What is psychotherapy in the age of AI
A colleague recently told me about a client who apologised for “taking up time with feelings” when ChatGPT or Claude could probably solve their problems faster. It reminded me of the story of the French painter Paul Delaroche, who upon seeing the first photograph in 1839 proclaimed “from today painting is dead!”. Yet here we are today, almost two hundred years later, and painting is thriving in ways that no one in the 19th century could have imagined. Photography did not kill painting, rather photography freed painters from making accurate replicas and faithful copies. Instead of being focused on portraits and still-life – the bread and butter of the painter’s trade – painters started to paint their feelings, fleeting impressions, and abstract forms. In that instant modernism was born. The rest is art history.
Just as photography freed painting from mere representation to explore emotion and creativity, AI’s therapeutic capabilities might liberate psychotherapy from its more mechanical functions. As anyone who tried to self-therapize with AI could attest, the AI therapist excels in unconditional positive regard, compassionate understanding, and empathy all available on tap 24/7. But that creates an interesting paradox; the very consistency that makes AI therapeutically valuable might also highlight what is irreplaceably human in a therapeutic encounter.
RD Laing said, “the really decisive moments in psychotherapy, as every patient or therapist who has ever experienced them knows, are unpredictable, unique, unforgettable, always unrepeatable, and often indescribable.” Does it mean that AI has no place in therapy? No. AI might excel in consistent support, psychoeducation and structured interventions. After all, AI digested all the available literature on psychotherapy and psychoanalysis; it read and memorised all those academic articles that we have only archived to be read at a later date. Describe your symptoms to your friendly AI chatbot, and it will provide a diagnosis and several coping strategies. Placebo it might be, but it is a known fact that pink placebo pills are more effective than blue ones.
But perhaps anti-depressants are an earlier iteration of an attempt to replace human to human therapy with something more mechanical, more evidence based. For Wilfred Bion such approaches miss something essential about the healing process. Bion spoke about the concept of “reverie”, a receptive and dreamlike state in which a therapist allows themselves to be affected by the client’s unconscious. This mental state can be compared to that of a painter who is approaching the canvas, brush in hand, with determination and curiosity, or to a mother instinctively knowing what the baby needs. Against the all-knowing AI, the human, all too human therapist must arm themselves not with technique or even empathy but with something like “reverie”: creative unknowing, a space of vulnerability and uncertainty in which the therapist might notice their own unconscious responses to the client’s material.
Christopher Bollas speaks of “unthought known” those aspects of experience that exist before language. These preverbal acts of care, Bollas argues, underpin our responses to experiences throughout our lives. The therapeutic relationship becomes a space where these pre-conscious experiences can emerge and be transformed through human encounter. This is not about applying techniques or even offering interpretations, but about creating conditions where something new can emerge between two people.
Perhaps psychotherapy is currently at a crossroads that might parallel how painting moved from portraiture and still-life to exploring light, emotion and perception. Psychotherapy might shift from providing support towards exploring the more creative, intuitive and relational aspects of psychological healing.
TL/DR The question is not whether AI will replace therapists, but whether this moment will help therapy discover what it always aspires to be: a space for the full complexity of human experience to be uncovered through a genuine encounter.