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Thursday, December 21, 2023

Chatbot therapy is risky. It’s also not useless

A.W. Ohlheiser
Originally posted 14 Dec 23

Here is an excerpt:

So what are the risks of chatbot therapy?

There are some obvious concerns here: Privacy is a big one. That includes the handling of the training data used to make generative AI tools better at mimicking therapy as well as the privacy of the users who end up disclosing sensitive medical information to a chatbot while seeking help. There are also the biases built into many of these systems as they stand today, which often reflect and reinforce the larger systemic inequalities that already exist in society.

But the biggest risk of chatbot therapy — whether it’s poorly conceived or provided by software that was not designed for mental health — is that it could hurt people by not providing good support and care. Therapy is more than a chat transcript and a set of suggestions. Honos-Webb, who uses generative AI tools like ChatGPT to organize her thoughts while writing articles on ADHD but not for her practice as a therapist, noted that therapists pick up on a lot of cues and nuances that AI is not prepared to catch.

Stade, in her working paper, notes that while large language models have a “promising” capacity to conduct some of the skills needed for psychotherapy, there’s a difference between “simulating therapy skills” and “implementing them effectively.” She noted specific concerns around how these systems might handle complex cases, including those involving suicidal thoughts, substance abuse, or specific life events.

Honos-Webb gave the example of an older woman who recently developed an eating disorder. One level of treatment might focus specifically on that behavior: If someone isn’t eating, what might help them eat? But a good therapist will pick up on more of that. Over time, that therapist and patient might make the connection between recent life events: Maybe the patient’s husband recently retired. She’s angry because suddenly he’s home all the time, taking up her space.

“So much of therapy is being responsive to emerging context, what you’re seeing, what you’re noticing,” Honos-Webb explained. And the effectiveness of that work is directly tied to the developing relationship between therapist and patient.

Here is my take:

The promise of AI in mental health care dances on a delicate knife's edge. Chatbot therapy, with its alluring accessibility and anonymity, tempts us with a quick fix for the ever-growing burden of mental illness. Yet, as with any powerful tool, its potential can be both a balm and a poison, demanding a wise touch for its ethical wielding.

On the one hand, imagine a world where everyone, regardless of location or circumstance, can find a non-judgmental ear, a gentle guide through the labyrinth of their own minds. Chatbots, tireless and endlessly patient, could offer a first step of support, a bridge to human therapy when needed. In the hushed hours of isolation, they could remind us we're not alone, providing solace and fostering resilience.

But let us not be lulled into a false sense of ease. Technology, however sophisticated, lacks the warmth of human connection, the nuanced understanding of a shared gaze, the empathy that breathes life into words. We must remember that a chatbot can never replace the irreplaceable – the human relationship at the heart of genuine healing.

Therefore, our embrace of chatbot therapy must be tempered with prudence. We must ensure adequate safeguards, preventing them from masquerading as a panacea, neglecting the complex needs of human beings. Transparency is key – users must be aware of the limitations, of the algorithms whispering behind the chatbot's words. Above all, let us never sacrifice the sacred space of therapy for the cold efficiency of code.

Chatbot therapy can be a bridge, a stepping stone, but never the destination. Let us use technology with wisdom, acknowledging its potential good while holding fast to the irreplaceable value of human connection in the intricate tapestry of healing. Only then can we mental health professionals navigate the ethical tightrope and make technology safe and effective, when and where possible.