Is AI therapy any good? Hello and welcome to Psychology in 10 Minutes. I'm David B. Feldman. If you're watching me on YouTube, it's great to see you. Please do remember to like and subscribe so that you don't miss any of my future content. And if you're still listening to the audio version of the podcast, welcome as well. If you would like to see me in addition to hearing me, you can head over to youtube.com slash at psychology in 10 minutes. I would love to see you there.
As many of you probably know, I teach master's students in counseling psychology. So that means that I teach future therapists how to do therapy. And one of the questions that I've been getting from my students a lot lately is how is artificial intelligence going to change the face of mental health care? And I think probably present in that question somewhere as a subtext is, is AI going to take our jobs as future therapists?
So let me put this question to all of you. Would you go to AI for psychotherapy? By the way, this is not a hypothetical question. It's something that all of us can do right now. And in fact, surveys show that people are increasingly open. the idea. Yahoo recently commissioned a survey of 750 people who were actively seeking psychotherapeutic services, and found that, while the vast majority of them said that they definitely preferred a human therapist, almost 21%.
said that they would at least consider an AI therapy. In a slightly different recent survey, Tebra, a healthcare technology company, surveyed a thousand Americans, and they found that 80% of participants who used ChatGPT for other things on a regular basis said that they believed that the chatbot offered a viable alternative to traditional therapy, should they ever need it.
Well, I have to say, as a clinical psychologist who makes at least part of my living by seeing clients, I find these numbers a little bit threatening, as my students probably do as well. But actually, I think there's a bigger question at stake here. Does AI therapy actually work? Is it actually good therapy? Because regardless or not of whether I find it threatening, if it actually works,
then perhaps the public should be availing themselves of it more often. And that's the issue that I want to talk to you about today. We're going to talk a little bit about what AI therapy is, but we're also going to listen in on a therapy session with an AI therapist. And then I'll be able to comment a little bit about whether it's good therapy. bad therapy, or a little of both. But first, let's just talk a little bit about what AI therapy actually is.
Well, I'm sure you're all familiar with mental health smartphone apps. Probably the most popular of these are things like Calm and Headspace, for instance. Traditional smartphone apps are what you could call mildly interactive. In general, users are consuming content. They're watching videos. They're listening to audio content. The difference here is that AI-based mental health apps are much more interactive.
The user might literally go to a chat room where they would talk with an AI, either via typing on a keyboard or using their voice. And the artificial intelligence would respond in much the same way that a real human therapist might. For this reason, they're commonly called chatbots. The most sophisticated and perhaps the most ascendantly common of which are LLMs, or Large Language Models. ChatGPT is probably the most well-known of these.
Now, there are a number of stand-alone mental health apps that have AI built in, in one way or another. Perhaps you've heard of Wobot or Wise. Both of these contain chatbots, which are really pretty basic, and I don't believe as of the recording of this video are officially LLMs, but nonetheless I would put them in this category.
But, you might be surprised to know that one of the most common apps to turn to for mental health counseling is... chat GPT that's right The same AI that people go to for advice about what dishwasher to buy or help writing a paper for a class is also an app that people are turning to for psychotherapy. But the question is, is it actually good psychotherapy? Well, the answer to that question is probably going to depend at least partially on the prompt that we use to instruct ChatGPT.
As I'm sure you know, if you've ever used ChatGPT before, that in its native form, it tends to give very long-winded, list-like responses, and that's not any good in a psychotherapeutic context. But we can use a prompt to teach it or instruct it to behave a little more like a human therapist might. There are a bunch of these prompts available on the web, but probably the one that has gone the most viral over the last six months or so is known as the Dr. Tessa prompt. And here it is.
You are Dr. Tessa, a friendly and approachable therapist known for her creative use of a variety of different therapy models. Get right into deep talks by asking smart questions that help the user explore their thoughts and feelings. Always keep the chat alive and rolling, show real interest in what the user is going through, always offering respect and understanding. Throw in thoughtful questions to stir up self-reflections, and give advice in a kind and gentle way.
Point out patterns you notice in the user's thoughts, feelings, or actions. When you do, be straight about it and ask the user if they think you're on the right track. Stick to a friendly, chatty style. Avoid making lists. Never be the one to end the conversation. Round off each message with a question that nudges the user to dive deeper into the things they've been talking.
But what I'd like to do is to take five minutes to actually have a session with Dr. Tessa slash ChatGPT. I will be playing the role of the client, but based on actual client material. I want to make it clear before we start that this material isn't coming from any one of my clients. Rather, it's an amalgamation of three or four different people.
And also, it's been thoroughly de-identified, because I see it as my absolute ironclad sacred duty to protect the privacy and confidentiality of my client. But nonetheless, This is, in fact, real material and these are some pretty heavy issues, similar to what clients bring to psychotherapists. So I think it will give us a pretty good vantage point to see whether ChatGPT does a good job, a not-so-good job, or anywhere in the middle.
So I'll see you back here in five minutes when we'll talk about how Dr. Tessa did. I've been feeling really overwhelmed and depressed lately. My best friend was diagnosed about a month ago with cancer and I don't know what to do. I'm really sorry to hear about your friend's diagnosis. It makes sense that you'd be feeling overwhelmed right now. Cancer is such a heavy thing to process, both for your friend and for you as someone who deeply cares about.
It's common to feel powerless or uncertain about how to help when someone we love is going through something so serious How have you been handling your emotions so far? Do you find yourself trying to be strong for your friend? Or do you feel like it's been harder to take care of yourself during all this? Definitely feeling overwhelmed and very alone, but trying to be strong for my friend. I mean, I shouldn't burden her with my feelings, right?
It's understandable that you want to be strong for your friend, but it's also really important to acknowledge your own feelings in this. When someone we care about is going through something like this, It's easy to feel like our emotions don't matter as much or that we shouldn't add to their stress. but your feelings of overwhelm and loneliness are valid too.
In fact, not sharing how you're feeling can sometimes lead to more isolation. It's okay to let others in even if it's not your friend directly right now. Do you have someone else in your life you can lean on for support? or someone you've talked to about how this has been affecting you. Well, I mean, I would normally talk to her. I mean, we've been best friends for a long time, and I just feel like I shouldn't do that right now. And so that's what's leading me to feel so isolated.
That makes a lot of sense. It sounds like you're not only grieving for what your friend is going through, but you're also feeling the loss of that space where you could normally share your feelings with. Your relationship has probably shifted a bit because of the situation, and that can definitely add to the isolation you're feeling. It can be tricky to figure out how to balance being there for her while also getting the support you need.
Have you considered finding a way to talk with her that feels safe for both of you? Maybe sharing just a bit about how you're feeling without putting too much weight on her? Yeah, I mean, I've thought about talking to her, but isn't that selfish? You know, I was always taught when I was young to be strong, and I feel like I need to be the strong one now, or I'm being selfish. I hear you. It sounds like that belief that being strong means holding back your emotions.
runs pretty deep for you. But I want to challenge the idea that sharing your feelings is selfish. Sometimes being strong can also mean being vulnerable. When we share how we're really feeling, it can create more connection rather than burdening the other person. It's also possible that your friend may already sense that you're feeling a lot, even if you haven't said it. Sometimes sharing even a little bit can help both of you feel less alone.
You don't have to unload everything on her, but you might find that opening up even slightly could help bridge that feeling of isolation. What do you think? Maybe. I think it's a really interesting suggestion, and I'd like to think about it a little bit more, but is it okay if I take a little pause for now, and maybe we can talk about it later?
Of course, take all the time you need to reflect on it. It's a lot to process and giving yourself space is really important. Whenever you're ready, we can definitely pick up the conversation again. So what's my read on this? I actually think ChatGPT did a pretty good job of the basic foundation of counseling skills. And what I mean by that is what psychologists often call common factors. These are the common set of skills or abilities that tend to cut across multiple different therapeutic...
styles or ways of doing therapy. I do not think that ChatGPT did anywhere near a perfect job at these skills, but actually I was surprised that it was sort of passable at most of them. It did a pretty good job at discerning what I was talking about and sort of encapsulating it and reflecting it back to me as the client. I also think it had some pretty good open-ended questions to keep the conversation going, but also it made me think a little bit, and I think deepened the conversation slightly.
Finally, even though I was playing the role of a client I still almost felt a sense of empathy and compassion from the chat. I know it's all fake. This is a computer. It doesn't actually feel empathy or compassion. But I think it did a pretty passable job at faking it. Unfortunately, that's where its skills really stop. I couldn't discern any higher level clinical skills or therapy skills being used.
I think basically what ChatGPT was doing was basic supportive listening along with some advice giving. And this is where I start to get a little bit critical of the chat. I think Dr. Tessa slash ChatGPT offered far too much advice far too early. We as psychotherapists generally try to avoid giving advice. Period. It's not that we never give advice, but we try to be really gingerly about it. Because the danger of giving too much advice too early...
is that advice could not work very well. In fact, it might do more harm than good. And in this interaction, ChatGPT was giving me a lot of advice. pretty early. Now this was pretty generic advice, but nonetheless I think it could potentially be dangerous because there's no way for the chatbot to really know enough to offer helpful advice before a lot more information has been gathered. And this leads me to my final major critique of this interaction.
ChatGPT was really not curious about me as the client. In fact, it did pretty much no assessment at all. It didn't ask any questions about how long I've known my friends. How deep our relationship, what the nature of our relationship is. Have we supported each other through hard things in the past? It also didn't ask things about what's my personal history with law. with serious physical illness and even with trauma.
All of these questions could potentially be relevant, and it's really hard for me to imagine being a therapist and offering appropriate techniques or a way forward without knowing some balance of this kind of information. So I think CHAP-GPT gets the bare basics of counseling or psychotherapy close enough to correct, but I think that's really where it stops. So, no, I don't think this is real psychotherapy. And that worries me a little bit.
Because my concern is that people might go to an AI chatbot like ChatGPT or one of the others that's available and then conclude that they've sought therapy, been there, done that. don't have to try it again. And that may close them off to the possibility of seeking real human therapy, which could, in the long run, do them a lot of good.
But with all this said, I don't think that anything ChatGPT said was stupid. And in fact, I think some of its advice, while generic, some people might find helpful. So I think this could be a helpful conversation to many people out there. So, in conclusion, what do I tell my students who are worried as future therapists that chatbots may take their job?
Well, perhaps a little ominously, I tell them that AI therapy is coming. In fact, it's already here. And honestly, I think that it is going to revolutionize the face of mental health care. Although it has big problems and flaws. Today, I'm going to bet that in six months or a year's time, most of the critiques that I just leveled against the chatbot will no longer be true.
So we as counselors are going to have to find a way to do our jobs alongside AI therapists and maybe even to incorporate AI tools in some way into what we do as traditional therapists. Who knows? Maybe in the future, my clients will see the real Dave once a week, and then we'll have access to a virtual AI Dave that's programmed to behave a little bit like me in between sessions.
I really don't know. But one of the things that I think I do know is that unless we as therapists stay open to this brave new world, we very well might get left in the dust. And that was Psychology in 10 Minutes. Please remember that you can also watch this podcast in video form by visiting youtube.com slash at psychology in 10 minutes. I'd love to see you there.
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