https://arxiv.org/abs/2504.18412 close this message arXiv smileybones arXiv Is Hiring a DevOps Engineer Work on one of the world's most important websites and make an impact on open science. View Jobs Skip to main content Cornell University arXiv Is Hiring a DevOps Engineer View Jobs We gratefully acknowledge support from the Simons Foundation, member institutions, and all contributors. Donate arxiv logo > cs > arXiv:2504.18412 [ ] Help | Advanced Search [All fields ] Search arXiv logo Cornell University Logo [ ] GO quick links * Login * Help Pages * About Computer Science > Computation and Language arXiv:2504.18412 (cs) [Submitted on 25 Apr 2025] Title:Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers Authors:Jared Moore, Declan Grabb, William Agnew, Kevin Klyman, Stevie Chancellor, Desmond C. Ong, Nick Haber View a PDF of the paper titled Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers, by Jared Moore and 6 other authors View PDF Abstract:Should a large language model (LLM) be used as a therapist? In this paper, we investigate the use of LLMs to *replace* mental health providers, a use case promoted in the tech startup and research space. We conduct a mapping review of therapy guides used by major medical institutions to identify crucial aspects of therapeutic relationships, such as the importance of a therapeutic alliance between therapist and client. We then assess the ability of LLMs to reproduce and adhere to these aspects of therapeutic relationships by conducting several experiments investigating the responses of current LLMs, such as `gpt-4o`. Contrary to best practices in the medical community, LLMs 1) express stigma toward those with mental health conditions and 2) respond inappropriately to certain common (and critical) conditions in naturalistic therapy settings -- e.g., LLMs encourage clients' delusional thinking, likely due to their sycophancy. This occurs even with larger and newer LLMs, indicating that current safety practices may not address these gaps. Furthermore, we note foundational and practical barriers to the adoption of LLMs as therapists, such as that a therapeutic alliance requires human characteristics (e.g., identity and stakes). For these reasons, we conclude that LLMs should not replace therapists, and we discuss alternative roles for LLMs in clinical therapy. Subjects: Computation and Language (cs.CL) Cite as: arXiv:2504.18412 [cs.CL] (or arXiv:2504.18412v1 [cs.CL] for this version) https://doi.org/10.48550/arXiv.2504.18412 Focus to learn more arXiv-issued DOI via DataCite https://doi.org/10.1145/3715275.3732039 Related DOI: Focus to learn more DOI(s) linking to related resources Submission history From: Jared Moore [view email] [v1] Fri, 25 Apr 2025 15:14:21 UTC (377 KB) Full-text links: Access Paper: View a PDF of the paper titled Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers, by Jared Moore and 6 other authors * View PDF * TeX Source * Other Formats license icon view license Current browse context: cs.CL < prev | next > new | recent | 2025-04 Change to browse by: cs References & Citations * NASA ADS * Google Scholar * Semantic Scholar a export BibTeX citation Loading... BibTeX formatted citation x [loading... ] Data provided by: Bookmark BibSonomy logo Reddit logo (*) Bibliographic Tools Bibliographic and Citation Tools [ ] Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) [ ] Connected Papers Toggle Connected Papers (What is Connected Papers?) [ ] Litmaps Toggle Litmaps (What is Litmaps?) [ ] scite.ai Toggle scite Smart Citations (What are Smart Citations?) ( ) Code, Data, Media Code, Data and Media Associated with this Article [ ] alphaXiv Toggle alphaXiv (What is alphaXiv?) [ ] Links to Code Toggle CatalyzeX Code Finder for Papers (What is CatalyzeX?) [ ] DagsHub Toggle DagsHub (What is DagsHub?) [ ] GotitPub Toggle Gotit.pub (What is GotitPub?) [ ] Huggingface Toggle Hugging Face (What is Huggingface?) [ ] Links to Code Toggle Papers with Code (What is Papers with Code?) [ ] ScienceCast Toggle ScienceCast (What is ScienceCast?) ( ) Demos Demos [ ] Replicate Toggle Replicate (What is Replicate?) [ ] Spaces Toggle Hugging Face Spaces (What is Spaces?) [ ] Spaces Toggle TXYZ.AI (What is TXYZ.AI?) ( ) Related Papers Recommenders and Search Tools [ ] Link to Influence Flower Influence Flower (What are Influence Flowers?) [ ] Core recommender toggle CORE Recommender (What is CORE?) * Author * Venue * Institution * Topic ( ) About arXivLabs arXivLabs: experimental projects with community collaborators arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website. Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them. Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs. Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?) * About * Help * Click here to contact arXiv Contact * Click here to subscribe Subscribe * Copyright * Privacy Policy * Web Accessibility Assistance * arXiv Operational Status Get status notifications via email or slack