AI Can Be Helpful. But It Can't Do What Happens Between Two Humans.
Can AI Replace a Therapist? A Therapist's Perspective on What Creates Real Change
As a therapist, I have a confession to make: I use AI regularly. ChatGPT specifically, although my colleagues keep telling me Claude is where it's at.
I use it to brainstorm ideas, organize my thoughts, summarize information, and occasionally help me think through a business problem from a different angle. In many ways, I think AI is remarkable. It can provide information instantly, explain complex concepts, help people reflect, and make knowledge more accessible than ever before. Recently, I've even seen people wonder aloud whether AI might eventually replace therapists altogether and honestly, it's a reasonable (albeit scary) question.
After all, AI can explain attachment styles. It can teach coping skills. It can suggest communication strategies for couples. It can provide journaling prompts and validate emotions. For many people, it is available more often, more quickly, and at a lower cost than traditional therapy.
I recently read an article in the New York Times discussing how more and more patients are using AI instead of consulting their doctors. Again, I understand why. Healthcare can be expensive, confusing, and difficult to access. AI is available at 2 a.m. when you're worried about a symptom and don't want to wait three weeks for an appointment and you want a response that is understanding, nonjudgmental and patient. Something insurance driven medicine doesn’t always offer. I have a friend who is a renowned dermatologist in Colorado (and is also one of the most kind and smart and wonderful people I’ve ever known) and she is seriously struggling under the pressure of the 15 minute appointment that demand and insurance requires. But even as AI becomes more sophisticated, most people still recognize that there is a difference between receiving information and receiving care. I think therapy is facing a similar moment.
*Also, please, please, go to your dermatologist for an annual appointment and don’t consult AI instead*
Why Most People Don't Come to Therapy for Information
The truth is that most clients don't come to therapy because they lack information. Most people already know more than they give themselves credit for. For example, they know they should establish better boundaries, they know they should stop people-pleasing, they know they should communicate differently with their partner, they know they need more self-compassion and they know that avoiding difficult conversations isn't working.
The problem usually isn't a lack of knowledge, The problem is that knowing and changing are not the same thing.
In fact, one thing I often tell clients is that insight is necessary, but not sufficient. Insight helps us understand the problem. Change happens when we begin experiencing ourselves, our emotions, and our relationships differently in real time.
My Personal Trainer Taught Me Something Important About Therapy
A few months ago, I started taking my own exercise more seriously. After developing panic disorder and a few terrible panic attacks at the gym a few years ago, I finally felt ready to overcome my fear. I wanted to build strength, improve my cardiovascular health, and create a more sustainable exercise routine. Naturally, I turned to AI for help. It created a thoughtful workout plan, answered my questions, and helped me understand concepts like progressive overload and recovery. At the same time, I was also working with a personal trainer.
On paper, it seemed a little redundant. Both could tell me what exercises to do, both could explain proper form and both could answer questions. But very quickly, I noticed something important; My trainer was seeing things I couldn't see. During certain exercises, she noticed that I was holding my breath. She noticed tension in my body that I wasn't aware of. She could tell when my nervous system was becoming activated and when I was pushing through an exercise in a way that wasn't actually serving me. I told her my smart watch was telling me my heart rate was high but my eyes told her I was starting to panic... and she stopped me in real time and had me do a breathing exercise that immediately lowered my heart rate.
The workout plan wasn't the issue because the issue was what was happening in real time. AI couldn't see my shoulders creeping toward my ears and it couldn't hear my breathing change. It couldn't notice the subtle signs of anxiety showing up in my body. It only had access to the information I consciously provided. My trainer had access to all the information I didn't realize I was communicating.
What AI Misses: The Power of Immediacy in Therapy
That experience has stayed with me because I think therapy works much the same way. One of the most powerful tools therapists use is something called immediacy. In simple terms, immediacy means paying attention not just to the story someone is telling, but to what is happening in the room right now. For example:
A client may be talking about their marriage while fighting back tears.
A husband may insist he's not upset while his eyes dart toward his wife and he lets out a small eye roll.
A wife may say she is fine while saying it passive aggressively.
A client may tell me they are “good" while their fists are clenched tightly in their lap.
Someone may begin talking about a painful memory and then suddenly change the subject.
A client may she she is “numb” while also shedding a single tear
These moments often tell us more than the words themselves. Sometimes the most important intervention I make in a session is simply slowing down and saying, "What just happened for you right now?" or "I noticed your eyes filled with tears when you said that." Or, in couples therapy, "I noticed that look. Can we stay there for a moment?"
The breakthroughs often happen there.
They don’t happen in the advice, the handouts, the coping skill, or the explanation. They happen in the moment that someone sees and feels what is happening for them, maybe when they didn’t even notice themselves. Therapists often work with information clients don't realize they're communicating. The trembling voice, the nervous laugh, the sudden shift in posture, the tears that arrive before the words do, the eye roll that appears before resentment is acknowledged, the sitting in the furthest possible spot in the room, the touching of hands in an honest moment. These moments matter because transformation rarely happens when someone receives new information. Rather, transformation happens when someone has a new experience.
Steven Spielberg's Warning About AI and the Human Soul
Recently, Steven Spielberg was discussing artificial intelligence on Michelle Obama's podcast. He described AI as incredibly useful, but ultimately unable to replace something essential. He talked about how AI can be a tool, but that there is no substitute for the human soul. While he was talking about filmmaking, I found myself thinking about therapy.
Therapy is not simply the exchange of information. It is a human relationship, and two nervous systems sitting together (or three). It is having someone notice the thing you didn't realize you were communicating. It is being challenged when you need challenge, comforted when you need comfort, and accompanied through experiences that are often too painful to navigate alone.
Knowing and Changing Are Not the Same Thing
I suspect many therapists will use AI. Many clients will use AI. I know I will continue to, especially for handouts. AI can provide education, insight, reflection, and support…but healing has always happened in relationship. There is still something profoundly human about sitting across from another person who notices your trembling voice, your nervous laugh, your long pause, or the tears gathering in your eyes and gently asks:
"What's happening for you right now?"
That moment is difficult to automate and I hope it always will be, because knowing and changing aren’t always the same thing.