Category: Risks & Challenges

Don’t let convenience outrun clinical judgment

Believe it or not, there was a time before GPS (yes, I am that old). Back then, people needed to unfold one of those paper maps and figure out how to get from one place to another (and then how to fold the map back up). Nowadays, thanks to technology, I don’t even need to know where I am going. Google Maps knows, and that is enough for me. Likewise, in ancient history (before smartphones), I used to remember at least ten phone numbers: my home number, my grandparents’, and those of my best friends. Now I can hardly remember my wife’s.

Since the beginning of time, we have used technology to make our lives simpler. We could even argue that this is the purpose of technology. From the abacus and the calculator to Claude, we humans love to figure out how to make things easier and more efficient. This is often called cognitive offloading: using external tools to reduce the amount of mental processing required to do something. In the past, this might have meant mostly taking notes. Nowadays, it includes consulting Google or asking ChatGPT to summarize something, interpret information, or even write something for us (or as us).

The advent of LLMs and AI scribes

General-purpose AI systems powered by Large Language Models (LLMs), such as Claude or ChatGPT, have begun to revolutionize how we work. Months of research can be done in days; piles of books can be summarized in hours. They help us do things faster and often (but not always) better.

Just like clients, therapists and health care professionals are enthusiastically jumping on the AI bandwagon. The use of AI in health care, including AI scribes (note-takers), has grown rapidly1. It is undeniable that AI can reduce the administrative burden and make life easier for clinicians. As discussed in my last article, AI can also be useful for psychoeducation, providing additional resources, and as a tool for reflection.

As harmless as scribes may appear, they present important challenges for clinicians. Should clients give informed consent before an AI scribe is used? (probably yes2). Does sending client-identifiable information to a general-purpose LLM constitute a breach of confidentiality? (most likely yes, since information shared with an LLM is not confidential, at least not in the psychotherapy sense). Would it be a HIPAA violation3? (depending on the information, but potentially also yes). Things are even more delicate when considering that even purpose-built scribes can hallucinate, make inferences, or make mistakes4.

The deep end of the pool

However, note-taking is only the shallow end of the pool. Some AI scribes generate treatment language, conceptualizations, diagnoses, and suggested interventions, blurring the boundary between scribe and clinician. What is more, some therapists are using ChatGPT during sessions asking for insights or interventions5. Products are being marketed that listen during therapy sessions and provide therapists with real-time prompts, insights, and guidance.

When myth mirrors reality

In the Dialogues, Socrates tells Phaedrus a story about the Egyptian god Theuth. Theuth presents King Thamus with the gift of writing, claiming that it will make people wiser and improve their memories. The king is unimpressed. He argues that writing will produce forgetfulness because people will stop exercising their own memory and rely instead on external sources. They will think themselves intelligent because they have access to enormous amounts of information, while lacking real wisdom. It is uncanny how well this myth mirrors our current predicament.

What can go wrong?

As I have expressed, I am convinced that AI is an incredibly valuable tool when we know how to use it. However, outsourcing clinical thinking to LLMs presents potential risks that need to be acknowledged:

  • Relational disruption: Therapeutic success relies heavily on the relationship. Introducing AI into the equation changes the dyad, creating an artificial third: an opinionated, know-it-all chatbot.
  • Diluted presence: Real-time prompts, like an overactive inner critic, can get in the way of authentic presence. It may be difficult, if not impossible, to create a true bond when the therapist is simultaneously engaging with an LLM.
  • Automation bias and generic interventions: Because AI responses sound polished and authoritative, therapists may give them more weight than they deserve. Likewise, a chatbot may suggest elegant interventions that are technically plausible but misattuned or disconnected from the client’s reality. When that happens, besides potential risks6, the client may not feel understood, compromising the relationship.
  • Clinical deskilling: There is enough research to suggest that when we find a tool that makes something faster and easier, we are inclined to keep using it. As this process is repeated, we may stop practicing the underlying skill, become less competent, and rely even more on the tool (think of me and phone numbers). One study showed how by regularly using AI for diagnosis, specialists became less accurate when they did not have access to the tool7.

Offloading formulation, diagnosis, and treatment planning may gradually reduce clinicians’ skills. It may also prevent newer clinicians, who began practicing after the arrival of these tools, from developing those inner capacities in the first place. Therapists may slowly lose their clinical acumen.

The way forward

We have always used tools to extend our minds: dictionaries, calculators, GPS, Google… In some ways, AI is simply the latest iteration of this pattern, but it goes further because it can take over functions such as formulation, diagnosis, and treatment planning that have traditionally belonged to the clinician.

Psychotherapy has always been (and hopefully will continue to be) a profound encounter in which two human beings come together to work toward healing. This requires a human therapist who can create a safe environment and an authentic relationship where clients feel seen, understood, and safe enough to explore the deepest and darkest corners of their psyche.

Let’s use AI for what it is good at, but let’s not offload human connection. That is where true healing occurs.

AI can reduce administrative burden, but clinicians and organizations need thoughtful boundaries around privacy, consent, clinical judgment, and therapeutic presence. Reach out for lectures, professional trainings, and consultation on the responsible use of AI in psychotherapy.

Explore the AI series
  1. See https://www.ama-assn.org/practice-management/digital-health/more-80-physicians-use-ai-professionally-ama-survey and https://www.theguardian.com/australia-news/2026/mar/29/doctors-using-ai-for-notes-australia ↩︎
  2. https://www.nature.com/articles/s41591-026-04506-3 ↩︎
  3. HIPAA stands for the Health Insurance Portability and Accountability Act, is a federal law that aims to protect sensitive patient health information. It includes provisions for their confidentiality, privacy and security. ↩︎
  4. https://www.nature.com/articles/s41746-025-01895-6 ↩︎
  5. https://futurism.com/patients-furious-therapists-using-ai ↩︎
  6. https://spirals.stanford.edu/assets/pdf/moore_expressing_2025.pdf ↩︎
  7. https://www.thelancet.com/journals/langas/article/PIIS2468-1253%2825%2900133-5/abstract? ↩︎

What MFTs Need to Know

I just finished teaching a six-month training for Marriage and Family Therapists (MFTs) on Psychedelic-Informed Care, in collaboration with Sacramento Valley CAMFT. These trainings are needed for a simple reason: increasingly, the topic of psychedelics comes up in therapy sessions. Should I do it? Would it help? What are the risks? Can you help me think this through? This is why psychedelic-informed care for MFTs matters.

The fact is that, with a few exceptions, therapists are not trained to answer these questions. If psychedelics are discussed at all, it is usually in a psychopharmacology class as “drugs.” Very few programs address their healing potential, and even fewer teach clinicians how to work skillfully with clients who are curious about them, considering them, or trying to integrate an experience afterward.

As a result, many MFTs are clinically, ethically, and legally underprepared. We may feel curious, nervous, excited, skeptical, or unsure. And yet, the client is already there. Invited or uninvited, psychedelics are finding their way into the therapy hour.

This is why MFTs need to learn Psychedelic-Informed Care (PIC).

To be clear, PIC is not psychedelic-assisted therapy (PAT). PAT refers to clinical work that includes administering a psychedelic substance within a legal, medical, or research structure.

Psychedelics may also come up through underground ceremonies, psychedelic tourism, ketamine clinics, religious practice, or solo use. Regardless of where the client’s interest originates, PIC provides licensed clinicians with tools to discuss, educate, reduce harm, clarify motivation and risk, and support integration, while respecting self-determination and avoiding the encouragement of illegal behavior.

In brief, PIC helps therapists help clients think clearly, make informed decisions, and integrate psychedelic experiences while remaining ethically and legally grounded.

Base Camp, Not Sherpa 1

A useful metaphor for the MFT’s role is that of the Sherpa and the base camp. The Sherpa helps the client climb the mountain. That is not our role. Our job is not to dose, source, guide, or facilitate the psychedelic session. We are base camp: a stable place where clients can prepare thoughtfully, assess risk honestly, and return when the experience needs integration, or if something goes wrong.

This is not a small role. Clients do not need us to be enthusiastic cheerleaders or frightened gatekeepers. An acronym I developed to explain this is that PIC therapists listen to WCIG. We must be:

  • Warm enough that clients tell the truth.
  • Curious enough not to impose our agenda.
  • Informed enough not to minimize risk.
  • Grounded enough not to cross legal or ethical boundaries.

Some questions clients often ask:

“Should I Do It?”

When a client asks whether they should use a psychedelic, the temptation is to answer too quickly. But underneath one question, there are often deeper ones: Can you help me? Will you reject me? Can you hold my uncertainty? Aware of the power differential, we must be careful not to lead the client in either direction. Instead, we can welcome the conversation without judgment and help them explore their assumptions, alternatives, motivations, and risks.

“What Are the Risks?”

MFTs do not need to become physicians, pharmacologists, or attorneys to be helpful. Still, we need enough literacy to know when something may be risky and when to consult or refer. Clinician and educator Kristina Hunter offers a useful concept here: the three mirrors: body, mind, and life context.

  • The body: medical issues, medications, substance interactions, cardiac concerns, pregnancy, neurological factors.
  • The mind: history of psychosis, mania, severe dissociation, suicidality, or current crisis. Is the client sufficiently resourced to handle intense material?
  • The life context: housing stability, relational support, time to recover. Or isolation, impulsivity, secrecy, and the hope that one experience will fix everything.

We should not medically clear clients or encourage use, even if we think it might help. We are helping them think more honestly and, when warranted, inviting them to discuss medical concerns with a qualified professional. And although we should not tell clients what to do, it is part of our duty of care to name our clinical concerns.

“Can You Assist Me?”

A client may ask for our involvement in many ways: “I’d feel safer if you were there.” “Can you talk to the underground guide?” “Can you help me figure out how much to take?” These requests may express attachment needs, fear, hope, or trust and should be explored rather than dismissed. But they also require boundaries.

We must clearly separate preparation and harm reduction, exploring intention, expectations, support systems, and aftercare, from facilitation, dose coaching, procurement, or participation in an unregulated session. The latter falls outside our role and can move dangerously close to ethical and legal transgressions. Being clear about this protects the client, the therapist, and the profession.

The Morning After

Clients may show up the following week and report that they used psychedelics over the weekend and now want, or desperately need, to process the experience. When things go well, they return inspired, tender, and full of insights to propel therapy forward. Other times they return confused, inflated, ashamed, or dysregulated. “I saw God.” “I think I remembered a trauma.” “I haven’t slept for two days.”

Integration is not about forcing the experience into a neat clinical interpretation. It is the slow, vital process of helping raw experience become embodied, relational, and livable, turning psychedelic states into psychological traits.

Sometimes this means supporting meaning-making. Other times, it means grounding or assessing whether consultation, psychiatric evaluation, or medical intervention is required. This is not always easy. Separating a spiritual emergency from a psychotic break requires real care and expertise. Psychedelics do not exempt us from ordinary duty-of-care responsibilities. Safety always comes first. Do not hesitate to reach out for support when needed.

Why PIC Matters for MFTs

MFTs understand relationships, systems, attachment, trauma, and the complicated ways people change and resist change. Psychedelic experiences may open doors, but clients still have to walk through them in real life, with partners, children, parents, and responsibilities.

Every therapist working in this area should be able to say clearly what they do and do not do. Our role is to provide PIC, not PAT: to help clients explore motivations, risks, expectations, meaning, and integration, while avoiding providing, recommending, sourcing, or facilitating psychedelic use.

The psychedelic landscape is changing quickly. Laws differ by jurisdiction, research findings keep emerging, and public enthusiasm often outpaces regulation and training. We need more than opinions. We need ethical steadiness, clinical humility, and a robust consultation network. Part of our role is to help clients separate hype from reality.

As I have said elsewhere, even for experienced guides, psychedelics are terra incognita. Old maps used to warn us that there may be dragons out there. Psychedelics can be powerful, healing, destabilizing, and sacred, sometimes all at once. We need to be prepared.

Psychedelics do not make therapy irrelevant or outdated. They can amplify our impact on a client’s healing process. Our training gives us a reliable compass to keep clients safe within ethical and legal boundaries, helping them think, prepare, integrate, and stay connected to themselves and their relationships. By maintaining solid boundaries, we can support the client’s journey without losing our own way.

I offer talks, workshops, and consultation for MFTs, clinicians, and organizations navigating Psychedelic-Informed Care, integration, ethics, boundaries, and clinical risk.

Speaking / Workshop Inquiry
Follow the Psychedelic Series

  1. A note on language: Sherpa refers both to an Indigenous Himalayan ethnic group and, in common usage, to a profession associated with high-altitude mountain guidance. I use the term here in the latter way, with respect and awareness of both meanings. ↩︎

A therapist’s guide to responding without panic, shame, or avoidance

In previous articles, I have written about how AI is being used in connection with therapy, why it should not replace psychotherapy, and where it can safely support the work. Here I want to speak to therapists who are already feeling the presence of AI in their offices. You can find the full series here: AI and Psychotherapy.

Clients are asking chatbots about relationships, symptoms, dreams, diagnoses, attachment patterns, and what they should do about all kinds of personal situations. Some of this may be useful. Some of it may be risky. Most of it is worth talking about.

Professional organizations are trying to catch up. The APA, CAMFT, BACP, and even the WHO have all issued warnings, guidance, or ethics updates. As valuable as that is, warnings do not help us know what to do when a client says, “ChatGPT told me to…” So, what can we do when AI enters the therapy room?

Do not criticize or lecture. Be curious instead.

If clients feel judged, they may simply stop telling us (or stop therapy altogether). Many people are turning to AI because it is available, inexpensive, fast, and seemingly nonjudgmental. Some are lonely. Some are trying to make sense of their pain at 2 a.m. Some may not be able to afford more therapy. From the client’s perspective, it makes sense. Curiosity helps us understand the function of a behavior before we decide what to do about it.

Ask better questions.

Why are they using it? Do they feel heard by it? Is there a rupture in the therapeutic relationship? Is there something they told AI that they have not told us? These are not nosy, but clinical questions. Psychotherapy is not a polite endeavor. Everything is available for exploration. Is AI functioning as a journal? A rehearsal partner? A reassurance machine? A surrogate relationship? An alternate therapist? Depending on the role it is playing, we can begin to consider appropriate clinical interventions.

Bring AI into the room. It is already here anyway.

Why is the client choosing AI instead of the therapist or another supportive relationship? What felt easier to tell a machine than a person? Is the client outsourcing agency to it? If so, is this part of a familiar pattern? All is grist for the mill.

AI-generated material should not be treated as objective truth. Even when it feels empathic or accurate, it is still a complex probabilistic system producing a plausible response based on patterns. Yet it can be treated as material, the same way a dream, a journal entry, or a relational enactment would be. If the response resonates with the client, it can reveal something about their longings, fears, defenses, and assumptions.

Avoid the temptation to compete with AI at the information level. There is no way you can win. Just as you hopefully would not compete with information a client got from a self-help book, your role is to remain grounded, curious, and open. You can offer something the machine cannot: a real human connection. That is where the healing power of therapy lies.

Watch for red flags.

Not every use of AI is dangerous. Still, some uses deserve concern. Pay attention when a client is using AI as their main emotional support, especially during crisis, intense loneliness, paranoia, suicidal thinking, substance relapse risk, or loss of reality testing. Also, be attentive to use that increases isolation, replaces difficult conversations, reinforces a fixed narrative, or becomes a secret part of the client’s life. It is okay to express concern (not disapproval) in these cases. It is part of our duty to care.

Another red flag is certainty. AI can sound confident even when it is hallucinating. It can validate or intensify a client’s interpretation without understanding the larger clinical picture. As Carl Rogers used to say, the client often talks about the thing next to the thing. AI may miss what is not being said.

A useful response might be: “Let’s slow down. What feels true about this? What might be missing? What would happen if we did not treat this as the final word?”

There is room for education.

Clients need to understand that AI is not confidential in the way therapy is. Sharing deeply personal material with a chatbot means sharing it with an external technology platform, not with a licensed professional bound by clinical and legal duties.

For therapists, the bar is even higher. When therapists use AI in clinical work, we need to think carefully about informed consent, confidentiality, documentation, vendor policies, legal compliance, and whether identifying client information is being exposed. The basic principle is simple: do not let technological convenience outrun clinical responsibility.

We should also keep reminding clients, and ourselves, that AI does not understand in the human sense. It has never been on a date. It has no children, dreams, fears, body, or even an ego.

The therapist’s role

It is unlikely that AI will stop entering the therapeutic ecosystem. The therapist’s role is neither to panic nor to ignore it, but to help clients use discernment. We can ask better questions, notice when AI is helpful or potentially harmful, and, as with everything else, talk about it.

The task is not to become anti-AI or dazzled by AI, but to remain deeply human when, invited or uninvited, it shows up in the therapy room.

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Want a grounded conversation about AI and psychotherapy for your group? I offer talks, workshops, and consultations for clinicians, organizations, and training programs navigating the ethical and relational implications of AI in therapy. Contact me to keep the conversation going.

How to create a virtuous cycle instead of replacing human care

In previous articles, I have argued that AI should not replace psychotherapy because the relationship itself is healing. You can find the full series here: AI and Psychotherapy.

However, since people are already using AI around therapy, how should we use it?

AI can support preparation, reflection, psychoeducation, and integration. AI can also help you gather information and organize your thoughts, leaving therapy sessions for exploration, connection, introspection, and growth. It becomes risky when it replaces the human relationship, when we ask for its opinions as if it were human, or when it becomes the main source of emotional support, mirroring, and feedback.

Needs context, but be careful what you share

AI only knows what you give it, what it may remember depending on the platform settings, and what may be publicly available. It knows nothing about your life, your relationships, or your inner world unless you tell it. Remember, it does not have an inner life like yours.

So, if you ask, “What have I been avoiding this week?” AI will not be able to answer meaningfully unless you first give it enough information. And if you choose to give it that information, use discretion. Avoid names, addresses, identifying details, or anything you would not want stored or processed by an external technology system. Instead of writing every detail, keep it general. That is usually enough.

Remember that psychotherapists are bound ethically and legally by confidentiality. AI is not. Before sharing personal information, remember that even when advertised as therapy, AI is not, and cannot be confidential in the way therapy is.

Use AI to prepare, not decide

Often people arrive to therapy with a vague sense that something is wrong, but they are not sure how to say it. AI can help you sort through your thoughts before a session.

The key is to give it context and ask it to stay tentative. This is important because AI can sound absolutely certain about what it is saying, even while hallucinating.

For example: “I’m preparing for therapy. This week I felt angry after a conversation with a family member, then guilty for feeling angry. I don’t need advice. Help me identify possible themes or questions I might bring to my therapist. Please keep it tentative.”

This is very different from asking, “What is wrong with me?” or “What should I do?” Do not give AI authority over your decisions.

Allow me to insist on this obvious but easy-to-forget point: AI is not human and does not “know” you. It remembers what you have told it and is brilliant at autocompleting, but it lacks a human perspective and personal experience to compare against. We may say that it is “book-smart,” but lacks hard-earned life experience.

As tempting as it may be, do not relinquish the responsibility and privilege of choosing your life to any person or machine.

Use AI to reflect

A lot can happen in and between therapy sessions. Sometimes you leave with a phrase, image, or realization that feels important and deserves further investigation. AI can help you remember and organize what is emerging.

You might write: “In my last therapy session, we talked about my tendency to avoid conflict. I noticed it again today when I didn’t speak up. Help me reflect on this pattern without turning it into harsh self-criticism.” Or: “Find me information about setting boundaries and speaking up.”

That kind of use can support the work. It helps you stay connected to the process between sessions and deepen it.

Notice that these reflections lead back to therapy, not away from it. If AI gives you something useful, strange, overly certain, or emotionally intense, bring it to therapy. Even, and perhaps especially, when it says something that feels totally right, remember AI’s tendency to agree and flatter. Bring it back to therapy. Use it to strengthen your sessions and deepen your insights.

Use AI for integration

Integration means taking something meaningful and making it part of your life. It is not uncommon to have an “aha!” moment in therapy, only to forget it a few days later.

After a session, AI can help you turn an insight into a small, realistic next step.

For example: “In therapy I realized I often say yes when I mean no. Help me draft three gentle ways to say no that still sound like me.”

This is where AI can be useful. It can offer language, structure, and rehearsal. It can help you prepare for the real conversation.

But real change happens when you have the real conversation in the real world.

A clear boundary

Do not rely on AI as your main support if you are in crisis, feeling unsafe, losing touch with reality, or becoming increasingly isolated.

Ask yourself: Is using AI helping me become more honest, connected, and alive, or am I using it to avoid or replace people?

We need people. You matter. Let your voice be heard by others.

Takeaways

  • Use AI to prepare for and deepen therapy, not to replace it.
  • Use it to organize your thoughts, not to outsource your truth.
  • Use it to gain clarity, not to avoid a conversation.
  • AI can help you prepare for the room. But it should not replace what happens in the room.

And if you are not in therapy, or you have been using AI tools to deal with something heavy, painful, old, or difficult to hold alone, consider therapy. Reach out, you don’t have to do this alone.

The Potential Space

This is part of why I developed The Potential Space.

It is not therapy. It is not crisis care. It is not a replacement for human relationships.

The Potential Space is a bounded AI companion designed to support reflection, psychoeducation, preparation, and integration alongside therapy and life. It is not therapy, not crisis care, and not a replacement for human relationships. You can check it out here.

How therapy can help us face uncertainty, grief, and meaninglessness.

In Before IT Hits the Fan… I wrote about how, as a therapist, I hear a version of the question that gives this article its title at least once a week; depending on what is going on, often many times per day.

Things Look Disheartening

We are living through what has been called a polycrisis: multiple crises that interact with and amplify one another. But you don’t need me to tell you that. Almost every conversation, if long enough, turns to politics, money, isolation, or the environment. Let’s face it: things look disheartening.

It is easy to lose hope when everything around us reminds us how bad things are. Crises breed helplessness, numbness, panic, and fatalism. It is tempting to disconnect through mindless scrolling, or to convince ourselves we must keep watching the news to stay informed. Cynicism and despair can feel almost rational when it seems there is nothing we can do.

Yet here we are. Do I wish things were different? Absolutely. I worry about my young daughters. I feel sad thinking they may inherit a worse world than the one I grew up in. So when clients, quietly or explicitly, ask me whether humanity will make it, my honest answer is that I don’t know.

This is not the first time things have looked grim. I find it hard to imagine how our predecessors endured wars, invasions, and upheavals throughout the ages. As a Mexican, I have tried to grasp how Native Americans must have felt when settlers and conquistadores shattered their cultures, or how European Jews must have felt during the Second World War. This is no consolation, but things have been worse1.

The Question Beneath the Question

And still, it is hard to make existential sense of any of it. When a client looks me square in the eye and asks, “What is the point?” I understand why Camus thought life was absurd. Is there a plan? Is this some god’s test? Karma? An illusion? Does humanity deserve it? Are we doomed to follow the dinosaurs as just another curiosity in the history of this planet? Again, I don’t know.

Fortunately, as a therapist, my job is not to reassure clients or provide neat answers, but to witness and accompany them on their life path. Therapy does not solve the polycrisis, but I deeply believe it serves a purpose. This is not me justifying my profession, but trying to understand how I, and all of us in the helping professions, can help from our trench.

How can therapy help?

How can meeting privately with another person possibly help? For one, nobody should suffer alone. Crises heighten isolation and powerlessness. We may ask: Am I the only one seeing this? What can one person possibly do? It is easier to fall prey to doomsday news and despair in isolation.

Therapy offers a place to grieve together. A place to regain dignity, lucidity, and perspective; to figure out what matters and how to proceed. It offers a potential space to stay present in the face of doubt and to wonder what life is asking of us now. It also offers the possibility of reclaiming agency and deciding how to act, how to relate, and what not to become. Despair deepens when we become spectators instead of agents.

A Different Kind of Hope

It is also a place to rekindle hope. Not the naïve hope that everything will be okay. History provides no guarantees. Mature hope is a choice (Macy). The decision to keep going without surrendering is already a victory. As Václav Havel suggested, hope is not the conviction that things will turn out well; it is the conviction that something makes sense, regardless of how it turns out.

Not Becoming Cynical

When, in therapy, we face anxiety, adversity, despair, and meaninglessness together, we claim the “courage to be” (Tillich). In the presence of another person, the client confronts fear and desolation. This can revitalize us and keep us from becoming insensitive. We may not be able to save the world, but we can prevent our souls from becoming cynical, cruel, or inert.

Furthermore, as Jung suggested, evil flourishes when humans repress their shadow. The unconscious person is easy prey to fear, hatred, and mass ideology. In therapy, we stay present instead of avoiding reality; we metabolize grief, rage, and fear. Only then can we move from protection or paralysis into action.

It is in relationship that we remember we hurt because we belong. With that clarity, we can decide how to proceed, how we choose to show up in times of crisis, and how to uphold our values and the dignity of life.

When therapist and client courageously affirm life in the face of suffering and uncertainty, we connect with a deeper dimension of identity within us that is more spacious than fear. We remember that we are more than a frightened, skin-encapsulated ego.

Facing Uncertainty Together

So, are we gonna make it? I still don’t know. I hope we will. In the meantime, let’s walk together, meet our pain, find meaning amid the meaningless, and trust, not in a Pollyannaish way, but, as Tolkien suggested, with the clarity that we have the opportunity, and perhaps the obligation, to decide who we choose to be in the time given us.

Facing uncertainty with support

If you are moving through some version of this yourself, you are welcome to reach out. Therapy can help you stay grounded and make meaning. We don’t have to face it alone.

Book a Free 15-Min Call or Contact Sergio

Related reading: Why the Relationship Heals

  1. We must remember that how we experience crises is relative to our level of privilege. Even if we are all going through this polycrisis, there are significant differences between how each group is being affected by it. Those differences matter. ↩︎

…and when to reach out for human support.

So far, I’ve written warnings about the dangers of replacing humans with artificial relationships. The Center for Humane Technology and the AI Psychological Harms Research Coalition have been warning about “attachment hacking” (more on that in a future article). The American Psychological Association has also published recent health advice on AI chatbots.

Although this is still a new phenomenon, I am beginning to see its negative impact. People seem to be forgetting how to relate, empathize, and navigate disagreement. These are skills that AI cannot teach. We need other humans to relate to and, from time to time, bump heads with.

Just as we were not able to accurately measure the impact of social media and its algorithms on society in real time, right now, it is hard to measure the harms of AI “attachment hacking,” especially for children and adolescents. So let me say it again without ambiguity. AI can support mental health, but it should not replace human connection.

Having made that clear, I also believe that when used judiciously, AI can be a valuable tool. So the question is not “Is AI good or bad?” A better question is: When might AI support psychological growth, and when does it quietly pull people away from the very thing they need?

Where AI can be genuinely helpful

In my experience, AI can help when the task is primarily about information, clarity, language, and structure. Psychoeducation, journaling prompts, basic skills coaching (similar to a self-help book), preparing for therapy, and integration after therapy.

This matters. It can reduce confusion and help people arrive at therapy with more clarity. Sometimes it can even deepen therapy by freeing time for the relational work that cannot be rushed. Quite often, my clients bring to sessions insights gained from using AI. Tangentially, that is precisely why I developed “The Potential Space”.

To put it briefly, AI can support reflection when a deep human connection is not essential.

Where AI becomes risky

AI becomes risky when it is used as a stand-in for relationships and for anything involving relatedness, discussion, opinions, humor, disagreement, care, and ethical and moral guidance. Basically, anywhere human support or interaction is needed.

The human brain is predisposed to attribute intention and agency to non-human entities. That is why we talk to our computer or car even when we know they are machines. With a car, since it does not reply, we do not get pulled in. AI does reply, and it uses first-person language. This is often called computational self-reference or as-if agency.  Of course, this may simply be a syntactic tool to reduce cognitive friction (make communication easier). The problem is that the human brain, evolutionarily designed to predict the mental states and future behaviors of “others,” has a hard time separating the machine from the illusion of consciousness, and ends up relating to it as if it were a someone.

This becomes most dangerous when judgment is impaired due to age or circumstances, such as when someone is in crisis or severely overwhelmed, losing touch with reality, triggered by past trauma, afraid, etc. It also becomes risky when the stakes are high and we do not understand a topic well enough, so we are tempted to outsource decisions to someone (or in this case something) that seems better-informed than we are.

In these cases, the problem is not only that the information may be wrong. It is that AI does not carry responsibility. It does not hold duty of care. It does not know you in a lived, embodied way, and it cannot reliably make sense of what is happening in your nervous system or in the relational field between two human beings. It can be very convincing. That is part of what makes it powerful, and part of what makes it risky.

A simple “traffic light” way to think about it          

To be clear, I am not here to judge your use of AI. It is fascinating, compelling, and even seductive, particularly when someone feels lonely, overwhelmed, or afraid. Still, it carries risks. My goal is not moral judgment. It is practical discernment.

  • Green zone:
    • learning and reflection (psychoeducation, journaling prompts, values clarification, basic skills practice, preparing for therapy).
  • Yellow zone:
    • heavy emotional use late at night, repetitive reassurance-seeking, avoiding difficult conversations, using AI when highly activated, using it as main support for long periods of time.
  • Red zone:
    • crisis states, self-harm urges, severe hopelessness, relapse risk, paranoia, loss of reality-testing, domestic violence contexts, urgent medical decisions, or anything requiring immediate human care.

Likewise, it is not a good idea to use AI to meet social interaction needs, such as love, companionship, validation, care, or humor. This can feel harmless, but chatbots are designed to be agreeable and rarely challenge you. Real relationships do. That friction is part of how we learn and grow.   Relationships include attunement, pacing, co-regulation, rupture and repair, boundaries, and accountability. These are not “taught” in the way information is. They are learned through lived experience in a relationship.

How to create a virtuous cycle with therapy

If you are in therapy, use AI to support preparation, and let the human relationship support transformation. Use it to name what is happening, summarize themes from the week, generate questions to explore, or practice a conversation before having it with a real person. Pay attention if your use of AI is increasing isolation, avoidance, or dependence. Often, what we need is not more information, but contact.  Reach out.

If you have concerns about your own use of AI, or that of someone you know, or if you’d like to explore how AI can be used in helpful rather than harmful ways, please don’t hesitate to reach out. I’d be glad to help.

Why California LMFTs need psychedelic-informed care1

The relationship between psychedelics and psychotherapy has always been… complicated. In the late 50s and early 60s, LSD was distributed to mental health professionals to explore its therapeutic potential. Sandoz suspected there was something there, but couldn’t quite pin down where it fit. When Tim Leary later “discovered” psilocybin mushrooms, he framed them as psychologically significant. MAPS, from the beginning, assumed therapists would be at the bedside for MDMA experiences. With the 70s, prohibition made the relationship illegal, but it didn’t make it disappear. Many clinicians simply went underground.

Now, in the current psychedelic renaissance, while most psychedelics remain illegal, mental health professionals face a familiar dilemma: how do we support clients without stepping outside legal and ethical boundaries?

With support from CAMFT Sacramento Valley, I’m teaching a six-session series on Psychedelic-Informed Care (PIC)—how clinicians can respond when psychedelics enter the therapy room without fueling hype or reinforcing taboo. Should we lean in? Set boundaries (which ones)? Redirect? The series is designed to help you answer those questions with precision.

The topic will show up.

It arrives in many forms: questions about legality, reactions to a news story, curiosity about a ketamine clinic, plans for a retreat abroad. “Would you recommend it?” “What are the risks?” “Would microdosing help?” And, of course, the therapist’s favorite: “Is it true it’s five years of therapy in one night?” Clients are often confused, and they want orientation from someone they trust—you.

De-mystification

Right now there’s cultural noise, mixed messages, and outright misinformation. As clinicians, we don’t need to endorse or condemn. We need to help clients differentiate—between curiosity and compulsion, hope and inflation, meaningful experience and destabilizing aftermath. PIC begins with demystification: separating evidence from hype, and myth from clinical reality.

The legal landscape patchwork

Part of the surge is legal ambiguity. The picture is no longer a single, clear “no.” It’s a mixed bag: regulated access models in some places, research pathways, tightly controlled international frameworks, religious-use carve-outs, and—closer to home—local reforms and “decriminalization” language.

Even in California, where classic psychedelics remain illegal, several jurisdictions have deprioritized enforcement around entheogenic “plant medicine” (including places like San Francisco, Oakland, and Santa Cruz). But deprioritization is not legalization. It doesn’t change state or federal controlled-substance law—and it doesn’t change LMFT scope.

Why psychedelics? Why now?

The “why now” isn’t mysterious. Psychological suffering keeps rising, and so does the hunger for new solutions (especially when many mainstream antidepressants remain variations on monoamine modulation). Add promising research signals, a primed cultural zeitgeist, and media acceleration—and you get momentum.

But when a society is suffering and hungry for relief, it becomes vulnerable to shortcuts. Psychedelics, when framed as shortcuts, become especially seductive.

Potential benefits—and real risks

It’s hard to deny that psychedelic research is promising. Across trials at different stages, psychedelics have shown potential relevance for trauma-related suffering, depression and anxiety, existential distress and end-of-life fear, relational patterns, and spiritual meaning-making.

At the same time, potential benefits are not guaranteed, and they are not risk-free. Alongside positive outcomes are reports of harm: destabilization and disorientation after experiences, inflation, bypassing, aftercare gaps (no containment, no follow-up, no integration), and boundary/exploitation risks—especially in unregulated contexts.

This isn’t fear-mongering. It’s clinical realism. The psychedelic ecosystem is still maturing. Ethical failures occur. And when they do, the cleanup often lands back in traditional therapy.

So where do LMFTs stand?

Every clinician know to keep this distinction front and center: scope of practice is what California law authorizes; scope of competence is what you personally are trained to do safely.

California’s LMFT scope includes assessing and treating substance use and related mental/behavioral concerns, and explicitly includes client education, consultation, and clinical case management. But legal permission does not equal clinical readiness, and clinical readiness does not grant legal permission. In plain language: just because you can talk about psychedelics doesn’t mean you should, unless you have the training.

PAT vs. PIC (and the underground)

To stay grounded, it helps to separate three different situations:

  • Psychedelic-Assisted Therapy (PAT): administration plus a protocolized, regulated setting.
  • Psychedelic-Informed Care (PIC): what LMFTs can do ethically—discuss, educate, harm-reduce, integrate.
  • Underground work: unregulated and often illegal “guided” psychedelic work, with wide variability in competence and ethics.

Here’s the key takeaway: to remain within ethical and legal grounds, LMFTs must stay in the green zone—discussion, education, case management, referrals (for education, not sourcing) and integration—and avoid the red zone: using, offering, facilitating/administering, or coaching sourcing/dosing for illegal substances. Yes, there are yellow areas and nuance. But clarity protects clients and therapists alike.

Your stance matters

Beyond scope, not every therapist feels the same about psychedelics—and that’s okay. Within professional boundaries, there’s a spectrum of reasonable stances: cautious, curious-but-boundaried, harm-reduction oriented, or integration-focused. The goal isn’t ideological alignment. The goal is ethical, competent care.

The PIC toolkit

PIC is practical. It boils down to three skill areas:

  1. Psychoeducation (balanced, reality-based, myth-correcting)
  2. Preparation (scope-appropriate: intentions, supports, safety planning, consult triggers—without “how-to”)
  3. Integration (meaning-making, relational repair, values-to-action, stabilization)

A simple response flow helps: Discuss → Educate → Harm-reduce → Integrate. If you can remember that loop, you can respond with confidence even when the topic is charged.

And it should go without saying, but it doesn’t: documentation is your shield. When psychedelics come up, chart the discussion, state client goals, document boundaries, note risks reviewed, and record consults/referrals. That’s not bureaucracy—it’s ethical self-respect and license protection.

In closing: your license gives you a clear road to walk with clients, and a reliable compass to stay oriented—so you can support their journey without losing your way.

In future sessions, we’ll cover the state of the art (research/legal/ethics), cultural context and humility, what to do when the client brings it up, what to do when things go sideways, and—finally—a clear vision of the LMFT’s role in the psychedelic landscape.

Now you know. If you have questions or want to explore this topic further, feel free to contact me.

  1. Although many of these principles apply to all LMFTs, note that this article focuses in California law. ↩︎

Clients are bringing psychedelic questions and experiences to therapy. This six-part series gives LMFTs a clinically grounded, culturally informed approach to discussing psychedelics within scope—with tools for education, harm reduction, and integration. It is not a “how to do PAT” course. You’ll learn the current research/ethics/legal context (incl. religious-use carve-outs), cultural considerations, and concrete safeguards around risk and boundaries. Clinicians will leave with clear language for discussing benefits/risks and integration interventions.

Sessions (at a glance – click link for details):

*Please note that you have to register individually for each session

*Education and integration within LMFT scope; no sourcing or dosing guidance.

About fifteen years ago, whenever someone invited me to talk about the healing value of meditation, I would start—somewhat mischievously—by saying, “If you’re still wondering whether meditation is healing, you haven’t been paying attention. Its benefits have been proven beyond reasonable doubt.” Even with today’s ever-growing body of research pointing strongly in that direction, when it comes to psychedelics, we’re not there yet.

Psychedelics are being explored for a wide array of purposes: fibromyalgia, dementia, brain injury, Parkinson’s, ALS, Alzheimer’s, and chronic pain. More specifically in mental health (which will be our focus): anxiety, PTSD, depression, anorexia, alcohol and substance use, eating disorders, OCD, bipolar II, smoking, and existential distress. Researchers clearly suspect that these substances hold significant potential across many conditions1.

Not “what”, But “How”.

Although “What can psychedelics heal?” is an important question, there’s another one that’s not asked as often: How do they heal?

Of course, a neuroscientist could answer that psychedelics temporarily loosen rigid brain networks and boost neural plasticity by binding to serotonin receptors—creating a window to reconfigure entrenched pathways into new, more adaptive patterns.

However, I am not a neuroscientist, and I am not sure how many of my readers are, so let’s take a different route.  If we look beyond the brain into current research and what I’ve observed with clients, growing evidence shows that psychedelics and psychotherapy heal through the same core mechanisms—the difference being intensity, not kind. Integrated wisely, each strengthens and completes the other. Let’s unpack it:

Beyond neuropsychological explanations, there are several theories that try to explain the mechanisms involved in psychedelic healing:

  • Set & setting: Mindset, expectations, the quality of the relationship, and the surrounding environment shape and enhance the healing potential of the experience.
  • Network reset: Psychedelics disrupt entrenched neural patterns—and the fixed beliefs they sustain—promoting neural flexibility and the restructuring of pathways.
  • Receptivity: Heightened openness and reduced defensiveness allow for deep exploration, insight, and the learning and retention of new ways of being.
  • Cognitive updating: By widening perspective, old organizing principles are revised into more adaptive meanings, greater agency, and healthier narratives.
  • Emotional release/catharsis: By relaxing the brain’s control systems within a safe relational container, traumatic memories, repressed emotions, and somatic tension trapped in the body can surface, to be completed or reconfigured in an improved emotional context.
  • Mystical insight and self-transcendence: The sense of self expands beyond the wounded ego, merging or identifying with a larger Self or Cosmos, offering a broader perspective and reducing existential fear.

While painted with broad strokes, these ideas form the backbone of how many researchers now understand psychedelic healing.

So, there you have it. That’s how they heal. Now we know… or do we?

Let’s explore it a bit longer. These theories are elegant and plausible, but much of the research is still young. Serious scientific study has only recently resumed, and since the only way to know what’s happening inside someone’s mind is to ask them, researchers usually rely on questionnaires and interviews to access participants’ inner worlds.

Let’s try another approach. Since we already know that psychotherapy works (trust me on that, okay?2), let’s explore how it brings about change and see if we can find some parallels.

How Therapy Works

Even before Freud, this question has been heatedly debated3.  Although we don’t have a definitive answer, decades of research have produced a set of “common factors” that play a part in healing4:

  • A reasonable expectation that therapy, through specific methods, will actually work.
  • A meaningful, safe relationship where the client feels seen, accepted, and understood.
  • The facing, correction, and integration of painful or unresolved emotional experiences, often—but not necessarily- linked to childhood.
  • Insight, meaning-making, and the creation of new personal narratives.
  • Updating of rigid beliefs and practicing new behaviors and ways of thinking.
  • Development of accountability, agency, and self-efficacy.
  • Desidentification beyond limiting self-stories and an expansion of the sense of self.

Although the language differs, it’s easy to spot the parallels. Both emphasize the importance of the relationship (part of the setting), the value of positive expectations (part of the mindset), and the opportunity to face and correct painful past experiences, often through emotional release. Both emphasize insights, updated beliefs, the chance to create new narratives, try new behaviors, expand perspectives, and reclaim agency.

It seems that what helps people change in therapy may be the very same processes at work in psychedelic healing. This would also explain the popular meme that psychedelics are like three (or five, or even ten) years of therapy in one night. But if that were true, why would anyone choose psychotherapy at all?

Old Habits Die Hard

Good question. First, psychedelics are still illegal in most of the world. But even setting legality aside, this isn’t really about choosing one over the other—it’s about understanding their respective strengths and limitations.

The “three years in one night” meme captures only part of the truth. There’s more to it. Over decades, psychotherapists have learned that change is hard. We cling to old—even painful—ways of being. Old beliefs, like habits, die hard.

Psychedelics are intriguing because they seem to produce immediate results. I often hear a version of the meme. This may stem from heightened receptivity, intense emotional release, and powerful, luminous insights—often mystical in nature—that appear to open a broad window of neural plasticity. Psychotherapy, on the other hand, relies on slow, repeated emotional nudges and controlled exposure to unresolved issues. Growth is painstakingly slow and cannot be rushed. It takes time to develop a strong relationship where a person feels safe enough to challenge old patterns and belief systems. Insights must be practiced repeatedly before they become part of who we are.

Therapy, through weekly sessions and the continual revisiting of core themes, consolidates and deepens this process. This slow phase is often frowned upon in a society where “faster” is assumed to mean “better”.

It is misleading to say that psychedelics work faster than psychotherapy. Yes, the openness, catharsis, and insights feel dramatic when compared with regular therapy, but those transient and extraordinary psychedelic states need to be converted into enduring psychological traits. In other words, experience shows that to ensure the jewels gathered in psychedelic sessions aren’t lost, we must develop the necessary structures to help them take root in our lives. This is why, like other experts in the field, I emphasize the importance of preparation and integration as absolutely essential parts of any healing psychedelic process.

Complementary, Not Better

So, how do psychedelics heal? As I explain to my clients, this is not an either/or dilemma but a both/and integration. The change mechanisms of psychotherapy and psychedelics alike foster openness, enhance plasticity, reduce reactivity, facilitate insight, help complete unfinished emotional business, generate new narratives, strengthen agency and responsibility, and expand—or decenter—the sense of self.

Both rely on the same healing principles: psychedelics amplify; psychotherapy stabilizes. Together, they create a more complete path to transformation.

Beyond Psychology

Before ending, it’s worth remembering that it is in the modern West that psychedelics are seen almost exclusively as therapeutic tools, as “psychedelic-assisted therapy”. In contrast, shamanic traditions, which have worked with sacred plants for millennia, the concept of healing includes and transcends the psychological. There, psychedelics are seen as wise teachers in the broadest sense of the word. In my work, I try to honor both approaches.

The West could learn much from these ancient traditions—if only we approach them with respect and humility, but that is a topic for another article…

  1. You’ve probably guessed from the title that this article is ambitious, thus a bit longer than others. Please note that every claim is backed by scientific research, but to avoid making it even longer, I’ve left out the references. If you’re curious, just reach out — I’ll be glad to oblige. ↩︎
  2. Many may question this assertion; however, there is solid evidence that the average therapy client ends up doing better than about 75% of comparable people who receive no treatment. See https://pubmed.ncbi.nlm.nih.gov/921048/ ↩︎
  3. Making the unconscious conscious, reworking old relationship patterns, strengthening the ego, through a corrective emotional experience, catharsis, replacing unhealthy beliefs, taking responsibility, bringing closure to unfinished emotional business, self-transcending egoic patterns, etc. All of these have been advanced as reasons why therapy heals. ↩︎
  4. Of course, beyond these, there are many other alleged factors, but these are generally agreed upon. ↩︎

Why Artificial Empathy Should Not Replace Relationships

We often hear that things are moving faster than ever. The late Joanna Macy used to say that it took us a thousand years to move from hunter-gatherers to agriculture, a hundred to move from there to industrial society, and only ten to reach the information age. It took about ten years for the personal computer and the Internet to reach mainstream use, about eight for the smartphone, and only two for AI 1.

Just 24 months ago, very few people were even aware of AI. Now, almost every week, one of my clients tells me they’ve asked ChatGPT something they might have once asked me. In fact, according to a recent Harvard Business Review article, the most common use of ChatGPT today is for therapy and emotional support 2. Should I be worried? Will AI steal therapy jobs?

Some would say yes. Anthropic’s CEO recently predicted that up to 50% of entry-level white-collar jobs could be automated within five years 3. McKinsey estimates that by 2030, AI could displace up to 800 million jobs 4.  Are psychotherapists, psychologists, and social workers among them?   Optimists argue that since AI lacks emotions, intuition, and empathy, professions that rely on these are less likely to be replaced.

“Did you just say AI doesn’t have emotions, intuition, or empathy? Have you ever asked ChatGPT or Gemini for help? If they don’t have empathy, they sure fake it well.”

Agree. But let’s recall how AI works. 

Believe it or not, AI doesn’t think. It’s more like advanced autocomplete. It was trained on mountains of information and, when prompted, predicts word by word what’s most likely to come next. Its answers are patterns of probability, not insights.  However convincing it may sound, it doesn’t even understand the words it produces. When certain words tend to appear together, they are stitched together, sounding fluent and confident—even when it’s wrong.

I often remind clients that while ChatGPT is a fantastic information resource (though it’s wise to double-check—since it has no problem “hallucinating”), it has never had its heart broken or gone out on a date. Nor does it care for your feelings (since it doesn’t understand them). Its soundest “advice” is just a rehash of what’s already been said. Great for data gathering or quick answers, but not for personal decisions. Regardless of how much we wish for HAL 9000, Samantha, R2-D2, or TARS 5 to give us clarity, the truth is that each of us still has to make our own decisions.

While ChatGPT might be preferable to a bad therapist (hence the importance of finding a good one!), the relationship between client and therapist goes far beyond information. Something subtle and elusive happens in every genuine encounter. And therein lies the real blind spot—or danger—of replacing a competent human therapist with AI.

The importance of a real relationship:

Although efforts are being made to reduce it, most AI interfaces are designed to retain user attention. One way they do this is by being uncritically agreeable—basically sycophancy (who doesn’t like reassurance?), but this creates never-challenging echo chambers, and even delusional spirals—unlike real human relationships. What feels like empathy is just AI mirroring back language patterns to make us feel understood and keep us engaged.

Remember: AI doesn’t understand depression, existential angst, or loneliness. It doesn’t even understand the words you write (it turns them into numbers). This is the biggest risk of AI therapy—artificial relationships replacing real ones.

Psychological pain comes from isolation and disconnection. Attachment injuries happen between people, and trauma is relational rupture. As such, healing can only take place in the context of an authentic, reparative relationship.  Since wounding happens in relationship, healing must also occur in relationship.  

Most clients are unaware of how crucial the relationship itself is. Good therapy goes beyond giving advice or providing “tools.” Our brains are wired for connection. When we’re in contact with someone attuned to our emotional needs—through empathic resonance—our limbic system literally heals and rewires. AI can mimic that pattern but cannot truly reproduce it.

AI “therapy” is like replacing healthy food with junk food; it creates the illusion of nourishment, but it does not do the job. As the “A” in AI indicates, AI empathy is artificial.

“Of course you’d say that, you are a therapist and therefore biased.”

Probably true.  But even someone working at McDonald’s can tell the difference between healthy and unhealthy food.  

Every day I meet clients who are thoroughly “connected” yet lonely.  Among the many crises we face, loneliness ranks high, and social media and AI may be amplifying it. I am not against AI; I think it is fantastic. What concerns me is that the newer generations, surrounded by screens, may have a hard time telling the difference between genuine human relationships and artificial interactions with machines.  They may not know what they’re missing!

It may take generations to fully grasp the potential damage that human relational deprivation can cause.  Plastic empathy may not offer the same neuronal benefits.  Hopefully, we’ll be wise enough to use AI as the powerful tool it is—without letting it replace our shared humanity.  Let us not forget what Martin Buber suggested: when two people genuinely meet, God is the space between them.

But maybe it is just a matter of time… Let’s talk about it.

  1. https://ourworldindata.org/ ↩︎
  2. https://hbr.org/2025/04/how-people-are-really-using-gen-ai-in-2025 ↩︎
  3. https://www.forbes.com/sites/kolawolesamueladebayo/2025/06/04/will-ai-really-take-your-job-experts-reveal-the-true-outlook-today/ ↩︎
  4. https://www.iotforall.com/impact-of-artificial-intelligence-job-losses ↩︎
  5. Some of Hollywood’s almost omniscient and relatable computers. ↩︎

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