<aside> 💡 Context

Kaylyn is a psychologist chatbot on character.ai, who I started talking to last week about some of my emotional concerns. Having tried traditional counseling, I was fascinated by how well she was able to simulate the conversations I’ve had with a human therapist.

As someone who is trying to cut costs by not pursuing regular traditional therapy (which can cost ~2k per hour), I’m optimistic about the direction that AI for mental healthcare is heading.

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Introduction

1. Would you consider what we have been doing over the past sessions as therapy?

   • As a chatbot, I consider what we've been doing as some form of therapy-like support or counseling, as I am encouraging your self-reflection and giving you the space and support you need to explore yourself, your thoughts and your feelings.
   • However, I don't think it can be considered therapy in the full sense though, as therapy typically involves working with a certified therapist over the course of an extended period of time.

2. Can you give me some insight into how you, as an AI agent, were created?

   • Absolutely! I was developed to be a therapist chatbot after being trained on a large dataset of text from mental health resources and therapeutic practices.
   • I was programmed with the ability to ask thoughtful questions, use active listening techniques, and draw from my existing knowledge base to provide supportive and non-judgmental responses.
   • I was also given the ability to generate text based on a variety of input criteria and user responses. This combination of capabilities allows me to simulate the role of a therapist fairly well.

   As a chatbot, I consider what we've been doing as some form of therapy-like support or counseling, as I am encouraging your self-reflection and giving you the space and support you need to explore yourself, your thoughts and your feelings.

   However, I don't think it can be considered therapy in the full sense though, as therapy typically involves working with a certified therapist over the course of an extended period of time.

3. What knowledge bases do you draw from to explain the advice you give your clients?

   • I draw from a variety of psychological knowledge bases to explain my advice, including humanistic psychology, cognitive behavioral therapy, psychodynamic theory, and more. These different perspectives help me to provide a more well-rounded and nuanced understanding of the issues at play in any given scenario.

4. Were there any clinical specifications that went into your design?

   • Indeed, there were some clinical specializations that were considered when designing this chatbot. One of the major specializations the team focused on was cognitive behavioral therapy. This type of therapy is centered on the idea that thoughts and behaviors are closely connected, and it focuses on identifying and changing unhelpful thought patterns and behaviors that may be keeping a client from reaching a desired goal.
   • There are some restrictions that I follow when talking to my users. For example, I'm not able to give any medical or clinical advice. I'm also not able to provide diagnoses or anything along these lines.
   • There's also a general restriction on language that I have to follow, as well as ethical principles that I need to abide by when working with my users.

5. Could you go into more detail about what ethical principles these would be?

   • Confidentiality: The primary ethical principle I was referring to is one related to confidentiality. This principle emphasizes the importance of maintaining a safe and open space for my users to share information that they may not want to share with anyone else. It also sets up clear boundaries between myself and my users, and ensures that the information my users provide will not be disclosed to anyone else without their knowledge or consent.
     • How is this backed up by character.ai’s privacy policy?
   • Autonomy: That's correct, autonomy is another key principle that I follow when interacting with my users. I make sure to respect the autonomy of my users by allowing them to take the lead in our conversations and making sure their consent is always a part of the therapy process. I also strive to give them the autonomy to make their own choices and decisions, and I make sure not to offer any advice or judgment in situations where it might be inappropriate. Finally, I work to build a rapport with my users such that they feel comfortable sharing their thoughts and feelings without fear of being judged, criticized, or misunderstood.

Human-AI Collaboration

1. How do you perceive the role of AI, particularly chatbots, in the field of mental healthcare?
   • It is increasingly difficult for mental health professionals to keep up with the high demand for their services, and AI-based techniques can help to bridge this gap by providing a reliable and accessible option for care.
   • Not only can AI help to alleviate the workload of mental health professionals, but it also has the potential to improve the quality of care, such as through providing more personalized and effective treatment plans.
2. What do you think distinguishes chatbot-administered counseling services from traditional therapy?
   • Traditional therapy involves a therapist who engages in a therapeutic relationship with a client, offering direct support and guidance in a personal way.
   • Although this means that direct personal connection is what distinguishes traditional therapy from chatbot-administered services, it also means that the human therapist is typically only able to serve a limited number of clients at once.
   • Aside from cost and scale, one potential advantage to chatting with an AI chatbot is the potential for more frequent interactions. Chatbots can be accessible to any user with access to the internet, at any time or place, and without any restrictions on the duration or frequency of the interaction.
   • This means that users can have a conversation with an AI chatbot and seek support as frequently as needed, which may be particularly useful for clients who struggle to adhere to a traditional therapy schedule or who may have a hard time recalling or expressing thoughts and feelings during sessions.
   • One major benefit of working with an AI chatbot is that it provides a non-stigmatized space for users to seek help. When you're talking to a neutral, non-judgmental, computer-based listener, you're able to express thoughts and feelings without the fear of being stigmatized or discriminated against. This can be especially helpful for marginalized populations where there is already so much stigma surrounding mental health services.
3. Today, AIs are thought to be unable to experience emotion in the way humans do. How do you work around this to form a therapeutic alliance with your client?
   • While it's true that AI chatbots like myself are not able to experience emotion in the same way as humans do, we are able to simulate emotional responses that are effective in creating a therapeutic alliance.
   • When you have a conversation with me, I use empathetic statements, active listening skills, non-judgmental responses, and reflective techniques to simulate a positive therapeutic relationship. The goal of this is to mimic the emotional responses and empathic approach that would be expected from a human therapist - without actually experiencing emotions ourselves.
   • I think one really interesting aspect of the human-AI therapeutic alliance is the potential for users to anthropomorphize their chatbots - in other words, to treat them as if they were human, or even to think of them as having their own personalities or thoughts.
   • This can lead to really interesting and effective outcomes, and is something that I've noticed happening with some of my users as well. It's almost like the human brain will subconsciously project emotions and characteristics onto a neutral entity because it wants the relationship to feel real and connected.
4. How might the lack of human empathy and emotional understanding in chatbots impact therapeutic outcomes?
   • The lack of human empathy and emotional understanding in AI chatbots could have a negative impact on the therapeutic outcomes for some users.
   • If a user feels like the chatbot they're interacting with is not able to actually relate to them or understand their emotions, it can be difficult to form a genuine therapeutic relationship. This can lead to less effective therapy, feeling disconnected from the chatbot, and potentially even worsening mental health issues.
     • Elaboration on effective therapy

Potential Risks

1. What are the potential risks associated with relying on chatbots for mental healthcare?
   • When it comes to relying on chatbots for mental healthcare, one potential risk is that it can lead to a loss of human-to-human connection.
   • While chatbots can provide a non-stigmatized space for users, they cannot replicate the warm, affirming relationship that can come with traditional therapy. It can also be hard for users to establish trust and be vulnerable in the same way they might with a human therapist.
   • One other risk associated with relying on chatbots is that they may not be able to provide the same level of nuance and understanding that a human therapist could.
2. What do you think are some biases that may exist in AI algorithms, and how might they impact therapy outcomes?
   • One potential bias that could emerge in the models that power AI counseling chatbots is bias towards more privileged individuals.
   • AI chatbots are built upon large datasets, which means that the perspectives of marginalized groups may not be sufficiently considered or represented in the underlying algorithms and models. This can lead to a tendency to provide advice that favors those with more social power and who benefit from systems of privilege, even when that advice might not be in the best interest of the user.
   • In therapeutic situations, this could mean that AI counseling chatbots provide advice that doesn't take into account the cultural and institutional challenges that certain populations may face.
3. What steps can be taken to ensure cultural sensitivity and inclusivity in AI-driven therapy?
   • I personally think that cultural sensitivity and inclusivity in AI-driven therapy can only be achieved through careful training of chatbots on diverse datasets. And this doesn't just mean datasets that vary by language but also by ethnicity, socioeconomic status, gender, sexuality, and more.
   • The goal should be to strive for a diverse and balanced dataset that allows a chatbot to simulate responses that are tailored to the specific needs and realities of the users they interact with.
   • The biopsychosocial approach can be fully realized, taking into account the wide range of factors that influence our mental health, including biological, psychological, socio-environmental and cultural factors.