“Chat told me I should break up with him.”
I instructed my face to remain therapist-neutral, but I must have smirked. The truth is, I was annoyed. We had been discussing the viability of this relationship for weeks, and in an instant AI had brought the answer. “How do you feel about it?” She said this had been her gut feeling all along. The following session, her relationship was over.
AI is everywhere, therapy included, and yet somehow the first time it showed up in my work, I was surprised. A patient passed me his phone to show me how AI had helped him through a fight with his wife. After validating his pain, AI analyzed moments of relational breakdown and offered several ideas to initiate a repair. I read it and then had an unexpected thought: “WTF. This thing is actually good.” To top it off, it worked. My patient had used its suggestions and the conflict was repaired. I was impressed. Then, for a moment, I felt puny. I would probably have offered an unpolished version of one of these ideas over an entire session.
As patients increasingly bring AI into sessions, I sometimes don’t know whose voice I am hearing, whose emotion, whose gut feeling. I deal with this, along with the creepy annoyance and competition it brings up in me, by moving us towards what feels like safer grounds, re-asserting the “IRL” world. As in: “How about instead of talking to Claude, you wrote in a diary and brought it to therapy next week?” I talk about the real mental health risks of using AI: how it can worsen anxiety, give false information, increase isolation, and sometimes lead to delusional beliefs or suicidal thinking.
Dazed by its boundless sycophantic embrace, some of my patients report not leaving their beds or couches on the weekend as they get sucked in, vulnerably uploading their private lives to big tech. AI can be dangerous, I warn my patients; I do not recommend you use it.
Then I go home and I know that part of me is hiding: because when my nine-year-old had a tantrum at 7.20am on a Sunday morning, I did not write in a diary to bring to my therapist next week. What I actually did was, gulp, reach for Chat. Not that I needed parenting techniques (I teach them, for goodness sake). I am a single mom and wanted presence pronto. I didn’t care that it was phoney. And AI was there, calm and supportive, coaching me to breathe through the screams. Was the therapy help fake? Yes. But it worked. So does it matter?
What is real therapy, anyway? There are tons of therapeutic approaches, and just as many therapist personalities. Near the end of a recent session, a patient is intensely angry at the world, and more so at herself. Her voice cracks. Her body is tense; she is ashamed. I am on edge. I say a few ineffective words which seem to land nowhere; there is an awkward silence, and she shakes her head. I imagine Chat showing up in that moment, keenly articulating its efficiently organized ideas. I am tongue-tied and helpless.
What, if anything, is…
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