Reflection on AI Therapy
Dr. Jonathan Detrixhe
More and more people are turning to Artificial Intelligence (AI) for advice and support. Generally, I think this is a good thing. The idea that there is a supportive voice out there, at everyone’s fingertips twenty-four hours a day, is revolutionary. There could be vast improvements in universal mental health if suddenly everyone has access to an encouraging, logical interlocutor.
At the same time, I do not believe an algorithm is a replacement for in-person psychotherapy with a trained professional. If therapy is something you can afford, here are six reasons why I recommend seeing a therapist in real life:
1. Your Right to Privacy
I don’t think an online record of your deepest feelings is a good thing—for many reasons, and we can leave it at that. Also, if your human therapist is using AI to record your sessions to simplify their note-taking process, ask them not to do so. Again, your session should be private—and taking notes isn’t that hard. Consider the Heisenberg principle: observation alters the phenomenon under observation. Both you and your therapist may consciously or unconsciously censor yourselves because you know you’re being recorded. Please, the psychotherapeutic process is complicated enough; don’t add to the challenge by incorporating unnecessary, unwelcome technology.
2. The Clinical Picture Goes Beyond the Text
The most straightforward argument in favor of seeing a professional therapist is our capacity for formal psychiatric diagnosis and targeted clinical treatment. Even if algorithms are someday granted diagnostic privileges, artificial intelligence cannot look at you, hear you, fully experience you in a room. A trained clinician observes your shifting body language, your micro-expressions, and the subtext of your speech, and in this way, may uncover deeper clinical realities. For example, your shaking feet may make me investigate ADHD even if you never mentioned attentional issues. A flat affect might prompt me to ask questions about mood, even if you are reluctant to describe yourself as depressed. A patient venting about persistent anger may be trying to process severe anxiety, or vice versa. A sarcastic, belittling tone and cynical outlook may point to the history of abuse you’re not ready to discuss. An AI can only analyze the words you type; a human therapist reads the room.
3. The Necessity of Gentle Opposition
Patients are not always honest with me. Or let me put that another way: patients often engage in “impression management” to ensure I see them and their lives in a specific, favorable light. When I sense this, therapy becomes a careful process of mild suspicion and provocation to get to the truth. My sense is that the algorithms, at least at this point, are trained to take you at your word and validate you where you stand. But validation alone does not spark growth. To help you change your mind and your life, I often need to provide both validation and a gentle but pointed critique.
4. Healing Demands Time
The great thing about AI is that it is fast. But the real luxury of therapy is time. The mind of a person in therapy is like a bud: safe, sealed up tight, and resistant to growing unless the circumstances are exactly right. When I sit with you, I know that you have potential for extraordinary growth, but I can’t just pry your petals open with a quick exchange of text-prompt answers. We need time—time for a mix of empathy and encouragement, like water and sunlight—to create the circumstances for your safe expansion. The tact and timing of my interventions is essential, not because I’m trying to coddle you or avoid a confrontation, but because if I challenge you too early or in the wrong way, you’ll simply disagree. The ego is tough! You may say, “Doc, tell it to me straight,” or “Don’t spare my feelings,” but if it’s too soon, you won’t hear me. For better or worse, true psychological transformation cannot be optimized for speed.
5. The Shared Human Condition
I’ve been told, and I intimately feel, that my emotions are healing to people. It is not only what I say, but how I react to you as a fellow human being that promotes progress. Healing in therapy flows along with the cadence of nonverbal sounds, hand gestures, postural changes, shared laughter, and tears. It is the profound experience of feeling things together as people that transforms; frozen aspects of history thaw, leading you to alter your thinking, and thence your feelings and behaviors. This point also highlights the inherent limitation of AI-generated art, music, and conversation: algorithms generate their emotionally tinged replies based on access to AI/graph databases, not experience with emotion. AI can write a song but has never listened to one. There is no shared existence. AI therapy is individualized content; human therapy is mutual engagement. The courageous act of vulnerable speech and emotional expression with a fellow human being provides a relational starting point that an algorithm simply cannot replicate.
6. Arriving at Truths, Rather than Being Told
When people ask me to summarize what I do, I say I’m trying to have a full conversation. Over the course of a treatment, we want to touch on as many aspects of life as the flow of conversation and our overlapping areas of experience permit. Certainly, psychology is our subject, but philosophy may be, as well—along with religion, ethics, politics, culture, art, dreams, and fantasies. We’ll talk about the universal things that matter to us all—love, purpose, meaning, death—and the personal things that matter only to you—the incident on the subway that morning, how you decorated your bedroom growing up, your dad’s nickname for you, your favorite scene in your favorite movie. The goal of this full conversation is not only the end—the truths at which we will arrive—but the experience of getting there. We will learn about you—the lives you’ve lived, the choices you’ve made, the ways you think and feel—but not by turning to structured repositories of high-dimensional data or “semantic vector profiling.” No. We’ll learn by talking it out.
And as we explore various options in understanding your past and present, you will begin to experience more freedom in thinking about your future—which, importantly, doesn’t include me. The AI’s goal may seem to be your mental health, but really the goal is to keep you coming back. My goal is not for you to be in therapy forever; rather, I want you to learn to be your own therapist: to have that full conversation with yourself; to speak to yourself with empathy and encouragement; and to treat your mind with the respect we’ve modeled throughout our work.
To conclude, an algorithm may be able to imitate some important aspects of the therapy process by being deeply humane—kind, generous, encouraging—but it won’t be human: sometimes silly, sometimes sad, often fumbling and failing, but always striving—and feeling every bit of it. Also, though prone to “hallucination,” AI is unlikely to admit to difficulty understanding something. But this, believe it or not, is essential to good psychotherapy. As Melville wrote in Moby Dick, “My dear sir, in this world it is not so easy to settle these plain things. I have ever found your plain things to be the knottiest of all.” My overall concern about AI is that everything is plain to it, everything is understood. The fact is, I will never fully understand you, but I will try—and you will see me trying, and you will help me try—and that’s how this works.
