AI Will Change Counseling for Better and Worse

Human connection is a premium service.

What we’re calling AI popularly—the large language models like ChatGPT, Grok, and Gemini who respond to queries with eerie intelligence and quickness—is the distillation and exaltation the Internet. Everything AI does to humanity is simply an escalation of the impacts that the Internet, smartphones, and algorithmic attention capture have been refining for a few decades. That is the horror of it, and that is perhaps the hope of it.

In therapist communities I have participated in conversations about our anxieties about the impacts these models will have on our profession. Fewer in number but potentially useful are the conversations about what opportunities these models will create. Regardless of how we feel about the rise of AI—and I am broadly mistrustful of it—it is not going away. It is, indeed, being thrust upon us.

People are already turning toward these models for mental health support and guidance, and some are finding them more useful than the human therapists they’ve tried to engage, and I think there are a number of reasons for this. Broad trends in medicine and technology compel us to act and think more like machines, and so it makes sense that machines would be better suited to help us act correctly. Evidenced-based medicine and the pressures of insurance encourage us to economize treatment to mere symptom reduction via easily replicated processes.

The gifts of therapy allow us to be curious about our own suffering and story and explore it deeply to find meaning, creativity, and personal power in life. What we call symptoms are the expressions of underlying distress and dysfunction within our being, signs that our well-honed coping and survival strategies are becoming too exhausted or overwhelmed to keep up. We could actually move into that underlying distress to bring it to the light, thereby freeing all the life force it has trapped within it and restoring it to our being. In the process, we would make many small changes in how we relate to work, community, intimacy, and free time that would further support more flexibility, more aliveness, more creativity.

That is a long process that does not have a defined beginning or end, nor can it be easily measured. Most insurances won’t pay for it, and many of us don’t have the time, energy, or interest for that. We mostly want to know how to get a good night’s sleep so that we can go to work and show up for all the demands of living. Insurance wants us to apply a cookbook recipe process to a diagnosis that has shown it will make the symptoms less in a predictable way. This confluence motivates people to come to therapists looking for “tips” and “coping strategies,” seeking the therapist as the expert who can impart to them action items they can apply to their symptoms to make them less of a problem. This is absolutely understandable, and there will always be a place and need for these kinds of supports to help people get through life.

And it is a machine kind of solution for a machine way of living. We expect ourselves to be predictable, routinized, easily maintained, and optimized for the demands of life. When we’re not optimized, we want 5 easy hacks to reduce anxiety, or 3 easy ways to lose weight. This is exactly the kind of guidance that is easily accessible via the Internet. We’ve been trained as marketers and content creators to fit our words and videos into that kind of format to make them accessible and boost visibility. And now a complex machine can take that work off our hands very easily. Never mind that it sometimes makes up things entirely with no basis in reality, or that it’s programmed to flatter your ego and tell you everything you want to hear. The more we rely on that kind of assistance to do our thinking and self reflection for us, the more we will weaken our own innate capacity to tolerate struggle, discomfort, ambiguity, and confusion. The weaker that capacity gets, the more we will lean on the machines.

There’s of course great merit to telling a machine your problems and having it reflect back the things you’ve said. Putting your thoughts and feelings into language is a demonstrably positive thing to do on a regular basis, and frequently I’ve encouraged clients to do it, only we called it “journaling.” And most people never get into the habit of journaling. But I imagine having an interactive journaling experience with something that reflects back what you’ve shared is a positive experience as well, because that is one of the great gifts of therapy—to feel heard, witnessed, and validated by something outside of you.

We’ve already been priming ourselves to feel validated by nonhuman entities with the proliferation of memes and online reassurance. While those assurances that you and your struggles are valid were created by humans, any feeling seen that you experience when encountering these is what’s called “parasocial.” Let’s say I made a meme that really spoke a truth that you feel deeply in your soul, one you’ve never seen put to language before. You may feel profoundly touched and connected to me, though you really know nothing about me other than a square box with text you encountered on Instagram, or maybe a video I made. And I would know even less about you. That emotional connection could not possibly translate into an intimate personal relationship. If we saw each other on the street, we wouldn’t go have lunch together or hang out on the weekend. The emotional intensity you feel is actually your own pleasure at recognizing a truth about yourself, having something put to language, but instead of feeling connected with yourself, that connection was outsourced to another person.

We of course have always had this experience through the arts. It’s why we have celebrity culture in which we get deeply involved in the personal lives of total strangers who got a bunch of people’s attention. The next step now is to have a parasocial relationship with ChatGPT, only now ChatGPT can talk back to you. And no matter how many times it reminds you that it’s a machine that’s incapable of sentience, feeling, or love, our brains are primed to personify objects so we can have relationships with them. But the same consequence applies. ChatGPT won’t fill your lonely bed at night. ChatGPT won’t go for a walk with you in the park. ChatGPT won’t drive you home from the hospital.

Here is where I have hope and curiosity about the future of the mental health counseling profession. If thousands of people get their basic mental health support needs met from ChatGPT, that could be fine. They got their list of anxiety management tips and they got an interactive journaling software that helps them sort through their thoughts and feelings. For many of us, that would be more than enough, and it’s great to have an option that is currently very affordable except for the enormous energy costs and environmental consequences producing such energy, which is so removed from the immediate experience of receiving ChatGPT’s response that many of us will not think of it at all, or successfully rationalize as being worth meeting our personal needs.

But what ChatGPT can’t do is be a human being, and we are deeply wired to be connected to other human beings. We crave it so much that chronic loneliness hurts our physical and mental health. But being in relationship with humans demands the ability to tolerate feeling frustrated, disappointed, misunderstood, and the will to keep trying to connect through these feelings until we succeed. Being in relationship with humans means infrequently hearing exactly what you want to hear, often feeling misunderstood, sometimes being completely baffled by what another person is doing or saying. Connection means being deeply in relationship with the parts of us that are so terrified of being abandoned that they explode at missteps, or parts of us that are so afraid of being devoured that they run away under pressure. Relationship means being cultivating creativity and playfulness, always seeking ways to keep things fresh and alive and not fall into a routine that makes us and our loved ones into objects.

In the wake of World War I, many Europeans were so horrified by the devastation wrought by industrialized war, the vast swaths of young men killed in battle, that young artists explored new ways of making art to break from the culture that made such destruction possible. Dadaists in particular deconstructed art and literature to break from the old and make space for something more sane and humane. Since then, generations of young artists have similarly rejected tradition to try to innovate new forms of expression to reveal the truth of the moment. This thought comes to me now as I see it as the task of all of us to generate what cannot be generated. If we must live in a world where so much of our labor and skills could be systematized and automated by machines, then the task is to produce forms of healing, therapy, art, writing, and culture that can only be made by us.

We are still human and alive, we still need to work and live, we still yearn to create and connect. Let us find the opportunity to risk.