When AI enters the therapy room

Last year I attended a conference on analytical writing as part of my continuing professional development. The main presentation, about writing from clinical work with people who were dying, was thoughtful and moving. Later, during a more general Q&A on analytical writing, I asked, with some anxiety, what people thought about AI.

I felt uncomfortable, as if I had deposited something unspeakable in the middle of the room. Perhaps I misread the response, but there seemed little appetite to discuss it. Since then, AI has come into many people’s lives and into the consulting room dressed for a party.

Some people are delighted by it; others regard it with suspicion. Many feel both. Over the past year, clients have told me they've used it to think through a difficult conversation, make sense of a symptom, develop a creative project, or ask a question they felt unable to ask anyone else. Some have found it helpful. Others have been left frightened, overconfident or, in some cases, more confused than before.

As a therapist, I want to know what happened between the person and the answer.

A place to play

A particularly touching example is someone who, after a profound loss, had become isolated. Through her own thoughtful use of AI, she began pursuing interests she might otherwise have left alone and taking pleasure in ordinary life again.

I have also seen a longstanding piece of writing come out of the proverbial drawer and begin to move after its author used AI as an editorial sounding board. And I have seen another person experiment with presenting a creative project in a form she had not previously imagined. In each case, new possibilities opened; however, the curiosity, choices and imagination belonged to the person exploring them.

These were different experiences, but each involved something more than mastering a tool. There was room to try things out without knowing the result. After long periods when grief or responsibility had taken up a great deal of space, play became possible again.

Winnicott understood the capacity to play as central to therapeutic life. I felt the force of that idea here: this was not frivolity, but a sign that more of a person could come into being. In therapy, we could notice that change together and recognise the confidence growing alongside it.

When an answer arrives too soon

There is, of course, another side to this. AI can sound remarkably certain about matters that are anything but clear. Give it one account of an argument with a partner, and it may return a verdict on the partner’s behaviour. Ask what is wrong with you, and it may offer an explanation so neat that you almost want to believe it. There may be something useful in either answer, but certainty can bring a conversation to a halt just when it needs to begin.

Therapy often involves staying with uncertainty longer than we would like. We discover that two apparently opposing feelings can both be true. We may want closeness and fear it; feel furious with someone and love them; long for change and resist it. An answer that arrives quickly can bring relief, but relief is not the same as understanding something, still less finding a way to live that understanding in one's own body and life.

Here I return to Therapy 101: the invitation to slow down. If a client brings an AI conversation into the room, before getting pulled into the content, I might ask: How did the process itself help? Was there anything in the answer that did not quite fit? What made you want to ask it then? And what is it like to bring its answer here?

How it feels to bring the answer to your therapist may be as revealing as the answer itself. For one person, AI may be an accessible place to rehearse thoughts before speaking to another human being. For another, its availability and apparent certainty may make it tempting to retreat from the more demanding experience of being known by someone who can disagree, misunderstand, be affected and repair a misunderstanding.

Using AI is not something to feel ashamed of.  It is a reason to be curious about the relationship you may have formed with AI, and what happens to our relationship when it is brought into the room.

The question of privacy

Curiosity cannot be our only response. AI systems invite us to type freely, sometimes precisely when we feel most distressed. It is easy to enter intimate details about ourselves and other people without stopping to ask where that information goes or how it may be used.

Clients may also reasonably wonder whether their therapist uses AI. Has it helped draft a general information sheet? Has it been used to prepare notes or think about their treatment? These are very different uses, with different implications. A client should not have to guess what happens to the material they share in confidence.

The questions run both ways. Clients may tell therapists how they use AI, but they are entitled to ask how their therapist uses it too. Therapists have particular responsibilities here. A client’s story is not ours to put into an AI system simply because it might help us think or write more quickly. Changing a name may not be enough when the circumstances themselves could identify the person.

Enthusiasm about what AI can do needs to travel alongside care about confidentiality, consent and the limits of the particular system being used.

What remains human?

I do not think therapists need to compete with AI for the quickest or most fluent answer. Often the work is to notice why a particular answer mattered, what it missed and what the person could not yet say when they went looking for it.

An AI conversation may help someone find words. It may support experimentation or offer comfort at an hour when nobody else is available. I can be glad of that and still value something different about therapy: two people meeting over time, with bodies, histories and feelings that cannot be tidied into a prompt. There is room for hesitation, for an awkward silence, for being surprised by what one has said, and for discovering what happens when another person stays.

AI is already in the room, whether or not it has been mentioned aloud. Frowning at it will not make it go away. We can ask what it has offered, what it has cost, and what happens between us when we begin to think about it together.