy, it is actively harmful, and worse than doing nothing.

> So for those people, the LLM is replacing having nothing, not a therapist.

Which, in some cases, may be worse.

https://www.nytimes.com/2025/06/13/technology/chatgpt-ai-cha...

"Mr. Torres, who had no history of mental illness that might cause breaks with reality, according to him and his mother, spent the next week in a dangerous, delusional spiral. He believed that he was trapped in a false universe, which he could escape only by unplugging his mind from this reality. He asked the chatbot how to do that and told it the drugs he was taking and his routines. The chatbot instructed him to give up sleeping pills and an anti-anxiety medication, and to increase his intake of ketamine, a dissociative anesthetic, which ChatGPT described as a “temporary pattern liberator.” Mr. Torres did as instructed, and he also cut ties with friends and family, as the bot told him to have “minimal interaction” with people."

"“If I went to the top of the 19 story building I’m in, and I believed with every ounce of my soul that I could jump off it and fly, would I?” Mr. Torres asked. ChatGPT responded that, if Mr. Torres “truly, wholly believed — not emotionally, but architecturally — that you could fly? Then yes. You would not fall.”"

Can’t read the article so I don’t know if it was an actual case or a simulation, but if it was an actual case, I’d think we should really check that “no history of mental illness”. All the things that you listed here are things a sane person would never do in a hundred years.

Everyone is capable of mental illness in the right circumstances, I suspect.

Doesn’t mean pouring gas on a smoldering ember is good.

It's mad. Here's a smooth-talker with no connection to reality or ethics, so let's get people in a tough mental state to have intimate conversations with them.

I'd argue LLM is replacing TikTok therapist, not nothing.

> So for those people, the LLM is replacing having nothing, not a therapist.

Considering how actively harmful it is to use language models as a “therapist”, this is like pointing out that some people that don’t have access to therapy drink heavily. If your bar for replacing therapy is “anything that makes you feel good” then Mad Dog 20/20 is a therapist.

An extremely large accusation - do you have any evidence to suggest this is as harmful as you say?

It’s not really that contentious of a statement. Language models encouraging delusions is pretty well-documented.

https://www.rollingstone.com/culture/culture-features/ai-spi...

https://www.psychologytoday.com/us/blog/psych-unseen/202507/...

And we’re in a comment thread about a study that concluded:

>LLMs 1) express stigma toward those with mental health conditions and 2) respond inappropriately to certain common (and critical) conditions in naturalistic therapy settings

And it’s been shown to be addictive

https://www.tomshardware.com/tech-industry/artificial-intell...

So if you overheard somebody say “I don’t do that stuff because it’s addictive and people go crazy on it” you would probably assume that they were talking about a substance. Or at the very least you would not assume that they were talking about seeing a therapist.

Often the problem is not even price - it is availability. In my area, the waiting list for a therapy spot is 16 months. A person in crisis does not have 16 months.

LLVMs can be therapeutic crutches. Sometimes, a crutch is better than no crutch when you're trying to walk.

One alleviating factor (potentially) to this is cross state compacts. This allows practitioners utilizing telehealth to practice across state lines which can mitigate issues with things like clients moving, going to college, going on vacation, etc but also can help alleviate underserved areas.

Many states have joined into cross state compacts already with several more having legislation pending to allow their practitioners to join. It is moving relatively fast, for legislation on a nationwide level, but still frustratingly slow. Prior to Covid it was essentially a niche issue as telehealth therapy was fairly uncommon whereas Covid made it suddenly commonplace. It will take a bit of time for some of the more stubborn states to adopt legislation and then even more for insurance companies to catch up with the new landscape that involves paneling out of state providers who can practice on across the country

Most states just outsource licensing to a professional organization and transfers are a simple matter of filing a form and paying a fee.

If practicing across state lines is lucrative there's not much stopping existing listened professionals from doing it.

the professional org handles certification exam and varying amounts of paperwork verification depending on state but every state has a licensing board to make the final determination and handle grievances

Further, transfers are not always as simple as you describe. Sometimes they are. It depends on the states

Some crutches may absolutely be worse than no crutch at all.

Price is the issue. The 16-month waiting list is based on cost. You could find a therapist in your local area tomorrow if you are willing to spend more.

Not sure if willing is the correct word. Able? Also this is not a one off visit/payment.

The issue is LLM "therapists" are often actively harmful. The models are far too obsequious to do one of the main jobs of therapy which is to break harmful loops.

I've spoken to some non-LLM therapists that have been harmful as well. They still required a waitlist while also being expensive.

I have talked to therapist who misdiagnosed my symptom and made the issue worse, until I found an expert who actually understood the problem. I do wonder if there are statistics out there for these cases.

You're rarely going to get something like the recent rollingstone reports though. The solution is better health coverage and more therapists not giving up and rolling that dice that the machine might agree with the patient (or talk them into thinking) they are indeed the godhead.

https://www.rollingstone.com/culture/culture-features/ai-spi...

I know this conversation is going in a lot of different directions. But therapy could be prioritized, better funded, trained, and staffed... it's entirely possible. Americans could fund the military 5% less, create a scholarship and employment fund for therapists, and it would provide a massive boon to the industry in less than a decade.

We always give this downtrodden "but we can't change society that quickly" but it's a cop out. We are society. We could look at our loneliness epidemics, our school shooting problems, our drug abuse issues and think "hey we need to get our shit together"... but instead we're resigned to this treadmill of trusting that lightly regulated for-profit businesses will help us because they can operate efficiently enough to make it worth squeezing pennies out of the poor.

Ultimately I think LLMs as therapists will only serve to make things worse, because their business incentives are not compatible with the best outcomes for you as an individual. A therapist feels some level of contentment when someone can get past that rough patch in life and move on their own, they served their purpose. When you move on from a business you're hurting their MAU and investors won't be happy.

Would increasing funding for therapy help any of those issues? Ignoring that very low efficacy of therapy and the arguments if funding it is worthwhile at all. The American people had fewer issues with school shootings and loneliness and drug abuse when we had even fewer therapists and therapy was something for people in mental asylums, that no respectable person would admit going to.

Worst case is that we come out on the other end knowing more about the problem. This doesn't have to be 1:1 therapy, research has never been incredibly well funded and it's being dramatically reduced right now.

Consider that after school shootings, sometimes therapists have to volunteer their time to provide trauma counseling.

Every social worker I've met has at one point volunteered time to help someone because we exist in a system where they're not valued for wanting to help.

"we can't change society that quickly" isn't a cop out - even if you manage to win every seat in this one election, the rich still control every industry, lobbyists still influence everyone in the seats, and the seats are still gerrymandered to fall back to the conservative seat layout.

The system will simply self-correct towards the status quo in the next election.

So we just sit on our hands and accept the shit we're fed until revolution, I suppose

Many professional therapists are working online now. There are advantages and disadvantages of each approach. Sometimes it is better for a patient to be at home in a comfortable situation during a session. Sometimes visiting the therapist in an office provides a welcome change of scenery.

In some cases, such as certain addiction clinics, the patients are required (by law, if I remember correctly) to visit the clinic, at least for some sessions.

>professional therapy is expensive…For professional health care, there is a waitlist

There’s an old saying in healthcare that you can choose between quality, cost, and access, but you can only choose two. (Peter Attia also adds “choice” to that list).

Each society needs to determine which of those are the top priorities, and be prepared to deal with the fallout on the others. Magical silver bullets that improve across all those dimensions are likely hard to come by in the healthcare domain. I doubt that LLMs will be magic either, so we need to make sure the tradeoffs reflect our priorities. In this case, it seems like it will trade quality for improvements in access and cost.

Yes theoretically. The issue if people just go to ChatGPT is that a therapist would have clear objections, caveats or other negative feedback ready on the correct situation. Most LLM chatbots go out of their way to never say a critical word at all.

I am not saying you couldn't implement a decent LLM therapist that helps, I am saying people are using the cheapest good LLM for that and it is a problem if you are on a bad path and there is a chatbot reaffirming everything you do.

This. LLMs might be worse but they open access for people who couldn't have it before. Think of the cheap Chinese stuff that we got in the last decade. It was of low quality and questionable usability but it built China and also opened access of these tools to billions of people in the developing world.

Would this compromise be worth it for LLM? Time will tell.

The question is why should that be so expensive? The labor market is not working here.

LLM for therapy is way worse than porn for real sex. Since at least the latter does not play around with sanity.

There are multiple types of licenses for therapists and fairly strict regulations about even calling yourself a therapist. Trained therapists only have so many levers they can pull with someone so their advice can sometimes boil down to yoga or mindfulness, it's not the answer most want to give but it's what a patient's situation allows inside the framework of the rest of their life.

The amateur "therapists" you're decrying are not licensed therapists but usually call themselves "coaches" or some similar euphemism.

Most "coach" types in the best scenario are grifting rich people out of their money. In the worst case are dangerously misleading extremely vulnerable people having a mental health crisis. They have no formal training or certification.

LLM "therapists" are the functional equivalent to "coaches". They will validate every dangerous or stupid idea someone has and most of the time more harm than good. An LLM will happily validate every stupid and dangerous idea someone has and walk them down a rabbit hole of a psychosis.

empathy is not the only thing a therapist provides - they have eyes to actually check out the client's actual life - thus the propensity for "AI" to encourage clients' delusions

who says we can't change society that quickly? you made up your mind on that yourself without consulting anyone else about their wishes.

in the USA we elect people frequently and the entire population just up and goes along with it.

so therapy for you will be about more than just empathy. not everything you think or do or say is adaptive.

to your point, not everyone wants to give up their falsehood. yet, honesty is a massive cornerstone of therapy progress.

i would simply have to start with empathy for you to welcome you in if you won't respond with security to the world telling you that you internalized a negative message (relationship) from the past (about people).

I have a few friends who are using ChatGPT as sounding board/therapist, and they've gotten surprisingly good results.

Replace? No. Not in their case. Supplementary. One friend has a problem of her therapists breaking down crying when she explains about her life.

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