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.

翻译：遭遇严重心理困扰的人们越来越多地将大型语言模型（LLM）聊天机器人作为心理健康支持工具。社交媒体上的讨论描述了这些互动如何对某些人起到救命作用，但证据表明，通用型LLM聊天机器人也存在显著风险，若设计不当，可能危及用户的福祉。在本研究中，我们调查了使用LLM聊天机器人寻求心理健康支持的人群的真实体验。基于对来自全球不同背景的21位个体的访谈，我们分析了用户如何为其聊天机器人创造独特的支持角色、填补日常护理中的空白，并在寻求支持时应对相关的文化限制。我们将分析扎根于关于有效支持的心理治疗文献，并引入治疗对齐（therapeutic alignment）这一概念，即让AI与心理健康语境下的治疗价值保持一致。我们的研究为设计师如何对待LLM聊天机器人及其他AI心理健康支持工具在心理保健中的伦理且有效的使用提供了建议。