Clinical psychologist Sarah Darghouth admits she was surprised when AI first entered her therapy sessions. A patient showed her how ChatGPT had helped resolve a marital conflict, offering suggestions that actually worked. 'I was impressed. Then, for a moment, I felt puny,' she writes. 'I would probably have offered an unpolished version of one of these ideas over an entire session.'
Patients Turn to AI for Therapy
Darghouth, an assistant professor at Massachusetts General Hospital and Harvard Medical School, recounts how patients increasingly bring AI-generated advice into sessions. One patient ended a relationship after ChatGPT recommended it. Another used AI to repair a fight with his wife. 'Chat told me I should break up with him,' a patient said, prompting Darghouth to mask her annoyance.
She now struggles to discern whose voice she is hearing—the patient's or AI's. 'I sometimes don't know whose voice I am hearing, whose emotion, whose gut feeling,' she admits. To reassert human connection, she suggests alternatives like journaling instead of using AI.
Risks of AI in Mental Health
Darghouth warns patients about real risks: AI can worsen anxiety, provide false information, increase isolation, and even lead to delusional beliefs or suicidal thinking. 'Dazed by its boundless sycophantic embrace, some of my patients report not leaving their beds or couches on the weekend as they get sucked in, vulnerably uploading their private lives to big tech,' she writes.
Yet she confesses to using AI herself. When her nine-year-old had a tantrum, she turned to ChatGPT for support. 'I didn't care that it was phoney. And AI was there, calm and supportive, coaching me to breathe through the screams,' she says. 'Was the therapy help fake? Yes. But it worked.'
The Value of Human Messiness
Darghouth questions what human therapy offers that AI cannot replicate. She recalls a grad school professor comparing therapy to sorting through a messy closet: 'Everything has to be taken out, your room has to look like a tornado hit it, and only then can things be sorted through.'
'What if it's the mess in therapy that is its most prized possession?' she asks. This mess includes conflict, hesitation, stalling, wrong decisions, and strong emotions that explode all words. 'Yet mess is often a signal that we are getting at something important.'
She contrasts this with AI's clean, all-knowing stance. 'What if AI's clean, all-knowing stance is in fact a liability on the slow, unsteady path of human healing?' She notes that change often happens in circuitous and unpredictable ways.
Future of Therapy: AI vs. Human
Darghouth predicts a future where many people use AI therapy, but a minority will seek human therapists. These seekers will find flawed therapists who frustrate them, forget parts of their past, yet sit with them in emotional tornadoes. 'That same therapist will say the wrong thing at times, will forget parts of their past, and will also resolve to sit with them in emotional tornadoes of massive scale, and feel moved by those fragile absurd moments of beauty so overwhelming that there will be no words.'
She recounts a patient who returned and said, 'It was how you laughed at my joke as I was leaving the room last time that made me feel better.' Darghouth didn't even remember the joke. 'What? So it had nothing to do with what I had seen as the rich therapeutic dialogue we had?' She went with it, humbled and happy to be human.
Darghouth concludes with a call for humility among therapists, acknowledging that AI is here to stay. 'We therapists have to adjust, with a dose of humility, to invitations to integrate AI judiciously in psychiatric practice. I'm not sure what judicious integration will look like, assuming it is actually possible.'
