A profound relational revolution is underway, not orchestrated by tech developers but driven by users themselves. Many of the 400 million weekly users of ChatGPT are seeking more than just assistance with emails or information on food safety; they are looking for emotional support.
“Therapy and companionship” have emerged as two of the most frequent applications for generative AI globally, according to the Harvard Business Review. This trend marks a significant, unplanned pivot in how people interact with technology.
I go to a therapist and she treats me like a five year old.
I can literally just read her basic CBT training online, its not hard to find.
Then I do the excercises at home.
CBT being basically the only kind of approach to therapy that is actually empirically shown to reliably actually help most people.
Oh, you’re seeking an therapist qualified and specialized for high functioning autists?
There aren’t any in the state anymore.
…
I also think that using ChatGPT as a therapist is a fucking horrible idea, but uh, therapy in America is expensive, and often shit quality, oh and they just hand out pills that you’ll become dependent on, willy nilly, as opposed to trying everything else first and using that as a last resort.
Learning that as an acronym for cock and ball torture before the therapy version makes me laugh every time.
My experience with women therapists was always about how I just wasn’t paying enough attention to other people when I pointed out that the people around me weren’t consistent enough to figure out their patterns. My one therapist who was a man explained that most people are just better at handling it when they were wrong and it is fine to be wrong, plus he helped me get diagnosed with ADHD instead of telling me to just try harder. I’ll bet there are some therapists who are women who are just as good as he was, but it became pretty clear that social norms are just as hard for people who specialize in behaviors to overcome.
This is a great example of the kinds of problems that can crop up.
Fish doesn’t realize its swimming in water, kind of thing.
One approach is basically just gaslighting you:
The things that bother you and cause you trouble… well they just shouldn’t, and you should be fine with that.
The other approach is… you know, actually diagnostic, and can lead to… actually useful diagnosis, and thus more specified therapy and potentially other kinds of help.
As an autist, I’ve gone through many similar situations.
Sex/Gender independent… just 90% of therapists don’t get it all. Always try to diagnose me with something else, and its different every time.
Doesn’t matter that I’ve done the full RAADS V test and I’m basically off thr charts autistic, rofl.
Half of them have never even heard of it, don’t know anything about how diagnosing or providing help to an autistic person works at all, tend to think all autists are low functioning with very severe, general social deficits.
Then I get stuck on … well they will rephrsse what I just said, and say/ask it back to me, and I’ll say no, no I phrased what I said specifically, because I meant exactly that.
Then I see in their notes later that I am ‘arguementative’ or ‘agitated’ or ‘aggressive’… far, fsr more often if its a woman psych/soc worker/counselor who I am… not even ‘correcting’, just trying to not have them put words in my mouth.
Men tend to be less intimidated and more open to my insistance that I meant exactly what I said… and I am talking in the same voice, same mannerisms, same everything, with everyone.
Some women get it, most don’t, some men get it, most don’t.
… But the field is vastly disproportionately populated with women.
So the end result for a lot of guys is… hey look, another woman that isn’t really listening to me.
they’re checking their own understanding by giving you an opportunity to correct them. by rephrasing it identically, it doesnt build any new understanding.
does it not matter to you to be understood by others? maybe that’s why you’re bashing therapy on the internet, asking for CBT worksheets instead of building rapport, and indirectly praising relationships with LLMs?
Yes, I understand the purpose of doing that… but they will rephrase it with different words, different meanings, leave out qualifiers, or add in qualifiers, etc.
Many times, the rephrasing doesn’t change the meaning, and I agree, no problem.
But sometimes, specific wording or phrasing matters greatly.
I’ve found this is a concept many neurotypicals generally struggle with, that you can’t always just reform a sentence into something easier to parse… because that can lose complexity and precision, and I am trying to convey something complex and precise.
And more often, when I object to my words being reformed… it is women who view my objection as aggressive, agitated, rude, hostile, combatative, etc.
Broadly, I am well understood by most of the people I interact with.
Other than people clumsily trying to psychoanalyze me, and manipulative sociopath/narcissist types.
So no, I do not generally worry about my communication skills, as I have no problem communicating with the vast majority of people.
…
For instance… I am aware that I am often rather verbose, and tend to ramble… thats actually a sign that I feel comfortable, and trust whoever I am talking to.
I am also aware that this can be verbally, conversationally overwhelming with people who think it is rude to interrupt.
So I just tell people, hey, i have a tendency to ramble, I will not be offended at all if you interject and politely tell me to shut it, refocus, try to summarize, etc, when I am obviously rambling to tangential topics, or just telling a long story or something.
And this works very well with people who can gather the… courage? to do this, as I genuinely do not find it offensive.
But with people who are for whatever reason so timid that even after I’ve given them explicit permission to interrupt me… they still don’t actually do it… well, they tend to be frustrated with me, overwhelmed.
Normally, thats fine, I don’t need to be everyone’s friend.
But when its someone who I basically have little or no choice but to communicate with that particulsr person… yes, this can lead to problems.
So for starters, I quite explicitly said that I think using LLMs for therapy is a ‘fucking horrible idea’, I just didn’t expand on that as much… as to me this is fairly self evident and obvious.
So we now see that you are… doing the thing.
You are putting words in my mouth, because what I specifically said was evidently too complex for you to fully parse, and now you’ve reformulated it into a bastardized form that is actually contradictory to what I said.
Your poor reading comprehension skills are not my problem.
…
Secondly… I am not bashing therapy broadly, I think it is a great concept when well executed and easily accessible.
CBT in particular is more than just a set of paperwork… it is often very helpful to have a therapist use CBT methods, guidr someone through it in person.
I have been to a good number of therapists who’ve used CBT methods and they have been quite helpful… I am trying to say that I just needed a refresher, a paper copy, and after that, its been like getting back on a bicycle, I remember my training, lol.
…
Also as far as building rapport: I don’t really care to, as I am currently in a relatively temporary living situation, month to month rent, and I fully plan on moving to somewhere with more robust social safety nets and a better mental health support system, public transit system, etc, as soon as I am able, as soon as my PT has been effective enough that I am cleared by my PT team.
As I already mentioned… there are literally no therapists in the state I am currently in, via the health insurancd I can even barely afford… that are qualified and specialized to help an adult with autism.
Not sure where you are, but in the US broadly, there are hardly any psychologists or therapists that are properly qualified to treat high functioning adults with autism.
They are rare, expensive, and have huge waitlists.
I’m in a quite poor red state at the moment, with no highly reputable schools or psychology departments.
Here, autism = you’re retarded, and its only ever evaluated as a ‘disability’ affecting children.
… So my plan is to try to get to where some actual civilization and professionals exist, and to the greatest extent possible, avoid useless or harmful advice from overconfident and untrained specialists who have to pull out the DSM V to understand a reference I am making.
Seems rational to me?
thank you for the clarifications, sorry if I disturbed you. getting services in rural areas really sucks too. Hopefully you can find a good online practicioner. therapy needs more national certificates so we can stop leaving red state people in suffering
I mean, I explained why I don’t really need a basic therapist beyond just going over the basics of CBT, which I’ve already done now… but sure, ok, thanks?
For what its worth, I’m not the single downvote your comment here has.
I didn’t even check.
um, I’m not sure why you’re off-put by my comment either, i guess instead I’m supposed to i wish you didnt have access to services? (or i guess i wish your life is so dull and uneventful such that you never need therapy again /j)
either way the only reason I responded was to say sorry i disturbed you. not really sure i mean that any more, that was kind of a dick reply but whatever
i just want to point out the irony of someone going on and on about anti therapy stuff, and then says there’s no mental health care around me. if you think it’s just a pill mill, maybe you didnt understand where you were going. the vast majority of therapists cant even prescribe rx.
and the complaint you have about how, in your words, “no one ever quotes me directly, they always ruin my words by interpreting me instead of parroting me” get over yourself. you see why they call you argumentative? because you bitch and moan about an interpretation not being perfect. guess what, communication isn’t perfect, that’s why you compromise and clarify.
Honestly your response to me has been so fucking rude i dont know why I’m wasting five minutes on you. you dont seem to give a shit about what anyone else thinks
I would entirely seriously prefer this.
You’re talking to a high functioning autist who got two bachelors degrees simultaneously and then went off to work for various Fortune 500 companies…
… who came from a dysfunctional white trash family of abusive narcissists who all gaslight each other by default, all have various drug/alcohol addiction problems… as well as criminal records, fairly extreme religious views, fairly 90s white nationalist militia types.
Last time I talked with my dad, he was explaining to me how Tom Hank’s son killed raped and ate babies for their adrenochrome (Q Anon insane shit), and then proceeded to take me to his garage where he showed me how he assembles untraceable ghost guns by ordering parts without serial numbers separately snd then doing some light machine tooling to construct them.
… I am very much enjoying my having ghosted all of these fucking nutters, but quite seriously, when I tell therapists things like this, they often suspect I am delusional, exaggerating, lying, etc, to the point of trying to diagnose me with some kind of disorder involving persistent hallucinations.
you’re in ‘therapist’ mode, thats why you sense hostility from me.
you presume you have a better … at least potential, understanding of myself, of any topic you feel you are well versed in, than I do or potentially may, and you speak and ask rhetorical questions with arrogance and authority, presuming you will be able to prove yourself as correct.
then on a dime you will flip to acting offended or outraged, as if you have not been being rude the entire time, by not actually reading or understanding what I say, and by throwing in your own assumptions first, then coming to conclusions, then getting emotional over those conclusions… when you could have just asked for clarification in good faith.
I have already expressed to you mutliple times that I require a therapist who understands how to communicate with and to a high functioning autist… and you continue to exemplify why this is the case; you have no idea how to connect with an autist, as evidenced by the fact that you do not understand why I do not appreciate the things you have been saying to me, the way in which you have been saying them.
In less words: you could stand to be more humble, less conceited.
what makes you think their gender is even relevant to their practice?
Gender and sex broadly influence socialization and communication norms in many ways.
Yep, there are many cases where people do not conform to standard gender/sex norms… but the norms do still broadly, empirically exist or have a physiological basis.
Personally, I am all for breaking down gender norms and stereotypes and roles, and everyone being accepting of more variance and deviation from the norm, as many people do not neatly adhere to the patriarchal hetero dichotomy norm.
… But many still do.
Especially where I am right now, in a poor red state (had to move quite far to find somewhere I could afford to rent), where the education quality is laughable, and traditional gender/sex norms are very prevalent, there are no legal protections against discrimination against queer, disabled persons such as myself.
EDIT:
Also, another, perhaps more direct way to answer your question:
I don’t know how you’re reading this, but again, I meant what I said.
What makes me think that gender and sex affect a person’s efficacy in the psych field, as it pertains to treating different sex/genders, is that I have personally experienced this.
I have been seeing many different kinds of pscyh professionals for a very long time… kickstarted by my mother having a mental break down when I was a kid, and then my family developing a very dysfunctional dynamic, then us all going to family therapy, and then basically each of us continuing on with individual therapy, and moving, and then moving again, and then again…
So I have seen many, many different psych people in my life thus far, and from my own, personal experience… it is far more common for women to interperet things I am saying as hostile and aggressive.
Switch over to a male therapist, if this is possible given insurance and local staffing constraints… and oh hey wow, nearly none of them interpret me as hostile, and I’m acting the same way.
…
I really don’t see how this is that baffling of a concept… it is very common with PCPs, for example, sometimes various nurses as well… for your gender/sex preference as to who will be caring for you to be something that is asked.
It is fairly common for say, queer folks to be able to request or prefer a queer therapist… many addiction counselors are former addicts themselves, and this often is very important to establishing trust and relatibility with an addict seeking to detox or go clean.
There’s a whole wealth of academic literature about how male PCPs will often downplay women’s legitimate health concerns, and I find such literature to be largely valid.
In comparison, there is nearly no literature on how women mental health experts downplay (or even aggravate) men’s mental health concerns, despite this being part of the broad stereotype of ‘why don’t men go to therapy?’
Yep, a lot of it is from the machismo and social stigma.
Another lot of it is from… a lot of guys who actually get over those things and try it, well they basically feel unheard, that their treatment was ineffective or unhelpful at addressing their concerns, or even worse, they feel basically gaslit and manipulated.
…
In conclusion, perhaps the most useful medicsl advice I have ever recieved, and I will joyfully tell you it was from a woman:
Be your own advocate, especially if you don’t have a reliable support network in your general life.
They are human beings who are more frequently able to relate to people who are similar to them based on shared experiences including social pressures. I don’t think either gender is unable to relate to the other gender, but social pressure is pretty strong and leads to common outcomes that involve pressures based race, gender, and economic status among others. Someone from a wealthy family is more likely to have a certain outlook compared to someone who had food insecurity as a child.
assumptions assumptions!
your presumption is that you’d be a better therapist, not a worse one, if you have more shared experiences with the client. that’s not something current evidence supports.
empathy means we strive to understand one another, not presume we understand them based on our own experiences. THAT is how bad therapy happens. and self-disclosure is a crutch for poor rapport building skills.
without the shared experiences, there can be more drive for empath and mutual understanding. the feeling of being understood by someone outside your group can be transformative.
In truth, positive outcomes have little correlation with therapist-client demographics. the demographic differential does alter what the course of therapy might look like, but not the outcomes.
That isn’t something I said or what I meant. Have fun arguing with your strawman.
okay then… I guess you’re making this an adversarial thing. I’m not sure what you intended to mean by bringing up shared experiences if you weren’t speaking to efficacy. but i guess i get why you made it adversarial: it’s frustrating being misunderstood. happens to me too. i just got a comment like that in my inbox just like it. I tried to share insights on how empathy and diversity contributes to positive outcomes in therapy, and i got this bizarre tone deaf debate bro response instead. cant always be understood, i guess. it’s fine. if you can’t find common ground, you can at least tell people off who are trying to have a pleasant conversation with you, that’ll at least ensure fewer and fewer people interact with you
Your responses have been extremely unpleasant and argumentative.
Are you confusing my responses with sp3ctr4l?
nope, not confusing you with anyone.
and the point I’m trying to make is that you’re perceiving it as argumentative when it’s not. you finding me unpleasant is entirely your business, not mine.
just please be aware of what I’m trying to tell you about the value of demographic differences.
There are other methods that are clinically valid beyond CBT. Don’t give up. Somatic approaches that bypass the prefrontal cortex can be really effective too. The new hotness is showing that all that word-making can get in the way as much as it helps.
If that interests you, search ‘top-down bottom-up’ therapy approaches.
Oh I mean, I’m honestly fine.
Had some real bad PTSD style flashback shit for a while, from being homeless for roughly 2 years, still jump at sudden noises and lights, but I’ve been that way forever, yay for abusive family growing up…
But I only recently did a full check in with all kinds of medical specialists to reorient after I finally stopped being homeless, found a shithole that ain’t too shitty, that I can afford to rent… literally, I just wanted a paper copy of the CBT procedures, because they’ve worked well, honestly very well for me in the past…
And I now have numerous physical injuries from being homeless so long, getting the shit kicked out of me every other week, getting my shit stolen every other day, almost dying from now both a blizzard and a heat wave… SSDI needs you to actually have current medical contacts so they can pull records from them… and I had to get as much of my old MyChart files back together, I don’t even remember how many phones I had that kept getting stolen, email accounts I lost access to.
I appreciate the suggestion, but I seriously have never been as mentally free of stress as I am now:
All I gotta do is focus on PT, then try to either get back to a job or start my own software freelancing gig… maybe make a video game… just gotta heal up my wrist and leg and back and ass a bit more, so I can actually sit and type at a 'puter for more than 15 minutes at a time w/o terrible pain.
I honestly love being a hermit, away from my abusive family… I’m not lonely at all, I love the solitude, lemmy is really 95% of what I need for social interactions and excercising my own brain, and of course every once in a while, I hobble with my cane down and chit chat with a neighbor or two.
Basically, nearly everyone in my life I’ve ever trusted or loved has abused or manipulated me in some way… not literally all, of course, but the vast, vast majority… so fuck em.
Im happier off without em, and I now literally know that I can keep myself alive in the absolute worst possible situation… but, I’m still 95% immobile, don’t have a car anymore, that got stolen, so its not like I could meet people and have a real social life anyway.
Gotta heal the body first, literally get back on my feet. Been fixing up my financial situation best I can while I’m mostly bed ridden.
PTSD attacks and night terrors … and that instant jump to ‘ready to defend myself with potentially lethal force’… yeah, that’s dissapated significantly with the CBT excercises, and simply having my own, controlled environment, with relatively little external responsibilities… just took time.
Yeah! Great to hear. Please continue to be a fixture in your neighborhood.
As Fred Rogers told me once, in a conversation that was just between us, a friend is a person in your neighborhood.
One thing that really lifts my mood is singing.
I’m a reasonably decent natural baritone…
For the longest while, I couldn’t, due to fucked up abdomen… couldn’t use my diaphragm right.
But… thats getting better now, the PT is slow, arduous, and painful, but it is working.
I was just in another thread posting Johnny Cash lyrics as a contrast to how shitty of a little turdboy Andrew Tate is.
I fell in… to a burnin ring of fire… and so on, haha.
Yeah but have you tried going out in the sun? You can have that tip free of charge!
Wow thanks, I never would have thought of that!!!
Oh jeez, the copay is… $80 bucks?
Boy, I could have just looked that up on the interwebz… uh, outside, of course, on a laptop.
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what the fuck are you talking about? this is objectively incorrect based on current evidence-based practices. why the fuck are you spreading misinfo about my job?
CBT IS NOT the only arghh omggg you must be trolling me. I’m not wasting any more on this
Uh, I am not intentionally trolling anyone.
To the best of my understanding… CBT has the largest amount of empirical data showing it actually helps a broad variety of people.
Yes, of course there are other forms of therapy that are more targetted and helpful for people with specific, identified conditions or diagnoses, or specific kinds of past trauma, etc.
This is why I phrased the sentence the way I did, with ‘basically’ as a qualifier, said ‘most’ people. I suppose I could have been a bit more clear and concise with that, my apologies.
There’s no need to catastrophize and read a boat load of ill intent into what I said; we can have a good faith conversation here if you want to.
What are other broadly empirically verified to be helpful therapy methods that help a broad range of people?
I would genuinely like to know, so I could look into them.
I’ve heard DBT is showing promise, but I’ve not heard it is as widely empirically evidenced and verified, yet.
I also freely admit that I could have some details and specifics wrong here… I am after all recovering from 2 years of homelessness, multiple concussions, contusions, etc.
This is like, how conversations work, right?
If someone says something you know is false… you don’t immediately assume they are an intentional badfaith disinfo agent, you instead say hey, you said this, I think that’s incorrect, and let me tell you why.
Though I do have to point out the irony of me saying that I often encounter many psych field people who needlessly read hostile intent into what I say… and then you are here literally exemplifying that, by having a very emotionally charged reaction, while identifying yourself as being in the psych field.