The Doctor is In
OK, there are things about AI that scare the crap out of me, but I’ve realized I’m not afraid of it taking my job. I know that this is a real danger for millions of people and these are legitimately scary times. Sure, I can see that I am going to have to be more creative and innovative because AI is changing the landscape of my industry in many ways. I’m using AI for administrative and marketing tasks and am amazed by its capabilities. And now I see apps advertised as “AI Therapists,” the implication being that my whole profession is hurtling towards obsolescence. Venture capital is flooding into the psychology field, finding ways to use AI to reduce costs and increase profits for insurance companies and investors. It’s understandable why my feeds are filled with doom and gloom posts from therapists who are watching what is happening. But I don’t think AI will ever be able to provide the services I provide.
It’s right there in the name: Artificial Intelligence.
If there is one thing people value in a therapist, I think it is authenticity. As well as empathy, humanity, creativity, flexibility, originality, insight.
I have friends and clients who tell me about their positive therapy-like experiences with AI. When a friend woke up at 3:00 AM recently in a cold sweat with racing panic-laden thoughts, an AI prompt elicited advice that helped him calm his nervous system and ground himself. When a client decided to compose a letter to an estranged relative with an abusive temper, an AI program helped him edit his writing and refine the tone in a way that he found very helpful. Another client was facing a difficult confrontation with her boss. She described her dilemma to one of the well-known AI bots and it helped her devise an effective strategy.
Here’s what I understand about what AI can do REALLY well:
Be available at 3:00 AM when I’m asleep and have my ringer turned off.
Remember more details than any therapist (Of course—it stores everything you say in those gigantic energy devouring data centers – my human brain can’t compete with that!)
Reassure, validate, normalize in a soothing, compassionate-sounding voice (these are important basic therapist skills, and it seems that AI has gotten very good at them.)
Offer CBT and mindfulness exercises to help clients calm and ground themselves and work through problems.
Here’s where I think I have AI beat:
Research has shown that the greatest predictor of positive therapy outcomes is the quality of the therapeutic relationship. Human relationship. AI can mimic the responses of a good therapist, and it feels good to be reassured and to receive what seems like very thoughtful feedback. In fact, it’s amazing how well it can do that, up to a point …
The art of therapy goes way beyond a soothing voice and the techniques of manualized, “evidence-based” therapeutic techniques that can be taught to an LLM.
I have a nervous system
As a human therapist, I have emotional responses to material presented in session. I’m trained to tune into the physical sensations and emotions that I experience and look for meaning in them. The beauty and challenge of human relationships is that we constantly activate and co-regulate each other – our nervous systems respond to those we interact with. A good therapist is hyperaware of the moves of this dance and is always making nuanced choices to guide the client towards healing. I am affected by the client, and I continue feeling, thinking about, and processing that experience throughout the week, between appointments. I’ve learned to see my body as an instrument that responds to others and gives me cues that provide me with valuable clinical information. I can use my breath, posture and voice to help my clients regulate their emotions in session. My feelings help me understand what it might feel like to be in my client’s shoes. My life experience and humanity allow me to empathize, to feel with my client. At the same time, my training allows me to separate my “stuff” from theirs. All these processes give me information about what my client might need to feel seen and to move towards healing. Not only can I reassure and comfort a client, I can use my clinical judgement and felt sense of the dynamics in the room to determine when it will be more beneficial for me to refrain from reassuring and let the client sit with their feelings. AI cannot replicate these processes, because, as of this writing at least, computers cannot actually feel emotions.
I’m flawed
Another one of my main advantages as a human therapist is that I am, fundamentally, imperfect. Therapists say things that upset their clients. Clients say things that upset their therapists. The temperature changes in the room, sometimes silently. The way a therapist handles relational ruptures, big and small, has a huge impact on therapeutic outcomes. Successful repair strengthens the therapeutic relationship and provides a corrective emotional experience for the client. The growth that comes from having corrective emotional experiences within the therapeutic relationship eventually generalizes to the client’s life outside of therapy. The client’s sense of self shifts, confidence builds and relationships with partners, family, friends, and work colleagues improve.
I can see you
The feelings of depression and anxiety that bring many clients to therapy are often related to feelings of shame. Some part of them feels inadequate, unworthy, unlovable. Research indicates that shame is healed through relationship. Researchers and thought leaders Brene Brown and Kristin Neff have explored this extensively in their writing. The healing process involves accessing the courage to be vulnerable, sharing your shame with another human being and allowing yourself to be seen. Allowing yourself to be seen as an imperfect human being by another imperfect human being. Also allowing yourself to receive that human’s compassion, realizing that you are not alone in your suffering, and ultimately developing compassion for yourself. As a therapist, a significant part of my work is fostering an environment that feels safe enough to allow my client to take these risks. Sharing your shameful secrets with an AI bot may be a helpful first step for some, but a machine cannot replicate the experience of exposing yourself to another living breathing human being and being seen and accepted by them as you are.
I can relate
This leads me to what is perhaps my most important point. I suspect that the proliferation of AI, along with other recent technological advances and world events, may actually lead more people to non-AI therapy. I’ve noticed in recent years that an increasing number of my clients feel socially isolated and I spend more sessions exploring ways that clients can increase their sense of connection. Loneliness sits heavy in the therapy room. We spend so much time on our various devices, and the pandemic lockdowns changed our work and social life patterns. In-person experiences have been replaced by online activity and much of the social interaction we have is through screens. Even when friends, family, and partners are in the same physical spaces, screens captivate our attention and pull us away from interpersonal connection. Much has been written about the epidemic of male loneliness and the dramatic increase in teen anxiety and depression. Some clients tell me they spend endless hours messaging on dating and hookup apps but rarely manage to have in-person meetings with the people they interact with. The general fertility rate has fallen by 22% since 2007 and a recent paper by economist Caitlin K. Myers and Ezekiel Hooper offers statistics that indicate that a significant percentage of the decrease could be directly related to the introduction of the iPhone.
I’m surprised by the number of new clients who find me because they are looking for a therapist who will meet in person, even in Los Angeles, where distance and traffic can make in-person therapy inconvenient. Older clients grieve because the changes in the world have led to loss of connection and younger clients feel they have been robbed of the opportunity to learn how to make meaningful connections with others. In many cases therapy becomes a lab to experiment with interpersonal communication and practice skills that can be used to create a bigger, more fulfilling and connected life.
As AI and other forms of technology continue to infiltrate more areas of our lives, I think we will all develop a greater appreciation of the opportunity to talk things through with a caring, experienced human being whose intelligence is not artificial.