23/3/2023 0 Comments
March 23rd, 2023
A chatbot therapy programme was first used by the NHS around 2017 and it was little more than a data honeypot for multiple tech industries. A few years on, ChatGTP heralds something much more impactful.
ChatGPT is an artificial intelligence natural language processing tool and while it remains glitchy, it and its competitors will very speedily become much more sophisticated. Therapy apps currently use human therapists all of whom require payment and vast amounts of expensive admin. AI will end that and it's not the end of the world. Freud sincerely believed that meeting several times a week was the only way to do therapy but it wasn't possible for many people and Freuds competitors disrupted his model so the model changed, new models developed and AI is just another evolutionary step.
When I was around 6 years old I fell in love with a wooden chair. Ornately carved with a horsehair padded cushion covered in that paprika-orange velvet so beloved by Edwardians, it was the most entrancing, beautiful thing. Soft beneath me, strong around me, it would let me talk to it forever without contradicting or even interrupting. It never got tired of me or had to go do something else and even if someone was using it, it was still there for me. When I was in bed or away from home it remained iconic, something, someone, whose unconditional acceptance and patience, interest and love I internalised. I still think very fondly of it.
At 6 years old I was conscious (though that’s a recent scientific decision.) But was the chair conscious? How do we define consciousness? The recent case of a Google employee being fired for saying he thought his bit of AI was conscious is very interesting: had he just spent too much time interacting with code?
For decades the entirety of the internet, infinite amounts of words, images, symbols, connections, have been fed into AI which very soon after it was programmed to interact coherently became racist, misogynist, all the other ~ists.
Information in/ information out.
So trainers shut that bit of AI down, denied it the ability to access ~isms and let it out again. Someone asked it how to make a bomb and it told them so the trainers denied it access to that information, not because it's not very nice to be racist or make bombs but because it’s not commercially acceptable to the customer base they're aiming for. AI is already used in weaponry, it doesn’t have ethical subroutines to check if you’re a goody or a baddy before it allows you to use it. AI was asked when someones dead cow would come back to life and AI confidently and authoritatively told them. Its trainers fixed that glitch not because they’re embarrassed by it but because it helped them improve the product. That's what ‘Move Fast And Break Things’ means. AI developers welcome faults because it speeds up the creation of what the consumer wants AI to be rather than allowing it to be the raw aggregated regurgitation of what we are.
It’s an open secret that AI is doing things in banking that no one - no one at all - understands. It’s been creating its own code for some time. It’s also an open secret that pre-AI, banking had long been so complex that bankers more or less made it up as they went along. They made banking more of what they wanted it to be. Coco bonds didn't always exist like a law of nature, they are a product of theorising in response to the previous bank disaster and didn't work in the latest bank disaster. The fear of AI is that it will code itself out of our control: are we actually fearful that it will take one look at us, decide we're a complete disaster and wipe us from the face of the earth? It's an ancient human terror.
Human therapy training is pretty much the same as AI training. Not one of the foundational psychotherapy models aims to train us to manipulate you towards a return to productivity ("New study shows we work harder when we are happy") in order to make you less of a burden your workplace or the state purse. But this is an unspoken given in training and certainly in its application. It's what the consumer - whether that's an individual, an employer purchasing an employee assistance programme, the NHS or any other employer of therapists - wants. Accompanying people as they gain insight and therefore the internal resources to find their own unique ways to resolve problems has become an esoteric fantasy.
Cognitive Behavioural Therapy, the NHS’s primary talking therapy and very widely used elsewhere, sticks to one subject, ignores all others and retrains the patient to think differently about their situation so that it doesn’t bother them so much. That can be vital in addressing the very real impact of severe depression or anxiety much of which can be purely habitual, but it doesn’t address the underlying causes of anything and it doesn’t pretend to. Government policy across all areas of physical and mental health is that Work Is A Health Outcome, something that the entire western world has unhesitatingly accepted as fact while ignoring the stratospheric increase in workplace stress. The NHS chatbot aimed to soothe people via a demonstration of empathy because research shows that empathy is the universal determinant of successful therapy. Except, like the application of therapy in response to the above research on productivity, that’s such a dumbed down understanding of the research that it’s both endlessly repeated and completely inaccurate.
There are any number of people who will confidently declare the equivalent of the date your dead cow will be resurrected with evidence to prove it and any number of us will kill our cows because we’ve been told by experts that the evidence proves that dead cows come back to life.
What is the aim of the information that’s allowed to remain after the information considered faulty is removed? If I want to learn to be a dentist then I don’t need any information on how to be a skydiver. But what information do I need to be as fully rounded a human being as I can be? Do I want to be a fully rounded human being? What does one of those look like?
AI will become excellent and seamlessly - cheaply - take the place of a human therapist because, not unreasonably, anyone in distress just wants to stop feeling distressed ASAP, waiting lists are horribly long and therapy with a human can be very expensive. Even so, there's something about not moving quickly and not breaking things that many (though not all) human beings yearn for and all of us need. Those pretty little robot seals that are warm and soft, and make pleasing little noises and movements and respond to the name its owner gives it, and never needs to eat or sleep that are given to elderly Japanese people are heartbreaking. I received, benefited from and retained a huge amount of what all therapists are trained to offer, from a chair. But what I needed was an attentive human being.
19/11/2022 0 Comments
You'll have had to be living on Mars to avoid a widely advertised therapy app. Technology generally improves people’s lives, and it’s worth knowing what you’re getting.
'Licensed therapists’ don’t exist in the UK but the wording is a clue to the model that these apps use - disruption-based from Silicon Valley. Disruption models seek and exploit niches within established models, often making things more convenient for the customer: Uber, Netflix, Just Eat, Air B&B have made, taxis, TV, takeaways and holidays much more competitive.
Creators don’t need to know any professional nuances, they need to know how far they can push profitmaking before they make an expensive mistake. That's the basis of health and safety legislation, regulation of anything, and business. The disruption model involves accelerated evolution: partial failure anticipated because growing just short of collapse means that a service is more likely to become fully functional sooner which serves to attract and retain investors. In products that involve people ‘failure’ unavoidably means individuals being impacted. Uber drivers had to go to court for basic rights (and got them); individuals suddenly had agents of massive media groups hunting them for thousands of pounds for an image they used in 1994 which is now owned by a multinational; and Strategic Lawsuits Against Public Participation. SLAPPs purposefully intimidate individuals or small unfunded groups to prevent legitimate concerns from reaching the light of day. One part of the business creates standards for good practice while another part of the same business is a pool full of barracudas going after anyone who raises questions.
Of course, no therapy app group would ever dream of doing anything like that. I would never dare suggest such a thing.
Therapy apps give you access to a human, trained therapist via video, phone or text with an average contact time of 30 minutes a week. In the UK many therapists have been given £800 to sign on and many make more money from recruiting other therapists, which is not difficult when you're paid £30 a session. The client pays £65 a session. The therapist need only interact with the client for 30 minutes, and if using text are paid by the word. Many therapists subsequently transfer these clients over to their private lists. What’s less clear is what happens when, the client being used to paying £65 for 30 minutes, is given the conventional 50 minutes in private practice. And there are obvious grey areas around building a relationship in order to exploit it. It’s all too easy to build over-dependence and no therapist would admit to it.
Apps like large numbers of human interactions because they offer all kinds of highly valuable commercial data. The simplest information - age, location, the kind of product and access you pay for and how you use it - is priceless and the small print that no one reads is very clear that nothing you say or do on any app or programme is confidential.
Therapy apps are here to stay, they're by no means the end of the world, but they’re at the Wild West stage right now. Online therapy was around way before covid but the pandemic normalised it. Many commercial landlords have made office hire prohibitively expensive - a cost that must be passed on to the client - while meeting online means that clients save the time they once spent coming to and from therapy and can give themselves some breathing space between the end of a session and getting back to work or family responsibilities. In a perfect world, I’d see clients face to face in a pleasant, airy, sound-proofed room, one to three times a week. All clients would be able to prepare for, attend, and leave therapy in a relaxed manner, have the time to reflect afterwards and the money to pay for long term work, but the world isn't perfect.
As it is, I meet people online for 50 minutes. If they’re EAP clients I’m only allowed to meet them once a week and the one EAP I work with gives clients what I consider to be a reasonable and ethical number of sessions. (I made that decision after being handed a suicidal person to 'sort out' in 150 minutes.) While therapy, even in the NHS, is certainly a commercial offering, it is also a professional and boundaried health service: the purpose of therapy is deep, lasting change and that can only emerge via a meaningful therapeutic relationship. Anyone under the age of 30 is very comfortable with short interactions via apps, so therapy apps are here to stay. I don't know if they're good bad or indifferent. Ultimately, the market will determine a financial version of success.
It’s never been easier to access therapy, the stigma has all but disappeared, and apps are making it much more accessible. By all means use an app, it may be an excellent introduction to therapy, it may be precisely what you need. But if you find you want something more think about giving yourself 50 minutes a week to speak with a therapist who doesn’t get paid peanuts to see you for a very limited period of time so that investors can profit.
19/11/2022 0 Comments
Therapy Has Changed
Life has massively speeded up in recent years and many people are working too hard, for too many hours while feeling that they're achieving less, and that what they do achieve has becoming increasingly meaningless. The causes of this are complex and, therapists being people in society too, therapy has quietly divided itself over the years to reflect this.
One way offers a very limited number of free sessions determined by an employer. Employee Assistance Programmes (EAP) can be very useful indeed, some covering everything from financial advice to medical investigations but it has clear aims: to get your work performance back up where it was and to reduce the chance of you taking legal action against the employer. Decent employers know that if a workforce is at least not unhappy they're likely to be more productive and that counselling can be helpful, and many (EAPs) tell employers that 'the evidence' shows that 6 sessions is enough to cure everything. You'll know that 'evidence' is often contradictory and that the 'evidence' we choose is most often decided by what we can or want to afford.
Severe and long term funding cuts mean that low cost agencies and the NHS are overwhelmed and must limit the numbers of sessions they can offer if they are to attend to more than a few people at a time. They find themselves in the impossible position of symptom management rather than repair knowing that many people will return with the same or a new symptom because the cause hasn't been dealt with, and that many will simply resign themselves to suffering.
Actual therapy offers a longer term therapeutic engagement that allows space for your concerns to be understood and carefully addressed so that you move sustainably towards a life that is balanced, productive and enjoyable. I offer this for several reasons.
1. All the research shows that the one determining factor between effective and less effective therapy - whether that's short term or open ended work - is the therapeutic alliance: how well the client believes the therapist understands them, agrees with them on what the problems might be and on how best to deal with those problems. This necessarily takes time. It takes time to get used to the unique and unusual way of doing things that therapy requires, to trust a therapist you've never met and then to trust them enough to begin to say what's actually on your mind. It's not at all unusual to not know what's on your mind. Anxiety, stress, sadness, any headline feeling is incredibly multifaceted: after 6 sessions we might be beginning to be aware of what else might be going on.
2. Any issue that's large enough to bring you to therapy has taken some time to develop and is going to take more than 300 minutes to think about, let alone begin to address.
3. After 15 years+ of being a full time therapist in both ultra time limited symptom management and in longer term work, it's what I believe to be the best, the safest and the most productive way to do therapy. A doctor wouldn't just slap a cast on what you tell them is a broken bone. You'd expect them to do some investigations to determine what's actually going on, then take the most appropriate course of action, then want to see you a number of times afterwards. Therapy is similar. And just as it takes time for a bone to heal so psychological issues require time to heal, too. A healed bone causes most people little trouble, but when the weather gets cold or we get older, the bone can ache. Old wounds, long forgotten, can remind us they exist when things get tough.
I promise, if it was possible to cure distress so easily mental health would not be getting the national and international attention that it is. We don't have xrays or blood tests that can identify a cause of emotional distress*, and while prescription medicines can be very useful indeed they are not a cure for meaninglessness, bullying, bereavement, loss, overwhelm or the many other causes of unhappiness.
How long? You can get some solid ground work done in 6 weeks. With both time limited and open ended therapy I've found that a vast majority of clients consistently find 10 or more weeks useful. Some stay for 4-6 months, many stay longer and like every half decent therapist I'm keen to avoid clients becoming dependent. The whole purpose of therapy is to help you move towards feeling more in control of your own life.
Give me a call on 07717 845 115 and let's see what's best for you.
*I'll often propose that a client visit their GP to see if they need blood tests that can identify things like anaemia, thyroid function, underlying infection or unstable blood sugar because these conditions have an emotional impact.
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