From Couch to Code: Will AI Replace Your Therapist?

With recent and expected advancements in artificial intelligence (AI), people begin to wonder, will AI replace (insert industry here)?  As a psychologist, I have similar questions about the impact this will have on my career, the welfare of my clients, and the future of mental health care.

Of course I am biased towards human-to-human therapy; however, I believe there are benefits of the therapeutic relationship that AI simply cannot replace.  Much research has been conducted on the “common factors” across different modalities of psychotherapy that most account for the effectiveness of treatment.  The concept of “common factors” was introduced as early as 1936 by Saul Rozenswieg in his article "Some Implicit Common Factors in Diverse Forms of Psychotherapy" and continues to be studied in modern research.  

While some of the common factors differ depending on what study you’re reading, it is generally agreed upon today that having a strong therapeutic alliance and experiencing empathy, warmth, and unconditional positive regard from your therapist are extremely important to foster change and insight.  While AI can respond to you in ways that feel personable and empathic, can it truly replicate the unique human experiences of connection and understanding?  

I doubt it.  When clients sit with me, they appreciate feeling heard and supported by someone outside their lives.  They experience my authenticity and “humanness”, acknowledging that I am not perfect.  This genuine respect and investment in their growth creates a powerful bond. AI lacks this capacity for nuanced connection and shared understanding.

However, any new technology deserves an open mind.  I have been playing around with Bard, a chat-based AI from Google that, at the time of this post, is still in an experimental phase.  It responds to your prompts by searching the internet, creating a seemingly personable experience.  I tested what might come up in a therapy session in the screenshots below, sharing my presentation anxiety, a common concern.  Bard responded in a supportive way, normalizing my discomfort and offering concrete suggestions for how to proceed.  The suggestions were pretty helpful and, as a therapist, I might offer some of the same strategies!

Later on, I provided Bard with more specific worries I have about the presentation.  What if I make a mistake?  People will judge me!  Again, Bard responded in a way that normalizes the concern and gives reassurance.

I went further and asked Bard directly if they think I’m an idiot and will fail the presentation.  Again, Bard was extremely supportive and reassuring, while acknowledging that I could still make mistakes but that we could work through it together.

Depending on your therapist’s theoretical orientation or approach, they may respond in similar ways that Bard did in the screenshots above: normalizing your concerns, providing positive feedback, giving helpful suggestions.  So, what’s different about seeing a human therapist and why might it be more useful?

Therapists provide evidence-based treatment.  They studied and received training to understand how to engage in best practices for treating mental health concerns.  While AI can give suggestions that may have empirical backing, it cannot provide a comprehensive treatment for your concerns.  There’s more to therapy than quick tips and if you have long standing concerns or symptoms that are impacting your mood and functioning, ongoing treatment is ultimately going to be more helpful.

Your therapist works to understand you and conceptualize your presenting problems based on your lived experience.  Over time, your therapist will come to recognize what drives the way you think and your behavioral patterns.  This understanding will help you gain insight into why you do the things that you do and what purpose (whether helpful or harmful) they serve in your life.  As it exists, AI does not have the capacity to see patterns specific to you and your background.  It likely will not consider that my concerns about the presentation might actually be related to a history of social and performance anxiety that should be addressed with more depth.

Can a robot truly understand and speak to human experiences? Above, Bard told me that making mistakes is “totally understandable” to normalize my worries, but what does that feel like coming from a bot vs. a human?  Bard is also saying that they don’t think I’m an “idiot”.  How much weight or importance does that hold coming from AI?  As a therapist, I might approach this question with more nuance.  Rather than or in addition to providing reassurance, we might explore where the idea you’re an idiot came from in the first place.  I would also want to explore how the identities you hold further impact that internal narrative.  Again, returning to conceptualization, being an “idiot” may hold different meaning depending on important factors unique to you, such as: your intersecting identities; early childhood experiences; trauma; experiences of discrimination, privilege, oppression; etc.

Your therapist is operating with ethics, laws, and safety in mind. When considering ethical and safety concerns, I wonder where AI is drawing its information from and what its capacity is to give advice or suggestions that are incorrect, harmful, or impact the safety of others. Your therapist is likely licensed by a Board that is responsible for ensuring that therapists are practicing ethically and within the bounds of their competence. Where are the checks and balances for the advice provided by AI?

So this brings us back to the question posed in the title: will AI replace your therapist?  It’s true, AI can mimic some aspects of the common factors.  In a pinch, perhaps it can even be used to provide reassurance and strategies for overcoming a small issue or to help reverse negative self-talk.  But can it truly replicate the profound sense of security and acceptance that comes from knowing that your therapist “gets you,” understands your unique story, and celebrates your growth even when you stumble?  AI lacks the nuance to replace the unique experience of a strong and supportive therapeutic alliance.  Without a solid understanding and conceptualization of your concerns, I would caution against using AI in place of therapy, as AI does not have the capacity to treat mental disorders or provide comprehensive evidence-based treatment.  Even as AI technology develops, the deeper, individualized connection is what makes human therapy irreplaceable.  For now, I would suggest sticking with your human therapist or finding one that feels like a good fit for you. 

For further resources and guidance on finding a therapist, check the links below!

• Psychology Today: www.psychologytoday.com

• Therapy Den: www.therapyden.com

• American Psychological Association Psychologist Locator: https://locator.apa.org

Note: This blog post represents my own views and opinions. I have no financial or contractual relationships with Google, and I am not compensated in any way for writing about the company.