People experiencing severe distress increasingly use Large Language Model
(LLM) chatbots as mental health support tools. Discussions on social media have
described how engagements were lifesaving for some, but evidence suggests that
general-purpose LLM chatbots also have notable risks that could endanger the
welfare of users if not designed responsibly. In this study, we investigate the
lived experiences of people who have used LLM chatbots for mental health
support. We build on interviews with 21 individuals from globally diverse
backgrounds to analyze how users create unique support roles for their
chatbots, fill in gaps in everyday care, and navigate associated cultural
limitations when seeking support from chatbots. We ground our analysis in
psychotherapy literature around effective support, and introduce the concept of
therapeutic alignment, or aligning AI with therapeutic values for mental health
contexts. Our study offers recommendations for how designers can approach the
ethical and effective use of LLM chatbots and other AI mental health support
tools in mental health care.

通过对来自不同国家背景的 21 位个体进行访谈，我们调查了使用 LLM 聊天机器人进行心理健康支持的人们的亲身经历，并对用户如何为他们的聊天机器人创造独特的支持角色、填补日常护理的空白以及在寻求聊天机器人支持时如何应对相关的文化限制进行了分析。我们将分析基于心理治疗文献中有效支持的概念，并介绍了治疗性对齐的概念，即将人工智能与心理健康背景下的治疗价值对齐。我们的研究为设计师如何以道德且有效的方式应对 LLM 聊天机器人和其他人工智能心理健康支持工具在心理健康护理中的使用提供了建议。