ERP Therapy Sucks

Admittedly ERP is an opposite scenario. Where you want to do a thing because you’re anxious/scared, and you have to not do it.

I have OCD (or had?) I did a course of ERP with a very good therapist who I would put as the most important person in my life after my partner and family even though I hope to never need to speak to her again. It was a life changing experience in that my average day-to-day quality of life went from something like a 2/10 to a 9/10. I frequently fantasised about killing myself. At least once a day, from ages 12-32. Though I thankfully never went as far as to make concrete plans.

With that context, I can't see a way in which ERP therapy with an LLM (at least, the consumer system prompts we are used to and often think of) would not backfire and be actively harmful.

There are two reasons, and both relate to the people-pleasing tuning that ChatGPT etc have:

1. ERP is actively uncomfortable, that is the point. But there is a delicate balance to the level of discomfort.

Too comfortable and you make no progress. Too uncomfortable and you can set yourself back enormously. We aren't talking one step forward and two back. I got overly confident two months in and put myself in a worse state than I had been on entering therapy (though not my worst state overall over the 20 years). I haven't seen many people in support groups do very successful self-administration of ERP for this reason. My therapist had to do a lot of non-verbal reading of my reaction to gauge if I was at an appropriate level of discomfort, as it was not something I was able to verbalise myself without a lot of practice and learning - and that learning and practice came from guidance by a human who didn't need me to be able to articulate it already.

2. Reassurance seeking is a compulsion, and it is one of the most common and difficult to stamp out.

I can't see an LLM not providing reassurance when asked for it, and so I can't see anyone using an LLM for therapy as making any progress at all without a level of discipline and awareness they would have had to obtain from in person ERP anyway.

I think this is absolutely true. My OCD was minimised greatly by treatment, but I am still prone to returning to certain patterns and have to put in active work to maintain my current state

> CBT is based on a theory that it is not events in themselves that upset us, but the meanings we give them.

> The question of the existence of the unconscious is crucial, because if CBT starts to take into account the possibility of unconscious meanings and logic, then it would become another branch of psychoanalysis.

I read quite a few books, from Transactional Analysis, to DBT therapist manuals, CBT manuals, and the one I loved the most and which actually helped me the most cure my BPD -- the Schema Therapy manual.

CBT seems very well suited/tooled for point therapies, very through, asks you to do homeworks, note down thoughts, I can absolutely see how it works very well for a broad spectrum of point issues.

Schema Therapy I find like it is a 3rd generation/refinement of the whole "unconscious" thing -- for me it made a lot of sense coming from TA with the Parent-Adult-Child, but I found ST approach to modes a lot more actually therapeutical -- what's the point to have mythological "Unconscious"/theory of mind if it's not actually therapeutical?

Reading Jeffrey Young's ST handbook and watching him speak actually made me cry -- I bet he would be an awesome therapist NO MATTER the formation, because he's a great human being and archetype of a THERAPIST: humble, empathetic, curious, calm, scientific, systematic and riguros, no-nonsense, results oriented -- and that's what EVERY therapy system out there should strive to achieve in creating therapists that actually help people.

BUT the question is what is "help" ? And for me, beyond anecdote the benchmark of therapies is curing BPD/NPD :)

The off center content, the jarring contrast between the background and the image, the padding at the bottom, the changing of the cursor to a very similar, yet different one... The page is clearly coherent, I don't meant to imply the author doesn't know design, but it's as if every bit was meant to annoy me slightly. It's almost impressive.