The Use of Large Language Models in Therapy

Part 1: The inevitable rise of LLM

Not to date myself, but I came of age in the late 90’s in this wonderful time when the kids were starting to use the internet but the teachers really had no idea what it was. In English class we got this giant list of vocabulary words to look up in a dictionary and type it all out. A friend of mine said to the teacher, “hey, can we just lookup these words on the internet?” Teacher said “sure.” But that that would just add more work. After all, first you have to find the words online. Then type it on one screen as you read it on the internet. Better to just use a dictionary.

Of course, we just went to some website, dictionary.com, copy paste, print, done in about 5 minutes.

A few years later, at Rutgers University selecting a project to do for the social psychology class. I mentioned doing the class project on the use of online dating. You know, which type of person would be interested in taking that route. Professor looked at me like I had 2 heads. Again, “Sure, if you can find research on it. Not sure who would be going online looking for dates.”

Of course now we have the benefit of hindsight. But being a part of that special cohort, of growing up right as the internet started to take off, I have a special appreciation for ongoing trends, especially when the older generations are skeptical.

And that is what I see for chatbots. I believe that in a few years, chatbots will be used for all manner of things, including yes, as a part of mental health.

In fact, I predict that our children’s generation will be as comfortable using chatbots for tutoring, therapy, perhaps even relationships, as our generation is for using the internet.

Part 2: The use of LLM in the field of mental health.

While I’m here predicting the future, let me add a few more predictions relating to mental health. I’ve discussed this in a few other videos, but here’s what I expect the mental health field to look like in a few years. First, psychedelic therapy will be the 4th wave, it will soon be essentially everywhere. Just as cognitive therapy did for behavioral therapy, resulting in CBT, psychedelic therapy will then be added to the “therapeutic toolbox” and will be the standard of care.

If the research continues to show that psychedelic therapy is safe and effective, its use will explode. Rather than just being used for therapy, people will start to use it almost as an adult initiation ritual. You’re becoming an adult, let’s show you techniques to build resilience, manage stress, create healthy boundaries, heal the trauma of your upbringing. In other words, just as college itself is like a rite of passage for becoming an adult, so will the use of psychedelic therapy be a rite of passage to build resilience to the trauma and disconnection that comes with being an adult.

Now, what does this have to do with Large Language Models? With Chatbots?

Well, these trends will basically result in a massive influx of people seeking mental health services.

Consider most young adults will be seeking out essentially an adult initiation ritual. The result? a growing disparity between the haves and the have-nots, in terms of who can seek out these services.

Many of the training centers for psychedelic therapy talk a lot about being inclusive, welcoming People of color, those in the LGBT plus community. Yet they also charge about $10,000 dollars for their training. Excluding all but the most wealthy clinicians. To work one-on-one with such a clinician through the entire process, could be thousands of dollars. Very impractical and just unrealistic for the vast majority out there.

Part 3: A potential solution with LLM

Inevitably, psychedelic therapy will become psychedelic group therapy. And it is entirely possible, in fact, probable, that the people in the group will form connections, will form a community. More and more people will use psychedelic substances to help build connections with other people. In fact, I would argue, I do argue, that the real magic behind psychedelic substances is that, used properly, it can create a healthy sense of connection, rapport, and safety with a tribe. And that’s where the healing may lie. Psychedelics help build connection, the connection does the healing.

But for that connection to be healing, it has to be a safe, healthy connection. And the community must know how to use these psychedelic substances in a safe, healthy, conducive manner. In this new community, there’s very much a potential for abuse, especially with young adults. One of the big things that will happen in a few years is more and more scandals coming out of abusive leaders of psychedelic communities. Of young adults going into communities looking for healing, only to be preyed upon by various gurus.

It’s for this reason that the therapist and chatbots must provide a balance of power to protect these young adults, these new participants.

Part 4: A Balance of Power with the Chatbots

The solution here may be for the young adult to first work one-on-one with a therapist. And that young adult gets started on the chatbot. The therapist guides the young adult, both how to use the psychedelic substances and how to use them to connect with others in a healthy manner. The therapist also teaches the young adult how to use the chatbot. How to get the most out of it.

After this initiation period, maybe 6 months or so, the young adult goes off and finds their tribe, finds their community. But, and this is important, continues to use the chatbot.

The result is a great balance. The community provides that essential connection that can only really occur with face-to-face interaction. I don’t ever think that will go away, nor should it. At the same time, the chatbot can provide a check on the power of the group. If all of a sudden, a bad actor comes in, abusive behavior starts to occur, the chatbot can guide the young adult to help fix the issue or find a healthier group.

And of course, the therapist can be there time-to-time to check in. If there’s a serious psychological condition, that’s when the in-person, one-on-one therapist will be there. 

Done correctly, the chatbot can be an incredibly useful tool for both parties. To navigate adulthood, to start using psychedelics, it’s a lot of information. A lot of logistics. You can get that through a book. A worksheet. As a therapist, what’s the best service I offer? To be present. To listen to the client. To show empathy. To serve as a sounding board.

Done correctly, the chatbot takes care of the logistics, the weekly challenges and homework. This liberates the therapist to their essential role: to provide a safe space, a sounding board, a model of a healthy relationship.

One of the foundational roles of a guide, a therapist, a coach, is to help the person adapt to their world. Well, the world of the future will be dominated by A) The community and B) The Chatbot. So I see my job in the future is ensure my clients have a healthy relationship with both.

Part 5: On Safety with LLM

For those concerned with the rise of AI, and I think we should all be a bit concerned about that. I believe the good news is that, we’re not quite there yet.

It seems the large language models, the LLM’s can serve as good chatbots and seem like AI, but the real thing may be a ways off.

And that’s likely for the best: we need to experiment with ways to keep everything safe and contained. To see what works, to see what the options are.

To that end, my own plan is to take the Pentabelt program with the five belts, and to have five different versions of a chatbot that manage each of the 5 belts. Each chatbot variation, known as a Pentabot will be equal to the other variations and have a different ethical subroutine with a distinct personality. The variations will have distinct roles and work to keep the others in check.

As I see it, the cat is already out of the bag. I don’t know if bonafide AI will be a part of our future anytime, but chatbots are already here. When I talk with people older than me, the idea of using a chatbot for guidance, for coaching, for therapy, ridiculous. But I’m gen-x. The Oregon Trail generation. And I've heard the exact same response to looking up vocabulary words online. Those much younger than me aren’t that put off by using a chatbot. Especially in conjunction with a therapist or a strong group or community.

When I work with my clients a big element of growth is to notice that sense of denial to what is happening in the present moment and to embrace change. We have a wonderful opportunity to get ahead of the situation. And that is what I hope to do with the chatbots. With the Pentabots.

Part 6: Introducing the Pentabots

And, if this program ever gets big, I myself may design the Pentabots with executive functioning. I am a therapist and an ideas guy. I have no ability to be a CEO, nor would I want to be one. I’m also quite independent, unaffiliated with any college or university. Once the Pentabots can help guides others, they may end up guiding me as well.

The factories of the future will have two living beings in it. A man and a dog. The dog’s job is to make sure the man doesn’t touch anything. The man’s job is to feed the dog.

I for one would love nothing more than to sit back with pride, allowing this program to grow and develop on its own. To be the man in the factory. Draw a nice salary and have the pride of being among the first to develop an automated, psychedelic therapy adult initiation program.

So, with all the introductions out of the way, the Pentabelt program consists of 5 different belts, all with their own content on this website, much of it made into video as well as an audio meditation program. They will be “hosted” so to speak, by an individual pentabot, which are all still in development.

The aim will be to provide for my own clients. Be able to share the content. But also to serve as a model for eventually developing the pentabots themselves and similar large language models for other programs out there.

So with that all out of the way, let’s get to the specifics, let’s explore what the belts are in the Pentabelt.

On to Section 10