Technology

therapy does not have to be expensive.

But it is though.

Your medicaid patients?

Poor. By definition.

Sure they might not pay a copay, but they pay for it in gas money to get to that visit, their barely running car now breaking down from visiting you, time off work they can't really afford, time filling out reams and reams of fucking paperwork to be able to qualify for anything, likely when they're already in a mentally comprimised condition to some extent... its all very stressful.

Which is very bad for mental health.

we have no reason to believe it would be any better than a paper journal and a CBT worksheet.

And the part you don't want to admit (at least here) is that ... that's actually quite helpful in and of itself for a lot of people.

Have a few sessions with a live, in person therapist, to teach you CBT, give you the paperwork, walk you through it.

Not all, but many people can take it by themselves from there, and not need to keep wasting time and energy on continually requalifying for medicaid, getting to and from psych appointments, dealing with scheduling delays and unavailability, etc.

Yep, a lot of people are also helped by basically just having someone to be able to talk to and feel heard.

But... that's often doable by just making either a friend or even casual acquaintance with someone who is capable of, and has the capacity for reflexive empathy.

Much less stress and paperwork involved there.

And also yes, some people with much more serious issues need much more serious help.

Unfortunately, the entire medical system in the US is utterly broken, and the only real solution is having a system that ... isn't broken, so that comprehensive screening and diagnosis is easily available without huge delays and costs... and more broadly, those people need to have the first two levels of maslow's hierarchy of needs taken care of.

But currently our society basically just takes those people and throws them into the streets, evicts them, forecloses on them, incarcerates them.

There simply is no systemic way to help those people without major systemic changes... and those ain't happening, they're moving in the opposite direction.

...

The problem with LLMs as therapy is that they are wildly overconfident, agreeable to the point of encouraging delusions and dangerous behavior, they hallucinate facts that aren't real... and they are not actually capable of legitimate critical thinking or reasoning.

They also will not introduce you to concepts you have never heard of before which you do not know are or could be very useful, unless you directly ask them to do that, and even then... they obviously are not experts themselves and may suggest dubious ideas.

But also, at the same time... people often do form what they will describe as meaningful relationships with an LLM. So... its not that 'it doesn't happen', its that its a psuedorelationship, a fascimile of a relationship, lacks in person interaction, a real human modulating their intonation, having micro expressions, body language, etc etc.