Artificial Intelligence and Therapy
by Toni Aswegan, LMHC, NCC, ACS
When it comes to Artificial Intelligence (AI), I’m the kind of person who wants to bury my head in the sand and pretend like it’s not happening. I tend to be like this with lots of new technology. When smartphones started to be a thing, I distinctly remember saying “I don’t need this! Why do I need to check my email all the time?!”
Well, we all know how THAT played out…
Technology innovations are happening, and will continue to happen, whether we like it or not.
As a therapist, I find AI to be particularly interesting (for lack of a better single word). There are parts of me that are excited about it (which I’ll talk about more below), and parts of me that are absolutely terrified about it (which I’ll also talk more about in this post). Somewhere in the middle is reality.
What I do know is that face to face connection cannot be replaced, and no one (I hope…) wants to replace that. I also know that mental health therapy can be hard to access, and AI might be a useful tool to break down some of the barriers to mental health and well-being.
So, I’m practicing taking my head out of the sand and thinking about what AI could mean for therapy in general, for clients, and for therapists.
Let’s start with a few disclaimers.
AI is NOT A REPLACEMENT FOR THERAPY. It is a tool that can be used to support therapy, but is not a substitute.
Another disclaimer: AI does not honor privacy and confidentiality.
Another disclaimer: AI can be full of misinformation, and often can be straight up WRONG about things. Always use critical thinking when using AI for any purpose, and especially if you’re using it for mental health support. It’s good to let your therapist know if and how you’re using AI in addition to therapy, so you can both talk about it, correct any misconceptions, add nuance, and continue to use the tool in effective ways outside of sessions!
But how can AI be helpful??
For those seeking mental health resources and support, AI can provide:
1) Psychoeducation
AI can be used to learn about diagnoses, coping skills, boundaries, nervous system regulation, and more. This knowledge can be discussed with a therapist and enhanced or dug into further between sessions.
Again, you want to be sure to check accuracy on facts with AI.
2) Journaling and continued reflection
AI can provide some excellent journal prompts to build on what you’re already exploring in therapy.
AI can help you practice CBT thought records by helping you reframe automatic negative thoughts (although, as a therapist, I do recommend that you try coming up with your own reframes first so that you can build this skill to be more portable!)
AI might be able to help you summarize or distill what you’re learning and applying in therapy, so that you can bring that to your next session and build on it!
3) Coping skills
AI can provide an opportunity to learn and review coping skills that you’re practicing in therapy.
AI can also support you in scripting out difficult conversations (setting boundaries, how to bring up something touchy with a friend, and more). I know this is a way that I’ve used AI and find it to be really helpful! It can get you started with a basic first draft that you can build on to sound more like you and what you specifically want to say.
Okay, now let’s talk about cool ways therapists can use AI. I’m not going to talk about this too much because unless you’re a therapist, you might not care too much about this, but, it’s interesting! AI can be used by therapists to gather psychoeducational information, develop exercises to use with clients, get ideas for treatment plans and notes (although a HUGE caveat here is that therapists CANNOT enter protected health information, that is, specific information about a client, into AI software—that is a clear HIPAA violation unless the AI software you’re using is HIPAA compliant and you have a BAA), writing policies, and even creating content for marketing.
Lemme take this chance to say hey, hi, hello, I’m a person writing this article! The fact that this is a thing that needs saying on the internet these days still unnerves me to my core…but, I’m not here to get into my existential fears about AI! I’m just here to talk about AI and therapy…Onward!
Let’s talk about what AI CANNOT do…
1) AI cannot provide real connection and empathy.
AI is NOT A PERSON. It can sound like it’s providing empathy to you, but it can’t feel emotions or give you the real experience of empathy. One of the best parts about therapy is the process of “feeling felt” by another person. This is the essence of empathy. Someone understanding, deeply and on a visceral level, what it feels like to be in your shoes. Empathy is a massive part of how therapy can be healing, and AI is just…completely incapable of that. So, while AI can provide a ton of useful information and support, it just cannot replace the value of real human connection.
2) It cannot offer personalized and nuanced support
AI doesn’t know you. Even if you give it as much information as you can think of, it doesn’t know you as a person. It can’t read your body language or facial expressions, or interpret subtle cues that you need to slow down, or even subtler cues that you need to be challenged. AI has no intuition, because again, it’s not a person, and can’t use nuanced judgement to help you in the way that is the best fit for you.
This is where therapy is especially helpful. I know that the internet is full of mental health information, advice, and ideas, and many people pretend like reading an Instagram post about boundaries means they’ve gone to therapy and know and have integrated exactly how to apply that in all of their complicated relationships…but information on the internet is just that: information. And information or insights don’t mean anything unless you actually apply them, and applying these insights is not something AI can do with you. In a relationship with a therapist, you can actively practice relational skills. The context of the safe therapeutic relationship is a fantastic container for this!
Also, AI can sometimes collude with you. I saw something on Instagram recently where a therapist used AI (as an experiment) to see how it would respond to paranoid delusions. What the AI responded with was some version of: “you’re totally right and everything you’re doing is okay!” While we do want to validate people’s experience, it’s clear that AI cannot apply a critical lens to what we talk to it about.
3) AI cannot help you process trauma
I can’t say this one loudly enough. Trauma processing absolutely should NOT be happening with AI. This is a process that needs to happen with other humans. So much of trauma therapy is nervous system regulation, and we just cannot be regulated by computers.
Read more about types of trauma therapy and nervous system regulation.
4) AI cannot help you get through a crisis
If you are suicidal, experiencing lack of safety due to abuse or violence, self-harming or are in another sort of crisis, AI is truly NOT the place to go for support. If you’re in crisis, please call a crisis hotline, reach out to your support network, and connect with a therapist.
Suicide crisis lines: 1-800-273-8255 or text HOME to 741741
Domestic violence hotline: 800-799-7233
5) Confidentiality and ethics…
I did ask ChatGPT about this one, and here’s what it said: “Therapists work under ethical guidelines, confidentiality laws (HIPAA), and professional standards. AI lacks accountability and can’t uphold legal and ethical responsibilities.” Read that again.
AI doesn’t have professional responsibilities and is not bound by an ethics code. Therapists are bound by codes of ethics and must abide by those in order to maintain their license and ability to practice.
AI doesn’t have the same ability as a person to examine systemic or cultural influences on your mental health. It’s programmed by people, and has lots of bias built in. Now, this is true of humans as well, but at a minimum, therapists have an ethical responsibility to work on and be aware of their biases, and address how it might be impacting their work. AI has no such responsibility or mandate, and can be harmful in this way.
6) I’ll say this one again, AI cannot provide real connection and empathy.
Something you hear in therapist circles a lot is that “60% of the change in therapy is due to the therapeutic relationship” or some such variation of this statistic. I don’t know if that number is accurate anymore, but what I do know is that the relationship developed in therapy is healing in and of itself. A real person present to empathize with you, validate you, challenge you, and support you, is not something that can, or should, ever be replaced by technology.
To put it short, AI just can’t offer the depth and connection that a relationship with a therapist can. While it can be helpful as an addition to therapy for depression, anxiety, trauma, body image, and more…it just can’t replace a person.
Phew, we did it! Was I sweating the whole time writing this? You bet! But, we know that AI is here to stay, and with anything new, it’s good to be informed and think critically about how you’re going to use it. This goes for every use of AI, but especially for AI used to supplement therapy for your mental health.
If you do want to connect with a human therapist, we have therapists with openings! In person sessions are available in Queen Anne in Seattle, and virtually for clients across Washington. We serve teens aged 13 and up, adults, couples, and families. We’ve got a wide range of specialties, including: depression, anxiety, PTSD, ADHD, grief, LGBTQIA+ clients, disordered eating, body image, and more. Our Seattle based therapy team is pretty dang rad, and we take insurance (Premera, Lifewise, Kaiser, First Choice, and Molina Medicaid). We have openings and you could get in for a session within the week! Fill out our contact form here to get started with scheduling your free 20 minute consultation.