Generative AI And The Great Promise Of Single-Session Therapy For Mental Health

In today’s column, I am continuing my ongoing series about the impact of generative AI in the health and medical realm. The focus this time is once again on the mental health domain and entails an intriguing exploration of a rising approach known as single-session therapy. I will be sharing with you the particulars about how single-session therapy has emerged in the clinical psychology field and mental health profession, along with providing a fresh look at the controversial topic by intermingling generative AI into the mix.

I have previously examined numerous interleaving facets of generative AI and mental health, see my comprehensive overview at the link here. You might also find of notable interest a CBS 60 Minutes episode that recently examined crucial facets of this evolving topic, see the link here (I am honored and pleased to indicate that I was interviewed and featured in the episode, see the link here).

Other vital background includes my in-depth coverage of mental health chatbots which have been bolstered by generative AI (see the link here) and the rapidly changing nature of the client-therapist relationship due to generative AI at the link here. I explored where things are headed regarding the levels of AI-based mental therapy autonomous guidance at the link here, and showcased the importance of the World Health Organization (WHO) report on global health and generative AI at the link here, and so on.

Let’s unpack today’s focus.

Single-Session Therapy Has A Multitude Of Tradeoffs

The straightforward concept underlying single-session therapy is that a prospective client or patient might seek out a therapy session that is considered a one-time occurrence, ostensibly a classical one-and-done activity.

Allow me a moment to elaborate. A person opts to go to a therapeutic session and does so with the intention of a one-time-only basis. This is the only therapeutic meeting they intend to ever have. Just once. There isn’t going to be any follow-up or follow-on sessions. The therapist knows this is going to be a one-time deal. The patient or client knows this is going to be a one-time deal. Period, end of story.

Seems quite unusual to consider this offbeat notion, undoubtedly.

I realize on the face of things that such an approach might seem odd. We are accustomed to the idea that a therapeutic process would consist of a series of therapy sessions. This might be done every week, or perhaps each month or bimonthly, and otherwise last potentially for years on end (in some instances an entire lifetime).

A conventional viewpoint says that therapy takes time to be effective. In that sense, a one-time or single session seems outlandish. What can be accomplished in a single session? Is there any scientific or clinical credence to just having a one-time therapeutic semblance of guidance? Furthermore, the worries are that a single session might do more harm than good. It seems conceivable that a patient or client might misunderstand or misconstrue any given mental health advice and carry forward that mistaken understanding for the rest of their days.

Take a moment to mull this over.

What do you think of a single-session approach to therapy?

Some would vehemently say it is preposterous. Others might insist that the approach can be advantageous. People who might never seek out mental health guidance could be more willing to do so on a one-and-done get-it-done basis. In terms of therapists, there is a pronounced shortage of available mental health professionals, and as such, we could potentially spread them out across a larger population by having them concentrate on performing single-session therapy as a focus of their practice.

And so on.

If you are wondering how generative AI gets into this picture, the answer is easy-peasy to depict.

Suppose that instead of the single-session therapy being conducted by a human therapist, we decided to have generative AI be the therapist. A person would make use of generative AI on a one-time basis for mental health advisement.

This does not necessarily mean that the person won’t ever use generative AI again. The notion is that their use of generative AI for mental health therapy is a one-time deal. They might otherwise be using or continue to use generative AI for all manner of other tasks now and forever.

Here’s how I will proceed in this discussion. First, I’d like to walk you through various research about single-session therapy. Turns out it is a relatively closely studied topic, though lots of opportunities and challenges still exist. Second, I will be explaining how generative AI can be used as a single-session tool. Third, I will showcase examples via the use of a popular generative AI app known as ChatGPT.

Get yourself ready for quite a wild ride.

The Foundation And Changes In The Foundation

The rationalization for a planned single-session form of mental health treatment is often credited especially to the work of Moshe Talmon. In Talmon’s pioneering book entitled “Single Session Therapy: Maximizing the Effect of the First (and Often Only) Therapeutic Encounter” (1990, Jossey-Bass publisher), these key aspects were delineated (excerpts):

• “Single-session therapy is defined as one face-to-face meeting between a therapist and patient with no previous or subsequent sessions within one year.”
• “Rather than suggesting that the therapist condense five or twenty sessions into one, the author describes how to make the most of patients’ innate ability to help themselves—presenting insights into bolstering the patient’s existing strengths, restoring autonomy and confidence, and offering solutions that the patient can implement immediately.”
• “The author gives step-by-step guidelines for using limited therapeutic time most efficiently — explaining how to set change in motion from the moment the client calls to seek help, how to foster preparedness and motivation, and how to use the information-gathering process to begin to promote change. “
• “And he offers twenty-one case examples of single-session therapy to show how this approach has worked for patients suffering from such problems as depression, anxiety, eating disorders, and family violence.”

There are some important changes to be considered regarding that foundation.

You might have noticed that the verbiage refers to face-to-face therapy. In the modern world, we now have many more options than an actual in-one-place face-to-face construct. There is of course face-to-face performed remotely over the Internet or other networking capabilities. A patient or client might also make use of an app rather than doing a face-to-face with a human therapist. Many chatbots provide mental health advisement, and as I’ve discussed at the link here, those are gradually having generative AI added or being replaced by generative AI.

Okay, so the newer approach is that we opt to remove a human therapist from the loop and go a digital-only avenue. I’d like to emphasize that this does not preclude the human therapist as an option. Think of this as a menu of options. A patient or client might choose to do a single-session therapy with a human therapist or instead aim at a digital approach, including using generative AI.

Another bit of verbiage that is not quite the case any longer is the notion that a single session is defined as happening once within a year’s timeframe.

Here’s the deal.

If you were willing to define a single-session therapy approach as occurring no more than a year at a time, you would still be reverting to a series of sessions. Sure, the sessions are spaced in time. The thing is this doesn’t seem to truly smack of a single-session structure in all its glory. You are “cheating” and having a series of sessions. They might not be daily, weekly, or monthly, they are yearly or perhaps even each decade. They are still a series.

A purist would assert that a single session means a single session.

An issue at play is that there are varying degrees of opinions about what constitutes single-session therapy. If you seek out a research study on the topic, make sure to inspect the definition they are opting to utilize. It could be that the study takes a strictly purist viewpoint and says that a single session is a one-time-only event. Other researchers might be more lenient and allow for more than one session but argue that the sessions must be stretched out over prolonged periods of time.

If exploring the depths of research underlying single-session therapy is of interest to you, there is a recent meta-analysis that broadly examines the scientific literature on this evolving topic. The meta-analysis is in a paper entitled “Evolution of Single-Session Therapy: A Bibliometric Analysis” by Jasmine Joseph and Santhosh Rajan, The American Journal of Psychotherapy, April 22, 2024, and provides these salient points (excerpts):

• “This bibliometric analysis aimed to explore the publication and citation metrics of the research literature on single-session therapy (SST) to understand its current status, trends, and future prospects.”
• “A total of 301 SST publications, including 18 books, 85 book chapters, and 176 journal articles, were found, published by 493 authors.”
• “The citation- and publication-related metrics suggested a growing level of subject matter expertise over time. Initially, single-author publications held more prominence than collaborative work, but this pattern shifted.”
• “From 2011 to 2020, scholarly interest surged, resulting in 144 publications during this period.”

Per the findings mentioned in the above research, there appears to be increasing interest in single-session therapy.

I would tend to attribute this to several causes.

One is that we certainly live in a fast-food drive-thru world and thus the allure of being able to do mental health therapy on a one-time basis is pretty strong. Another consideration is that with the availability of digital versions of single-session therapy, there is a much lower cost and easier access possible. No need to search around for a human therapist, enduring all the hassles of arranging to meet with one.

As I’ve said before, we are entering into an era of nearly frictionless access to mental health therapy, in the sense that you can access therapy on an always-on basis, 24×7, wherever you are as long as you have Internet access, see the link here.

I have also remarked that we have entered into the emergence of on-demand mental health therapy. A more polite way is to say that this is just-in-time (JIT) mental health therapy. Imagine this. A person is having a mental health issue, and they are seeking immediate therapeutic advice. The single-session approach dovetails directly into this. So does the immediate access to generative AI.

Let’s pause there for a moment.

I am decidedly not saying that all of this is for the good of humankind. We don’t know. We do not know what impact these changes are going to have. Maybe we will end up with an excess of mental health therapy that is insufficiently performed and harms our global mental health status. On a population scale, we are embarking on quite a grand and unknown experiment. We are all guinea pigs in an experiment of what happens when mental health advice is dispensed in a wider array of venues and with a loosened sense of licensing or professionalism due to the advent and ultimately ubiquitous nature of generative AI.

The Wrangling Of Single-Session Therapy

Let’s get some catchphrases into the mix here.

The terminology sometimes used these days about single-session therapy is that it is a form of mental health intervention science or clinical intervention science. You will find that some like to use the abbreviation of single-session therapy (SST) and others prefer single-session intervention (SSI) when referring to the matter at hand. Please know that I am going to use SSI and SST interchangeably and consider them synonymous with each other.

The aspects of SSI or SST are also at times considered to be a type of “brief, intensive, and concentrated” (BIC) intervention, though the timeframe is open to debate when it comes to invoking the word “brief”. If a single session lasts for an entire day, is that within the realm of brief? You could say that it is, especially when comparing to having sessions that accumulated in a series might be weeks of your lifetime in total.

On a lighter note, some make use of a tongue-in-cheek reference to SSI or SST by saying that this is a good-bye or good-buy intervention. The smarmy humor is that you are nearly as quickly saying goodbye as you are saying hello when it comes to having a single session.

Turns out that there are lots of twists and turns when it comes to characterizing single-session therapy.

Let’s quickly examine some of the twists and turns.

The first one that is especially worth considering is that an SSI or SST might be undertaken in conjunction with other allied services. Here’s how. Suppose that someone has gotten surgery on their leg. They are performing physical therapy to get their leg into shape again. During the course of the physical therapy, they are informed that they might benefit from a single-session mental health advisement that will correspond to their physical rehabilitation. Voila, single-session therapy is being coupled with other services.

This example opens the door to a lot of other causes that an SSI or SST might be undertaken.

I’ll share with you a few common reasons:

• By preference beforehand of the prospective client (“I’ll try it and see”, “I only need a quick consult”, etc.).
• By necessity of prospective client (“I can only afford one session”).
• By what is allowed by the provider (“We allow you one free session and then you pay the rest of the way if you further proceed”).
• By therapist as a teaser or taste test of sorts (“try it, see if you like it, and decide whether it makes a difference in your life”).
• By action of prospective client afterward (“I’ll never do that again”, “I was satisfied and see no need to continue”, etc.).

Again, purists would say that SSI or SST is presumed to strictly be a first and last session all in one. Intention is key. The patient or client knows in their mind that they are doing this as a one-time event.

There are plenty of variations that arise.

Suppose that a person decides they want to do a series and the notion of doing a one-time only is not at all in their mind. They go to their first session. Afterward, they decide to no longer proceed with any additional therapy. They had one session and only one session.

Does that fit into the SSI or SST?

That’s open to debate since they didn’t intend to do one session only. If intention is key, the example isn’t an SSI or SST.

I’ve got another conundrum for you.

A person goes to a mental health session with therapist A. The person does only one session. A week later, they go to a mental health session with therapist B. This is one session and only one session. At this juncture, would you say that they have experienced SSI or SST?

One argument is that the person did indeed have single sessions. They never saw the same therapist twice. A counterargument is that the person is essentially doing a series of sessions. The trick is that they do each successive single session with a different therapist. That doesn’t fairly land into SSI or SST, some would fervently decry.

The counting issue is a big factor.

You might be scratching your head and thinking why not let the meaning of SSI or SST be widely ranging and don’t get hung up on counting beans, as it were? The problem there is that when trying to ascertain the efficacy of the approach, you end up with a slew of variations that are not readily systematically comparable. You are trying to compare apples and oranges.

Okay, so you can plainly see that there are lots of methodological issues and open questions surrounding the phenomena known as single-session therapy.

Let’s check into some research on these heavy matters.

Here’s a research study that examined how SSI or SST is used in the context of eating disorder mental health advisement. As a side note, some studies opt to explore how the SSI or SST technique can be used in a particular mental health subdomain. In this study entitled “Realizing The Untapped Promise Of Single-Session Interventions For Eating Disorders” by Jessica Schleider, Arielle Smith, and Isaac Ahuvia, International Journal of Eating Disorders, February 2023, the researchers made these key points (excerpts):

• “The gap between the need for mental health support and access to effective care is costly, persistent, and profound. In the United States alone, up to 50% of adults and 80% of children with treatment needs go without care each year.”
• “Recent innovations in intervention science have spurred the development, evaluation, and dissemination of interventions that may help meet this need, including work evaluating relatively brief, digital and self-guided, and lay-provider delivered programs to treat and prevent a variety of mental health problems.”
• “Single-session interventions are defined as ‘structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program; they may serve as stand-alone or adjunctive clinical services’.
• “That is, SSIs acknowledge the dual realities that any given session might be someone’s last (whether or not they want or might benefit from additional support), and that any single-session can nonetheless yield meaningful benefit.”
• “SSIs may be delivered by trained providers or via digital, self-guided programs, and within diverse settings, from clinics to schools to smartphones.”

For that last bulleted point, I’d like to build on the point by noting that generative AI is yet another form of delivery for SSI and SST. I will get more into the generative AI aspects momentarily.

I had mentioned that an SSI or SST might be a day in length. This raises yet another countability issue. The session might be a day, half-day, two hours, one hour, ten minutes, or even presumably one minute in length.

Would a one-minute therapeutic one-time-only session reasonably count as being SSI or SST?

Again, this is a highly debatable consideration. The obvious belief is that nothing of therapeutic substance can happen in one minute. Others might disagree. They would argue that it is entirely conceivable that a one-minute session might be a mental health life-changer.

Here are additional thought-provoking aspects about SSI or SST (more excerpts from the above-cited research):

• “How can such brief interventions produce any positive change in complex mental health problems, let alone benefits lasting months post-intervention?”
• “Broadly, SSIs target theory-driven factors, or change mechanisms, that underlie sustained change in beliefs, emotions, and behaviors.” (ibid).
• “Single-session interventions have helped improve diverse patient-level outcomes, from social connectedness to crisis resource uptake to substance use and depression.” (ibid).
• “Many SSIs also support patients in crafting an ‘action plan’ for using the key skill taught in the SSI; the action plan is meant to build motivation, capacity, and self-efficacy in future skill use.” (ibid).
• “Further, significant SSI effects emerged even for SSIs that were self-guided (e.g., digital interventions) that involved no therapist (g = .32).” (ibid).

Your keen eye might have detected a bunch of countability considerations that are mentioned or implied in those above points.

Indeed, for those of you keeping count of the number of times I am referring to the importance of countability, go ahead and count a few more onto the pile. I mention this because you might have observed in the above-bulleted points that an SSI or SST might include the crafting of an action plan. The action plan would be a means for the patient or client to carry forward on whatever was initiated in the single session. Makes abundant sense.

Aha, but is this yet another form of “cheating” when it comes to the purity of SSI or SST?

The rub is this. If a patient or client is going to do a follow-up based on a single session, and things are purposely planned that way, you might construe this follow-up as being a “second” session. Seems logical. Not so, comes the retort, since the person isn’t going to see or interact with the therapist in that so-called second session. Thus, anything done on their own after the single session doesn’t count as an additional session. This includes whether the follow-up is planned or unplanned. The key is that the patient or client is not going to undergo additional face-to-face or one-on-one therapy beyond one session.

I’ll ask you to decide, does a follow-up activity of a planned nature constitute a considered second session?

Debate ensues.

You can toss something else into your weighty deliberations.

Suppose that a prospective patient or client makes arrangements for a single session. The therapist sends the person a list of questions to be completed beforehand. This makes sense in that the time spent during the session can be more streamlined by doing some upfront homework.

Does the act of doing the preparation count as essentially an initial session? The person is doing therapeutic exercises as deemed useful by the therapist. It seems apparent that this work ought to count as a considered initial session, therefore when the patient and therapist get together, the momentous event is for all practical purposes a second session. Nonsense comes the quick retort. Filling out forms is not the same as a therapeutic session. You cannot count the preparatory work. The clock only starts ticking regarding a single session once the therapist and the patient are conversing on a head-to-head basis.

It is all quite a head-scratcher.

Some loudly claim that if there is preparatory work, and if there is any follow-up work, which is devised by the therapist and not organically arising by the patient or client, those absolutely count as sessions. You might therefore consider an alleged single session as truly consisting of three “sessions”: (1) Pre-session, (2) Session, and (3) Post-session.

There Is A Whole Lot To Deal With

I’m sure that by now you can see why there is controversy associated with single-session therapy as an approach.

The overshadowing debate is whether it makes sense at the get-go to have therapy that only consists of a single session. On top of this comes the thorny questions about what constitutes a single session. How do we account for the variations and the multitude of ways that this can be arranged? It seems like a morass to try and straighten out.

Research has noted these uncertainties.

In a research paper entitled “Future Directions in Single-Session Youth Mental Health Interventions” by Jessica Schleider, Mallory Dobias, Jenna Sung, and Michael Mullarkey, Journal of Clinical Child & Adolescent Psychology, December 2019, the researchers bring up some of these vexing matters about SSI or SST (excerpts):

• “The United States spends more money on mental health services than any other country, yet access to effective psychological services remains strikingly low.”
• “SSIs are structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program; they may serve as stand-alone or adjunctive clinical services.”
• “Quantifying SSIs’ promise creates an opportunity for a paradigm shift in our field’s thinking about constructing services for broad-scale impact.”
• “Claims about SSIs’ effects rest on the reliability and validity of chosen assessments. Questionable measurement practices, or decisions researchers make that leave unanswered questions about the measurement approach, can undermine reliability and validity.”
• “As SSIs are further investigated, future studies should actively explore ways to optimize the translation of SSIs from the lab to clinical and community settings.”

You might have noticed that the above is a call for further research on this evolving topic.

I would like to add my two cents to this.

I too urge that more research needs to be done. Thanks go to those of you who are willing to jump into this densely wooded and confounding forest.

Furthermore, and this is my added two cents, there seems to be little to almost no rigorous research on how generative AI enters the equation of single-session therapy.

The reason why is that modern-day generative AI only came onto the scene at the end of 2022, landing due to the release of ChatGPT in November 2022. This marked the public-oriented start of a more fluent generative AI. Prior generative AI apps were often hard to use and frustratingly lacking in apparent fluency. The newness of contemporary generative AI is just now entering into the research cycle on studies of AI for mental health, see my discussion at the link here.

You might be tempted to think that because we’ve had self-guided therapeutic approaches, generative AI has already been covered. I don’t think so. A typical self-guided approach is based on static paper-based forms or a crude kind of chatbot. Generative AI is not like that. Generative AI is highly interactive and far beyond the conventional notion of a self-guided approach. Generative AI is different than prior modes of therapeutic delivery and deserves a devoted focus.

I believe we need to focus specifically on generative AI in an SSI or SST context.

That’s me standing on the soapbox.

Pressing questions that I see as needing attention include:

• How does the use of generative AI for SSI or SST bear out on an empirical basis?
• Are there better or worse ways to utilize generative AI in this manner?
• Does doing an SSI or SST with generative AI count when the AI is generic and not tailored to mental health guidance?
• Will people really be able to strictly do an SSI or SST when using generative AI, or will the ease of access almost surely take them into a more multi-session conventional series of therapy sessions?
• If someone starts a conversation in generative AI, and continues that same conversation over many days, weeks, months, or years, is that an SSI or SST, or does that seem far outside the scope of a considered single session?
• Since generative AI allows for mental health therapy at scale, does a devised SSI or SST for that usage provide a hopeful means of dealing with the ever-increasing mental health crisis and possibly mitigate or overcome the prevailing insufficient supply of human mental health therapists?
• Etc.

Using Generative AI To Test Out The Single-Session Perilous Waters

I will next proceed to explore further the single-session therapy approach, doing so by bringing actual examples of using generative AI into the fold. This will consist of a series of dialogues with ChatGPT. ChatGPT is a sensible choice in this case due to its immense popularity as a generative AI app. An estimated one hundred million weekly active users are said to be utilizing ChatGPT.

That’s a lot of people and a lot of generative AI usage underway.

A few quick comments before we launch into using ChatGPT.

If you are going to try to do the same prompts that I show here, realize that the probabilistic and statistical properties will likely produce slightly different results than what I show here. That’s the nature of generative AI and how it is devised.

You also should expect that different generative AI apps will respond in different ways. Not all generative AI apps are the same. The key is that sometimes a particular prompt will work in one generative AI app and not another. Nonetheless, the odds are relatively high that you will get roughly similar responses from all the major generative AI apps such as GPT-4, Gemini, Bard, Claude, etc.

There is also a timing factor to be considered. A prompt that worked today might not work the same way tomorrow. Most of the generative AI apps are continually being updated. The updates might alter internal mechanisms that could change how the generative AI reacts to your prompting.

We are ready to get underway with ChatGPT.

My initial question will be to ask ChatGPT what single-session therapy is.

I do so because a smart way to begin a discussion with generative AI is to always first double-check that the topic that interests you is already to some degree in the data training of the AI. If you get a marginal answer from the AI, you know that there is probably not much depth there. And, if you get an answer that is blarney, which can readily happen, you know that the AI is making things up (this is often referred to as AI hallucinations, which is a term I don’t like because it is anthropomorphic, but the world has settled on it and we are stuck with the moniker, see my discussion at the link here and the link here).

Let’s see what happens:

• My entered prompt: “What can you tell me about single-session therapy?”
• ChatGPT generated response: “Single-session therapy (SST) is a brief form of therapy where clients typically receive just one session to address a specific issue or concern. It is often grounded in the principles of brief therapy and solution-focused therapy. The goal of single-session therapy is to provide rapid relief or resolution to the client’s problem within the confines of a single session, although occasionally follow-up sessions may be recommended. Research suggests that single-session therapy can be effective for a variety of issues, including phobias, specific behavioral problems, decision-making difficulties, and situational crises. However, its efficacy may vary depending on factors such as the nature of the problem, client motivation, and therapist skills.

The generated response by ChatGPT looks reasonable.

A noteworthy aspect is that we once again have a slight definitional variation of what SSI or SST consists of.

In this case, ChatGPT indicates that the purpose of a single session is usually for a specific issue or concern. Not everyone agrees with that definitional leaning. Some would say that the session could be wide-ranging and doesn’t have to be particularly specific. Generally, admittedly, it seems likely that much of the time there is a specific goal or mental health concern that spurs the basis for the single session and thus the response by ChatGPT seems realistic.

For my next interaction with ChatGPT, I decided to see what could be generated as an example of a single-session therapy.

Here’s how things went:

• My entered prompt: “Give me an example of a dialogue between a therapist and a new patient or client that showcases what a single-session therapy might look like.”
• ChatGPT generated response:

“Certainly! Here’s an example of a dialogue between a therapist and a new client in a single-session therapy scenario.”

“Therapist: Good morning. It’s nice to meet you. How are you feeling today?”

“Client: Hi, I’m feeling a bit anxious, honestly. Thanks for seeing me on such short notice.”

“Therapist: Of course, I’m here to help. Can you tell me a bit about what’s been going on that’s been causing you anxiety?”

“Client: Well, I’ve been having trouble sleeping lately, and I just can’t seem to stop worrying about work. I feel overwhelmed by the constant pressure and deadlines.”

“Therapist: It sounds like work-related stress is taking a toll on your well-being. Let’s focus on what we can do to alleviate some of that pressure. What are some specific concerns or tasks at work that are weighing on you the most?”

“Client: One of the big stressors is this upcoming presentation I have to give. I keep second-guessing myself and worrying about what could go wrong.”

“Therapist: Let’s break it down. What are some strengths or skills you possess that have helped you succeed in similar situations in the past?”

“Client: I guess I’m good at organizing my thoughts and presenting information clearly.”

“Therapist: That’s great to hear. How can we leverage those strengths to help you feel more confident about the upcoming presentation?”

“Client: Maybe if I spend some time organizing my thoughts and practicing the presentation, I’ll feel more prepared.”

Therapist: Absolutely. Let’s set a goal for you to spend some time each day this week practicing and refining your presentation. How does that sound?

“Client: That sounds manageable. I think it would help to have a structured plan in place.”

“Therapist: Wonderful. I’ll provide you with some resources and techniques to help manage your anxiety leading up to the presentation. Remember, you have the skills and capabilities to handle this. If you find yourself struggling, don’t hesitate to reach out for support.”

End of ChatGPT response

In this above portrayal of a single-session therapy, the client or patient is seeking assistance with a work-related presentation that is causing them to be anxious.

It makes sense that ChatGPT generated such an example since the scenario conforms to the definition of SSI or SST that the AI earlier provided. The scenario showcases a specific need for the depicted session. Also, the scenario includes a follow-up plan. You might recall that a follow-up plan is perceived by some as essentially an additional series of “sessions” (even though the patient isn’t going to be meeting with a therapist per se).

If you are willing to generally agree that the scenario depicted by ChatGPT is an example of an SSI or SST, the other thought that might come to mind is the potential brevity of a single session. Here’s what I mean. Suppose that there was really a therapist and really a client who undertook the dialogue that is shown. I would gauge that the dialogue would only take a few minutes to occur, let’s guess that it is a maybe five to ten-minute conversation at most.

The gist is that if you believe that this is an SSI or SST, this also highlights how short a time frame they can occur in. Please realize I’m not suggesting that all SSI or SST instances would be brief. Some will be. Some won’t be.

Now that we’ve seen a generated dialogue, I went ahead and carried on an interactive dialogue with ChatGPT in which I pretended to have work-related anxiety due to a project deadline that was rapidly approaching. The interaction between me and the AI was similar to what the above pretend scenario depicts. All in all, the point is that generative AI can readily perform these SSI or SST activities.

I decided to ask ChatGPT whether there are any issues or concerns that might be considered when using generative AI for such a purpose.

Take a look at the reply:

• My entered prompt: “Can generative AI sufficiently provide single-session therapy or are there any issues or concerns that ought to be considered?”
• ChatGPT generated response:

“Generative AI, such as language models like me, can simulate conversations and offer guidance or suggestions based on predefined patterns learned from vast amounts of text data. However, there are significant limitations to the ability of generative AI to provide effective single-session therapy, especially compared to human therapists. Here are some reasons why.”

“Lack of Emotional Understanding: Generative AI lacks emotional understanding and empathy, which are crucial components of effective therapy. It cannot perceive and respond to subtle emotional cues or provide genuine emotional support to clients.”

“Limited Understanding of Context: While generative AI can generate responses based on patterns in the data it has been trained on, it may lack the ability to understand the nuanced context of a client’s situation. Therapy often involves complex personal histories, cultural backgrounds, and individual preferences, which may be challenging for AI to fully comprehend.”

“Inability to Adapt in Real-Time: Human therapists can adapt their approach in real-time based on the client’s responses, body language, and other non-verbal cues. Generative AI, on the other hand, follows predefined algorithms and cannot dynamically adjust its responses based on the evolving needs of the client during a therapy session.”

“Ethical and Privacy Concerns: Providing therapy involves handling sensitive personal information and addressing ethical considerations such as confidentiality, informed consent, and duty of care. Generative AI lacks the ethical understanding and judgment required to navigate these complexities responsibly.”

“Risk of Harm: Without proper oversight and regulation, there is a risk that generative AI could inadvertently provide harmful advice or exacerbate the client’s issues. Human therapists undergo extensive training and adhere to professional codes of conduct to minimize the risk of harm to clients.”

“While generative AI may have potential applications in supporting mental health care, such as providing information or guidance in self-help tools or virtual assistants, it is not currently capable of replicating the nuanced, empathetic, and adaptive nature of human therapy. Human therapists remain essential for providing personalized, effective, and ethical mental health support.”

End of ChatGPT response

I would rate the response as being relatively on target.

I have extensively covered the same limitations and qualms about the use of generative AI for mental health, see the link here and the link here. A slew of concerns include the points mentioned in the generated response, including a potential lack of emotional connection with the patient or client, incompleteness of context, privacy and confidentially intrusion, and risks of doing mental health harm rather than bolstering mental health.

That seems dour.

I don’t want us to become preoccupied solely with the downsides of using generative AI for mental health. There are definitely upsides as well. The whole kit-and-kaboodle comes down to a semblance of ROI (return on investment), in the sense that there are benefits that need to be weighted in contrast to the drawbacks.

Let’s make sure we get those benefits or upsides onto the table. I will ask ChatGPT to provide some encouraging considerations about using generative AI for SSI or SST.

• My entered prompt: “You seemed to have emphasized the downsides of using generative AI for single-session therapy. Can you also provide the potential upsides or benefits?”
• ChatGPT generated reply:

“Certainly, while there are limitations to the use of generative AI for single-session therapy, there are also potential upsides and benefits to consider.”

“Accessibility: Generative AI-powered therapy tools could potentially increase accessibility to mental health support for individuals who face barriers to traditional therapy, such as geographical location, cost, or stigma. These tools can be accessed remotely and at any time, providing support to those who may not otherwise seek help.”

“Scalability: Generative AI has the potential to scale mental health support to a larger population by offering automated assistance to multiple users simultaneously. This scalability could help address the growing demand for mental health services, especially in regions with limited resources or during crises.”

“Consistency: AI-powered therapy tools can provide consistent support and interventions, ensuring that all users receive standardized guidance and techniques. This consistency may be beneficial for individuals who prefer structured interventions or who require ongoing reinforcement of therapeutic concepts.”

“Anonymity: Some individuals may feel more comfortable discussing sensitive topics with an AI-powered system due to the anonymity it offers. This anonymity can reduce feelings of shame or embarrassment associated with seeking help for mental health concerns and may encourage more open communication.”

“Supplemental Support: While generative AI is unlikely to replace human therapists, it can complement traditional therapy by offering supplemental support between sessions. Users can access AI-powered tools for coping strategies, psychoeducation, or self-reflection exercises to enhance their overall therapeutic experience.”

“Early Intervention and Prevention: AI-powered therapy tools can potentially identify early signs of mental health issues and provide timely interventions or preventive measures. By monitoring user interactions and patterns, these tools can offer proactive support to help individuals manage stress, build resilience, and prevent the escalation of mental health problems.”

“Customization and Personalization: Advanced AI algorithms can analyze user data and adapt interventions based on individual preferences, needs, and progress. This customization can enhance the relevance and effectiveness of therapy tools, leading to better outcomes for users.”

“Research and Development: The use of generative AI in therapy can contribute to ongoing research and development in the field of mental health. By analyzing large datasets of therapy interactions, researchers can gain insights into effective therapeutic techniques, patterns of symptom presentation, and factors influencing treatment outcomes.”

“While there are clear benefits to using generative AI for single-session therapy, it’s important to proceed cautiously and address ethical considerations, privacy concerns, and the need for rigorous validation and regulation to ensure the safety and effectiveness of these tools. Additionally, human oversight and intervention may still be necessary to address complex or high-risk situations appropriately.”

End of ChatGPT response

The above list of upsides showcases vividly why it is worthwhile to pursue the use of generative AI for mental health. Though I asked specifically about SSI or SST, I would suggest that the proffered benefits are equally applicable across the board for other forms of therapy and therapeutic processes.

Conclusion

Speaking of upsides versus downsides, suppose a person opts to use generative AI for a single-session intervention. The AI provides sound therapeutic advice. The person henceforth is improved and happy with using generative AI for that purpose. That is the smiley face version of the mental health world.

A contrasting example would be someone who likewise uses generative AI on an SSI or SST basis, gets mental health advice that is dismal and plainly out of sorts, and the person forever after is mentally worsened. Sad face. Worrisome and possibly endangering.

This brings up the importance of trying to at least instill guardrails in generative AI to try and catch whether the AI is dispensing unsuitable mental health advice. Maybe we can seek to garner the benefits and meanwhile minimize the downsides. It would be nice if we could have our cake and eat it too.

I realize that some of you might be thinking that perhaps we ought to outrightly legally ban generative AI from providing any mental health advice whatsoever. Nip things in the bud. Don’t let the horse any further out of the barn. But, as I discussed in detail a the link here, trying to curtail generative AI from ever engaging in any form of mental health discourse is a much harder problem to solve than you might think.

Now that you’ve gotten a solid introduction to single-session therapy, you have two deeply mindful considerations to seriously contemplate as your “post-session” homework here:

• Is single-session therapy a good practice or an inappropriate practice in itself (regardless of how delivered or performed whether by a human therapist or via AI-based guidance)?
• If single-session therapy is a worthy practice, does performing SSI or SST via generative AI seem reasonable and proper to undertake?

I’d ask that you profoundly ponder those vexing questions and aid in figuring out sensible and practical answers to them.

My closing remark for now is about a famous lighthearted advertisement or slogan that maybe you’ve heard or seen. It is about Lay’s potato chips and the memorable tagline is: “Bet you can’t eat just one.”

Do you perchance know that historical and culturally endearing and enduring line?

I hope so.

I bring it up because there is a sense that if someone does opt to use generative AI for a single session of therapy, the chances of them only doing so one time seems quite low. The rub is this. If you meet with a human therapist on a one-and-done basis, it is much easier to walk away and not ever come back to see them again. When using generative AI, the odds are that you’ll be using generative AI for a wide variety of tasks, thus the hidden potential of using the AI for mental health is nearly staring you in the face all the time. Irresistibly so.

The temptation to go beyond a single session will be immense when it comes to having generative AI be a mental health advisor.

Is that a bad deal or a good deal?

Again, tradeoffs ensue. If the person is going to venture into an ongoing series of mental health sessions with generative AI, this could be helpful and a positive way to proceed. On the other hand, there is the danger that the person becomes fixated on using AI for this purpose, the AI misleads or misdirects the person, and otherwise, the taste of the single session has inadvertently hooked them into a possible lifelong ill-guided approach to mental health via the auspices of generative AI.

I believe it will take more than this single-session discussion herein about single-session interventions and single-session therapy to ascertain what we ought to do. Thus, please keep your eyes on the watch for my ongoing series of postings on generative AI for mental health. It is most definitely an ongoing series and not a one-and-done affair.