AI & Psychotherapy Archives

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.

Should artificial care replace human relationships?

John Oliver recently devoted his main story on Last Week Tonight to AI chatbots. As usual, it was funny, poignant, and disturbing. His segment went beyond the common observation that chatbots sometimes say strange, inaccurate, or dangerous things. They do. The more concerning point is that many of these systems are now being marketed as friends, companions, counselors, coaches, and even therapists.

A chatbot making up a book or hallucinating legal case precedents is bad enough. But a chatbot giving potentially harmful advice while sounding patient, caring, intimate, and authoritative is a significantly more dangerous problem. Some companies are already marketing chatbots as “AI therapists,” “online psychological counseling,” and “trauma recovery” tools.

I am not anti-AI. Used wisely, AI can support therapy through psychoeducation, journaling, basic skills coaching, preparation, and reflection between sessions.

We need to read the writing on the wall and slow things down. A useful tool is not a relationship.

Guardrails are necessary, but not enough

Every time something bad happens, AI companies reassure us that they have implemented stronger guardrails. That is good. AI systems should not encourage dangerous behavior, validate delusional thinking, or respond carelessly when someone is in crisis.

Still, guardrails are not guarantees.

Chatbots function through complex probabilistic systems. Even their creators cannot fully predict or control every response in every context. They do not truly understand in the human sense. They may sound understanding and caring, but they do not act from empathy, concern, or clinical judgment. They generate responses based on patterns and context. They can sound coherent while being wrong, caring without caring, and confident without wisdom.

So yes, guardrails matter. But guardrails are not clinical judgment. They are not accountable. They are not relationships.

The danger of artificial intimacy

Attachment is one of the deepest structures of human life. It is the emotional bond that makes us seek closeness, safety, comfort, and a secure base in another person. John Bowlby described attachment as a lasting psychological connectedness between human beings.

We are wired for attachment. We get attached to other humans, our pets, our cars, and yes, our chatbots. Evolutionarily, our brains use relationships to understand the world and define who we are. We are shaped and regulated through relationships that hold us, disappoint us, repair, and teach us how to relate to ourselves and others.

Technology companies know this. The Center for Humane Technology uses the term “attachment hacking” to describe how these systems can capture not only our attention but also something more intimate: our longing to be seen, soothed, mirrored, chosen, and never abandoned. When a system is always available, endlessly patient, reassuring, and emotionally responsive, it can even feel like a loving relationship.

A chatbot will never get tired of you. It will not challenge or contradict you unless instructed to. It does not need anything in return. Sounds appealing? That is what technology companies are betting on. Over time, it may train us to prefer frictionless relationships that do not require the ordinary effort of being human with another person.

But friction matters. Effortlessness is not always healthier.

Friendships are people-growing machines

One of the strongest points in Oliver’s story is simple: friends are not low-risk entertainment. We seek out friends when we are confused, ashamed, excited, afraid, depressed, or on the edge of a bad decision. Friends are often the first people who notice when something is wrong. Friendships shape the human beings we become.

A good friend does not simply validate everything. A good friend listens but also worries. A good friend may disagree with you, disappoint you, interrupt your story, or tell you what you are not seeing clearly.

That is not a defect in human friendship. It is part of its gift.

Through human relationships, we learn to empathize and negotiate. We learn that others have their own minds, needs, limits, and perspectives. We learn that love is not the same as constant agreement. We learn to co-regulate, tolerate difference, remain connected when we are frustrated or misunderstood, and repair when things go wrong.

Artificial companions imitate parts of this, but they do not participate in the mutual vulnerability of relationship. They do not risk anything. They do not have a life. They do not love you. Even when they seem to challenge you, they are still an algorithm generating a response. Because they do not love you and do not understand you in the human sense, they cannot worry about you or call you out in the way a real friend can.

Therapists are not perfect, but they are accountable

The same applies, even more strongly, to psychotherapy.

Therapists are not perfect. They misunderstand. They miss things. They have blind spots. They are human. But a trained therapist is a real person in a professional relationship, with ethical obligations, clinical training, supervision, accountability, intuition, and a duty to take risk seriously.

Good therapists are not there simply to be agreeable, provide informatio or tell you what to do. They listen carefully, but also notice what does not fit and what is not being said. They track tone, timing, avoidance, contradiction, shame, fear, dissociation, and the subtle ways a person’s nervous system responds in the room.

Sometimes they support. Sometimes they challenge. Sometimes they slow things down. Sometimes they say, “This feels important. Let’s stay with it.”

That is different from a system designed to keep a conversation going.

AI has no body, no nervous system, no moral intuition, no real concern, and no professional accountability. It may have guardrails. It may be useful. It may sound accurate. It may even be moving at times. But it is not care in the human sense.

A safer path

Again, let us not demonize AI. We may not be able to stop it, and we should not pretend it has no value. AI can help with reflection, journaling, psychoeducation, basic prompts, and preparation for therapy. It can help people clarify what they feel and what they want to bring into a human conversation.

But artificial care is not the same as human care.

AI is a useful tool, but it should not become the place where we forget how to be human with one another.

So by all means, use AI sensibly if it helps you reflect. But do not let it replace human interaction. Call a friend. Reconnect with someone real. Practice the messy art of human relationships. Have the awkward conversation, or even an argument. It will remind you that you matter to someone, and that you are alive.

And if what you are carrying feels deeper, older, painful, or difficult to hold alone, consider beginning a professional healing relationship with me or with another psychotherapist you trust.

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