'It cannot provide nuance': UK experts warn AI therapy chatbots are not safe
74 comments
·May 10, 2025lurk2
I tried Replika years ago after reading a Guardian article about it. The story passed it off as an AI model that had been adapted from one a woman had programmed to remember her deceased friend using text messages he had sent her. It ended up being a gamified version of Smarter Child with a slightly longer memory span (4 messages instead of 2) that constantly harangued the user to divulge preferences that were then no-doubt used for marketing purposes. I thought I must be doing something wrong, because people on the replika subreddit were constantly talking about how their replika agent was developing its own personality (I saw no evidence at any point that it had the capacity to do this).
Almost all of these people were openly in (romantic) love with these agents. This was in 2017 or thereabouts, so only a few years after Spike Jonze’s Her came out.
From what I understand the app is now primarily pornographic (a trajectory that a naiver, younger me never saw coming).
I mostly use Copilot for writing Python scripts, but I have had conversations with it. If the model was running locally on your own machine, I can see how it would be effective for people experiencing some sort of emotional crisis. Anyone using a Meta AI for therapy is going to learn the same hard lesson that the people who trusted 23 and Me are currently learning.
mrbombastic
“I thought I must be doing something wrong, because people on the replika subreddit were constantly talking about how their replika agent was developing its own personality (I saw no evidence at any point that it had the capacity to do this).”
People really like to anthropomorphize any object with even the most basic communication capabilities and most people have no concept of the distance between parroting phrases and a full on human consciousness. In the 90s Furbys were a popular toy that said started off speaking furbish and then eventually spoke some (maybe 20?) human phrases, many people were absolutely convinced you could teach them to talk and learn like a human and that they had essentially bought a very intelligent pet. The NSA even banned them for a time because they thought they were recording and learning from surroundings despite that being completely untrue. Point being this is going to get much worse now that LLMs have gotten a whole lot better at mimicking human conversations and there is incentive for companies to overstate capabilities.
trod1234
This actually isn't that surprising.
There are psychological blindspots that we all have as human beings, and when stimulus is structured in specific ways people lose their grip on reality, or rather more accurately, people have their grip on objective reality ripped away from them without them realizing it because these things operate on us subliminally (to a lesser or greater degree depending on the individual), and it mostly happens pre-perception with the victim none the wiser. They then effectively become slaves to the loudest monster, which is the AI speaking in their ear more than anyone else, and by extension to the slave master who programmed the AI.
One such blindspot is the consistency blindspot where someone may induce you to say something indicating agreement with something similar first, and then ask the question they really want to ask. Once you say something that's in agreement, and by extension something similar is asked, there is bleedover and you fight your own psychology later if you didn't have defenses to short circuit this fixed action pattern (i.e. and already know), and that's just a surface level blindspot that car salesman use all the time; there are much more subtle ones like distorted reflected appraisal which are used by cults, and nation states for thought reform.
To remain internally consistent, with distorted reflected appraisal, your psychology warps itself, and you as a person unravel. These things have been used in torture, but almost no one today is taught what the elements of torture are so they can recognize it, or know how it works. You would be surprised to find that these things are everywhere today, even in K12 education and that's not an accident.
Everyone has reflected appraisal because this is how we adopt the cultural identity we have as people from our parents while we are children.
All that's needed for torture to break someone down are the elements, structuring, and clustering.
Those elements are isolation, cognitive dissonance, coercion with perceived or real loss, and lack of agency to remove with these you break in a series of steps rational thought receding, involuntary hypnosis, and then psychological break (disassociation or a special semi-lucid psychosis capable of planning); with time and exposure.
Structuring uses diabolical structures to turn the psyche back on itself in a trauma loop, and clustering includes any multiples of these elements or structures within a short time period, as well as events that increase susceptibility such as narco-analysis/synthesis based in dopamine spikes triggered by associative priming (operant conditioning). Drug use makes one more susceptible as they found in the early 30s with barbituates, and its since been improved so you can induce this is in almost anyone with a phone.
No AI will ever be able to create and maintain a consistent reflected appraisal for the people they are interacting with, but because the harmful effects aren't seen immediately, people today have blinded themselves and discount the harms that naturally result. The harms from the unnatural loss of objective reality.
lurk2
Very interesting. Could you recommend any further reading?
trod1234
Robert Cialdini is probably the lightest book and covers most of the different blindspots we have, except distorted reflected appraisal in his book on Influence. He provides the principles but leaves most of the structure up to the person's imagination.
The coursework in an introduction to communication class may provide some foundational details (depending on the instructor), Sapir-Whorf has basis in blindspots.
Robert Lifton touches on the detailed case studies of torture from the 1950s (under Mao), in his book "Thought Reform and the Psychology of Totalism", and I've heard in later books he creates a framework that classifies cultures as Protean (self-direction, growth, self-determination/agency), or Totalism (towards control which eventually fails Darwin's fitness).
I haven't actually read his later books yet though his earlier books were quite detailed. I believe the internet archive has a copy of this available for reading as a pdf but be warned this is quite dark.
Joost Meerloo in his, "Rape of the Mind" as an overview touches on how Totalitarianism grows in the setting of WW2 and some Mao, though takes Freudian look at things (dating certain aspects which we know to be untrue now).
From there it branches out depending on your interest. The modern material itself while based on these earlier works often has the origins obscured following a separation of objectionable concerns.
There are congressional reports on COINTELPRO and you may find notice it has modern iterations (touching on protest/activist activity harassment), as well as the history of East German Stasi, and Zersetzung where governments use this to repress the population.
There are aspects in the Octalysis Framework (gamification/game design).
Paulo Freire used some of this material in developing his critical pedagogy which was used in the 70s to replace teaching method from a reduction of first principles (based in rome and the greeks) to what's commonly known as rote-based teaching, and later called "Lying to Children", which takes the reversal of that approach following more closely to gnosticism.
The approach is basically you give a flawed useless model which includes both true and false things. Students learn to competence, then are given a new model that's less flawed, where you have to learn and unlearn things already learned. You never actually unlearn anything and it induces frustration and torture destroying minds in the process. Each step towards gnosis becomes more useful but only the most compliant and blind make it to the end with few exceptions. Structures that burn bridges induce failure in math, and the effect is this acts as a filter to gatekeep the technical fields.
The water pipe analogy of voltage in electronics as an example of the latter instead of the first principled approach using diffusion which is more correct.
Disney and Dreamworks uses distorted reflected appraisal tailored towards destructive interference of identity, which some employees have blown the whistle on (for the latter), aimed at children and sneak things past their adult guardians. There's quite a lot if you look around but its not under any single name but scattered. Hopefully that helps.
The Dreamworks whistleblower interview can be found here: https://www.youtube.com/watch?v=vvNZRUtqqa8
All indexed references of it seem to now have been removed from search. I'm glad now that I kept a reference link in a text file.
Update: Dreamworks isn't Pixar, I misremembered,they are owned by Universal Studios, whereas Disney own's Pixar. Pixar and Disney appear to do the same things.
hy555
Throwaway account. My ex partner was involved in a study which said these things were not ok. They were paid not to publish by an undisclosed party. That's how bad it has got.
Edit: the study compared therapist outcomes to AI outcomes to placebo outcomes. Therapists in this field performed slightly better than placebo, which is pretty terrible. The AI outcomes performed much worse than placebo which is very terrible.
ilaksh
Which model exactly? What type of therapy/prompt? Was it a completely dated model, like in the article where they talk about a model from two years ago? We have had massive progress in two years.
neilv
Sounds like suppressing research, at the cost of public health/safety.
Some people knew what the tobacco companies were secretly doing, yet they kept quiet, and let countless family tragedies happen.
What are best channels for people with info to help halt the corruption, this time?
(The channels might be different than usual right now, with much of US federal being disrupted.)
hy555
Start digging into psychotherapy research and tearing their papers apart. Then the SPR. Whole thing is corrupt to the core. A lot of papers drive public health policy outside the field as it's so vague and easy to cite but the research is only fit for retraction watch.
neilv
Being paid to suppress research on health/safety is potentially a different problem than, say, a high rate of irreproducible results.
And if the alleged payer is outside the field, this might also be relevant to the public interest in other regards. (For example, if they're trying to suppress this, what else are they trying to do. Even if it turns out the research is invalid.)
sorenjan
What did they use for placebo? Talking to somebody without education, or not talking to anybody at all?
scotty79
I've heard of some more modern research with llms that had a result that Ai therapist was straight up better than human therapists across all measures.
cube00
The amount of free money sloshing around the AI space is ridiculous at the moment.
pavel_lishin
A recent Garbage Day newsletter spoke about this as well, worth reading: https://www.garbageday.email/p/this-is-what-chatgpt-is-actua...
kbelder
I think a lot of human therapists are unsafe.
We may just need to start comparing success rates and liability concerns. It's kind of like deciding when unassisted driving is 'good enough'.
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drdunce
As with many things in relation to technology, perhaps we simply need informed user choice and responsible deployment. We could start by not using "Artificial Intelligence" - that makes it sound like a some infallible omniscient being with endless compassion and wisdom that can always be trusted. It's not intelligent, it's a large language model, a convoluted next word prediction machine. It's a fun trick, but shouldn't be trusted with Python code, let alone life advice. Armed with that simple bit of information, the user is free to choose how they use it for help, whether it be medical, legal, work etc.
trial3
> simply need informed user choice and responsible deployment
the problem is that "responsible deployment" feels extremely at odds with, say, needing to justify a $300B valuation
EA-3167
What we need is the same thing we've needed for a long time now, ethical standards applied across the whole industry in the same way that many other professions are regulated. If civil engineers acted the way that software engineers routinely do, they'd never work again, and rightly so.
HPsquared
Sometimes an "unsafe" option is better than the alternative of nothing at all.
tredre3
Sometimes an "unsafe" option is not better than the alternative of nothing at all.
Y_Y
Sounds like we need more information than safe/not safe to make a sensible decision!
This is something that bugs me about medical ethics, that it's more important not to cause any harm than it is to prevent any.
jrapdx3
Actually, concern about doing harm is central to current concepts of medical ethics. The idea may be ancient but still highly relevant. Ethics declare a primary obligation of healers is "above all do no harm".
That of course doesn't exclude doing good, being helpful, using skills and technologies to produce favorable outcomes. It does mean that healers must exercise due vigilance for unintended adverse consequences of therapies, let alone knowingly providing services that cause harm.
The problem with "safe/not safe" designation is simply that these states are more often than not indistinct. Or put another way, it depends on subtle contextual attributes that are hard to discern. Furthermore individual differences can make it difficult to predict safety of applying a procedure.
As a result healers should be cautious in approaching problems. Definitely prevention is better than cure, it's simply that relatively little is known about preventing burdensome conditions. Exercising what is known is a high priority.
bildung
I you look at the horrible things that happened in medical history, e.g. https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study it's pretty clear why the ethics care more about not causing harm...
j45
Where the experts are the ones who's incomes would be threatened, there is likely some merit in what they're saying, but also some digital literacy skills.
I don't know that AI "advisory" chatbots can replace humans.
Could they help an individual organize their thoughts for more productive time with professionals? Probably.
Could such tech help individuals learn about different terminology, their usage and how to think about it? Probably.
Could there be .. a net results of spending fewer hours (and cost if the case) for the same progress? And be able to make it further with advice into improvement?
Maybe the baseline of advisory expertise in any field exists more around the beginner stage than not.
codr7
You see the same thing with coding. People with actual experience and enough of a perspective to see the problems are ignored because obviously they're just afraid to lose their jobs. Which is not true, it's not even on my list of things that I should be aware of.
Experience matters, that's something we seem to be forgetting fast.
bigmattystyles
The problem is they are cheap and immediately available.
distalx
It just feels a bit uncertain trusting our feelings to AI we don't truly understand.
James_K
Respectfully, no sh*t. I've talked to a few of these things, and they are feckless yes-men. It's honestly creepy, they sound like they want something from you. Which I suppose they do: continual use of their services. I know a few people who use these things for therapy (I think it is the most popular use now) and I'm downright horrified at the sort of stuff they say. I even know a person who uses the AI to date. They will paste conversations from apps into the AI and ask it how to respond. I've set a rule for myself; I will never speak to machines. Sure, right now it's obvious that they are trying to inflate my ego and keep using the service, but one day they might get good enough to trick me. I already find social media algorithms quite addictive, and so I have minimise them in my life. I shudder to think what a trained agent like these may be capable of.
52-6F-62
I’ve also experimented with them in that capacity. I like to know first hand. I play the skeptic but I tend to feed the beast a little blood in order to understand it, at least.
As a result, I agree with you.
It gives me pause when I stop to think about anyone without more context placing so much trust in these. And the developers engaged in the “industry” of it demanding blind faith and full payment.
rdm_blackhole
I think the core of the problem here is that the people who turn to chat bots for therapy sometimes have no choice as getting access to a human therapist is simply not possible without spending a lot of money or waiting 6 months before a spot becomes available.
Which begs the question, why do so many people currently need therapy? Is it social media? Economic despair? Or a combination of factors?
HaZeust
I always liked the theory that we're living in an age where all of our needs can be reasonably met, and we now have enough time to think - in general. We're not working 12 hour days on a field, we're not stalking prey for 5 miles, we have adequate time in our day-to-day to think about things - and ponder - and reflect; and the ability to do so leads to thoughts and epiphanies in people that therapy helps with. We also have more information at our disposal than ever, and can see new perspectives and ideas to combat and cope with - that one previously didn't need to consider or encounter.
We've also stigmatized a lot of the things that folks previously used to cope (tobacco, alcohol), and have loosened our stigma on mental health and the management thereof.
mrweasel
> we have adequate time in our day-to-day to think about things - and ponder - and reflect;
I'd disagree. If you worked in the fields, you have plenty of time to think. We fill out every waking hour of our day, leaving no time to ponder or reflect. Many can't even find time to workout and if they do they listen to a podcast during their workout. That's why so many ideas come to us in the shower, it's the only place left where we don't fill out minds with impressions.
52-6F-62
Indeed. I had way more time to think working a factory kine than I have had in any other white collar role.
squigz
I think GP means more that we generally don't have to worry about survival on a day to day (or seasonal) basis anymore, so we have more time to think about bigger issues, like politics or social issues - which I agree with, personally.
mrweasel
Probably a combination of things, I wouldn't pretend to know, but I have my theories. For men, one half-backed thought I've been having revolved around social circles, friends and places outside work or home. I'm a member in a "men only" sports club (we have a few exceptions due to a special program, but mostly it's men only). One of the older gentlemen, probably in his early 80s, made the comment: "It's important for men to socialise with other men, without women. Young and old men have a lot in common, and have a lot to talk about. An 18 year old woman, and an 80 year old man have very little in of shared interests or concerns."
What I notice is that the old members keep the younger members engaged socially, teach them skills and give them access to their extensive network of friends, family, previous (or current) co-workers, bosses, managers. They give advise, teach how to behave and so on. The younger members help out with moving, help with technology, call an ISP, drive others home, to the hospital and help maintain the facilities.
Regardless of age, there's always some dude you can talk to, or knows who you need to talk to, and sometimes there's even someone who knows how to make your problems go away or take you in if need by.
A former colleague had something similar, a complete ready so go support network in his old-boys football team. Ready to support in anyway they could, when he started his own software company.
The problem: This is something like 250 guys. What about the rest? Everyone needs a support network, if your alone, or your family isn't the best, you only have a few superficial friends, if any, then where do you go? Maybe the people around you aren't equipped to help you with your problems, not everyone is, some have their own issues. The safe spaces are mostly gone.
We can't even start up support networks, because the strongest have no reason to go, so we risk creating networks of people dragging each other down. The sports clubs works because members are from a wider part of society.
From the article:
> > Meta said its AIs carry a disclaimer that “indicates the responses are generated by AI to help people understand their limitations”.
That's a problem, because most likely to turn to an LLM for mental support don't understand the limitations. They need strong people to support and guide them, and maybe tell them that talking to a probability engine isn't the smartest choice, and take them on a walk instead.
"Prof Dame Til Wykes, the head of mental health and psychological sciences at King’s College London, cites the example of an eating disorder chatbot that was pulled in 2023 after giving dangerous advice"
2023 is ancient history in the LLM space. That person is totally out of touch with it.
Also, like most things, especially when they are starting out, the actual details of the implementation matter. For example, for the first few years that SSDs came out, there were a lot of models that were completely unreliable. I had someone tell me they would never trust enterprise data to run on an SSD. At the time, there were a few more expensive models like one of the Intel Extreme something that were robust, but most were not. However, since I had been using that reliable model, he was wrong to insist on going back to a mechanical hard drive. Things change fast, and details matter.
Leading LLMs in 2025 can absolutely do certain core aspects of cognitive behavioral therapy very effectively given the right prompts and framework and things like journaling tools for the user. CBT is actually very practical and logical.
If you take a random cheap inexpensive chat bot with a medium to low parameter count and middling intelligence and a weak prompt that was not written by a subject matter expert, then even with the advances in 2025, you will not get good advice. But if you implement it effectively with a very strong model etc., it will be able to do it.