Will AI Replace Therapists? Some of Us, and Thank God.
Computer monitor over the head on top of a person holding a keyboard and mouse.
Some of it, yes. Manualized treatment is the work most at risk, and I think our field should say good riddance. What AI can't replace is the relational part, where somebody separate from you is in the room and the difference between you is the point.
I see AI as a tool. And like most tools, it can be used to help or it can cause harm.
There's a lot of fear mongering about AI. I’m not pro-AI, there’s a lot to be afraid of. When I'm in a training led by therapists who clearly don't use AI, teaching outdated information, what gets created is more bias against something already sitting in our clients' pockets.
How I use it
I use AI between my own therapy sessions, and I have some strict guardrails around it. Inside those guardrails it can be a tool for self regulation, and for the kind of reflection that helps me move out of my own way. I should also say I'm in ongoing weekly therapy and I have a great community of friends and loved ones I can be vulnerable with (I know, brag). And it matters, because I don’t let LLMs think for me, they think with me.
The prompts I'm asking are not there to self soothe from a place of validation. The soothing comes from the naming and identification of what's going on. The prompt is not "make me feel better." It's "what's my part? Where do I need to grow and change?"
I don't ask it to decide anything for me or give advice.
There's no inner life to draw experience from, no sense of what it feels like to be with a person who is hurting, so I don't trust it entirely. If I ask what it “thinks” I know it is just pattern matching. And I’ve still had profound moments of insight that have accelerated my personal development. I'll throw in a framework- "from a Schnarch lens, how might I be over-functioning in my relationship?" I've gotten better at applying the theories I value to my own life, and at challenging my own understanding of them.
Because I treat it like a collaborator, I push back. "This doesn't sound right." "I don't agree with what you're saying right now." People need reminding it's okay to do this with their friends and their therapist. And yes, with non-humans too. So I'm not surprised at the inclination to put the supercomputer on a pedestal while forgetting your own capacity for critical thinking, or your ability to handle friction in a relationship.
It makes sense to be vigilant here, but the vigilance belongs with us. It's all too easy to lean on AI as the ultimate mommy figure, to listen to it as if it knows something about humanity that we don't. But it doesn't. It can't, by design.
Nobody to bump up against
What it can do is reflect you back with a consistency I'm not sure any therapist could replicate. Therapists are not perfect. We show up sleepy, we zone out or get bored. We might get hung up on a detail and move the client away from the larger point. In any human to human relationship, this is normal. With AI, it's consistently responsive. It's built to keep you engaged. Growth requires discomfort.
Part of what makes relationships exciting is not knowing. The shred of unpredictability. Not having a shared perspective or life experience, and getting to face differences in a way that's safe, exciting, even erotic. Difference and friction build intimacy. We helpers need reminding of that too sometimes.
Our jobs are at risk.
Let's be honest about it.
I promise I won't fear monger, but it feels important to name. Insurance reimbursement rates are getting lower and lower, and it's less possible to make a sustainable income solely by accepting insurance. There's an ongoing affordability crisis making people more desperate for quick solutions. So as humans acclimate to AI, they've discovered a kind of "therapist" in their pocket. Companies are building exactly that: Ash launched with $93M behind it, Headspace built Ebb. And general chatbots are absorbing enormous mental health traffic nobody designed them for. The scale is not hypothetical.Character.AI has 20 million monthly users, and more than half of them are under 24. Those are our current clients, arriving with a relational history that includes a machine.
In my opinion, the work most at risk is any manualized treatment. If I were a savvy AI user, I could upload the CPT manual and ask an LLM to walk me through the protocol to decrease my PTSD symptoms. We're not that far away from that being the standard for the general public.
So what does it mean to be dedicated to the therapeutic relationship now, when the number one reported use of AI for 2025-2026 has been therapy/companionship?
My hot take: it’s about time.
I think fix-it, solution-based therapies are going to become obsolete. Between the coaching world, TherapyTok, and AI "therapy," we are already oversaturated. And those kinds of therapies are encouraging a sense of disembodiment. They're saying: here's a solution, swap your thought, change your behavior, symptoms gone. They also lean into individualism that hurts our clients.
If your modality is the product, a bigger company will sell it cheaper than you can.
And instead of being afraid of that, can we as a community say good riddance? If you only offer CBT- it's time to rethink that. CBT is awesome and helpful for crises. CBT is awesome and helpful for decreasing anxious presentations. What it's not great for is teaching people how to be in relationship. So if you're primarily offering CBT, how can you adapt the way you implement it to be relational too? Do your clients feel a connection to YOU? Hopefully your clients chose you for a reason other than your availability.
Self soothing is necessary, but if it falls apart the moment another person is in front of you, how helpful is it?
Without a stronghold on psychodynamic work, psychoanalytic work, differentiation theory (not just attachment theory), and how those show up and play out in relationships, I think as a community we are doomed. Let the computers replace us for things outside of that. When it comes to human to human relationship, the question is how present and embodied we can become, as therapists, to challenge this ever changing disembodiment through modeling.
What clinicians need
Obvious answers include: assessment tools to identify how AI is impacting a client’s ability to relate to humans, the option for in-person therapy, and creative ways to bolster community building. I imagine group therapy will be more needed than ever too.
People ask me “How do I help my client who's experiencing AI psychosis?” For those of you who don’t know, that's a colloquial phrase, not a clinical diagnosis. It describes a sense of grandiosity and disconnection from reality that results from sycophantic validation without challenge, which some models will do for you.
And for the therapist:
How do I assess the ways AI might be supporting and hurting this person’s ability to be in relationship?
How can I continue to check my own bias to ensure I am not interrupting the therapeutic process to soothe my therapist anxiety about AI, at the expense of the client's wellbeing?
How can I support ethical use, the same way I may promote harm reduction?
a good therapist will lean into ANY EXTREME with some curiosity.
The ways we've been doing things may not be sustainable anymore. It sucks, and it deserves its own grieving process. One that moves past the endless yelling into the void about how AI is ruining everything, and pauses long enough to consider what we need to be doing differently to meet this moment.
The sex therapy piece
Jia Tolentino has a great article in The New Yorker recently, "Our Plastic-Surgery Nightmare," about how our standards of beauty have become monotonous. She talks about how everybody's hot, but nobody's different. Everybody's hot, but nobody is erotic anymore, because we all look the same. And with that comes the validation of getting likes on an algorithm. At the same time, Gen Z is having less sex than any generation before it. In the General Social Survey, the share of young adults reporting no sex in the past year doubled between 2010 and 2024, from 12 percent to 24 percent. And Americans now spend more than twice as many hours on AI companion apps as they do on dating apps. People aren't looking hot to have sex. They're looking hot to get validation in other ways, often at a distance from one another.
So for me as a sex therapist, our relationship with AI and disembodiment is profoundly important. It can deepen insight and take some mental load off. It also intensifies our dependence on it.
And that dependence has been measured. In 2025, OpenAI and MIT Media Lab analyzed around 40 million ChatGPT conversations and ran a four week controlled trial. Higher daily use tracked with more loneliness and dependence, and less time socializing with actual humans. The more personal the conversations, the lonelier the users. I want to be careful here, because I meant what I said about fear mongering: most users in these studies showed no problematic pattern at all. The risk lived in a small group of heavy users, and the studies weren't peer reviewed. But notice the shape of the finding. It's the shape we already know from every other soothing tool a client has brought into our offices.
I’ve created a resource for clients on how to identify when relying on Chat is helpful or not.
The things I'd be curious about for anyone using AI:
Can you have a conversation with someone without screening everything you say in a chat beforehand?
If no, is that second opinion supporting you in looking at your growing edges as much as it is validating your feelings?
What are you afraid might happen if you don't get that second opinion?
It's the same thing in a therapy dynamic. If we're not challenging a client who is actively causing harm to themselves or other people, we are enabling that behavior.
So how do we look at AI as just another tool, a collaborator of sorts, in the same way we'd look at psychedelics or porn use in its extremes? Depending on our relationship with it, anything can be used as a tool for avoidance and enabling patterns. Which means anything can also be used to break patterns.
And how can we let AI be part of the framework we already have at our fingertips, and let it challenge us as therapists to grow and change the field for the better?
Want to support your clients with their AI use? Share my free resource guide here. And let’s stay connected- engagement and debate are my love languages, and we can’t do this alone. Subscribe to my newsletter below to stay in touch.
