mental health technology 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.

…or why AI should not replace human connection

In my earlier article Should ChatGPT Be Your Therapist?, I briefly argued against it. This article further explains my answer.

Many people turn to AI because they are lonely, overwhelmed, or afraid. That is understandable. But if AI becomes a substitute for relationships, something important is lost. Our brains are wired for connection.

Before starting, let me insist that I am not anti-AI. Quite the opposite. I am excited about the possibilities of using it as a companion to therapy (more on this below). Used wisely, it can be genuinely helpful.

Although this is not often emphasized, psychotherapy is not only about providing information. It is a relationship. Good psychotherapy may feel like a simple conversation. Still, there is a lot going on under the hood at psychological and biological levels. Our nervous systems are shaped by contact with other human beings. Our attachment style (basically, the way we relate to others) is formed by how we experienced connection in early life. Who we are is, in large part, the result of our relationships. As it is often said, our wounding happens in relationships and can only be healed in relationship. We do not change only through insight. We change through connection.¹

We need to feel safe before we can change

Evolutionarily, our nervous systems are programmed to scan for safety. This is an automatic process that occurs mostly below conscious awareness.² Tone of voice, pacing, the steadiness of a presence, and the sense that someone understands us and will stay with us without collapsing or attacking. These signals shape how we experience the world and live our lives.

When we feel anxious, shut down, ashamed, or guarded, our whole system contracts. Thinking becomes rigid. Options feel limited. Emotions feel overwhelming. Sometimes we cannot even accept help when it is available. On the other hand, when we feel safe, supported, and accepted, something changes. We relax. We open up. Feelings become tolerable. Reflection becomes possible. We see more clearly and are able to choose. The body must feel safe before the mind can be free.

What the relationship does

It offers co-regulation. Meeting a grounded therapist is not just “nice.” Their steadiness helps settle our system. Over time, we become able to reproduce that steadiness, and it becomes available inside. This is one of the quiet phenomena of good therapy. We borrow regulation until we learn to provide it for ourselves.

It offers a different experience, not just advice. Even when people come to therapy for information, they often stay for something else. The client is constantly sensing the relationship. How does the therapist relate? Are they kind, clear, steady, curious? Can they hold boundaries with care? Can they tolerate strong emotion without collapsing or attacking? Over time, this becomes a living template for how to be with oneself and with others.

It creates a space to explore without shame, guilt, or rejection. After a while, as the client continues to feel accepted by the therapist, they may begin to wonder: “If my therapist accepts me as I am, maybe I can accept myself too.” Again, this relaxes the nervous system and makes room for change. In such an environment, you can explore how you protect yourself, how you handle closeness, how shame organizes your attention, and what you believe you are allowed (or not allowed) to feel. These patterns are often automatic and live below awareness. Over time, a stable relationship helps reorganize these implicit layers and experiment with alternative ways of being. Therapy changes people through lived experience, not simply through insight.³ ⁴

It offers rupture and healthy repair. Therapists are not perfect. Sometimes your therapist does not get it. You may feel misunderstood or even rejected. Often this triggers old experiences of not being seen or accepted, and the conclusion that something is wrong with you. What to do next? Shut down? Capitulate? End the relationship? If the therapist is skillful and navigates this with care and accountability, the nervous system learns something powerful. Conflict does not have to mean abandonment. Misunderstanding does not have to mean danger. This repair, while remaining in connection, is part of how trust is built, and it is difficult to replicate without a real person who can make mistakes, take responsibility, and show up again.

At the risk of oversimplifying, the therapeutic relationship is difficult to replace because healing is not purely cognitive. It is an embodied, relational process that unfolds through attunement, emotional resonance, and real-time interaction.

What AI cannot replace (at least yet)

AI can generate language that sounds empathic. It can reflect feelings. It can offer prompts. It can help you map patterns. You may even feel understood.

But AI is not alive. It does not have a body or a brain. It does not co-regulate in the full human sense. It does not track your breathing, posture, tears, long pauses, or the subtle shifts that guide pacing in real time. Even with voice or video, something central is missing. A real nervous system is not on the other side. AI cannot truly see you, even if it sometimes sounds like it does. And your nervous system knows when something is missing.

AI also lacks accountability in the way a human therapist does. Human therapists are trained to listen not only to words, but to context, tone, and what does not fit. A good therapist does not simply agree. Even a very empathetic therapist may challenge you if something does not make sense, needs clarification or if it make it tingle their -very human- spidey sense. As one of my teachers used to say, therapy is not a polite endeavor. A caring therapist will slow down, double-check, explore hunches, and name what is being said and even name what is not being said. AI cannot feel or care in this very human way. Technically, AI does not understand words the way humans do, and it cannot sense what is implied but unspoken. This always matters, but it matters especially at the edges, when someone is destabilized, overwhelmed, in crisis, paranoid, or losing touch with reality.

There is also the problem of overconfidence and hallucinations. AI can sound certain when it is wrong. That can be harmless in low-stakes settings, harmful in emotionally vulnerable moments, and dangerous in crises. Add privacy concerns, cultural mismatch, and the risk of overdependence, and the picture becomes clearer. AI can be a tool, but it is a risky candidate for replacement.

Where AI can genuinely help

None of this means AI is useless. It means we should understand what it is good for.

AI can support reflection when deep human attunement is not essential. It can help with journaling, psychoeducation, basic skills prompts, and preparing for therapy sessions. It can help you find language for what you are experiencing. It can help you organize a question you want to bring to your therapist. It can offer structure between sessions. I will develop this in more detail in future articles.

Used wisely, AI can even deepen therapy. When it helps with basic learning or clarification, more therapy time can be devoted to what requires human presence. That is meaningful synergy.

A gentle rule of thumb

If what you need is information, conceptual clarity, journaling prompts, or help exploring something already discussed in therapy, AI may help.

If what you need involves attachment wounds, trauma healing, deep grief, relational repair, severe anxiety, existential distress, or you are facing a crisis, a human therapist is usually safer and more effective. Certain kinds of healing require contact with a real person, in real time, over time. And again, since our wounding happened in relationships, it can only be healed in a human relationship.

If you are curious, you can try “The Potential Space” an AI companion designed to support users between sessions with preparation, psychoeducation, and integration.

Lewis, T., Amini, F., & Lannon, R. A General Theory of Love. ↩︎
Porges, S. W. The Polyvagal Theory. ↩︎
Schore, A. N. The Science of the Art of Psychotherapy. ↩︎
Cozolino, L. The Neuroscience of Psychotherapy. ↩︎