AI and AI-ish Therapy

AI is A Thing in the therapy world now. Most therapists hate it.

Most therapy platforms love it.

Many families wonder how it shows up, in comparison to a living, breathing human that sits in a room.

Therapy platforms tout the benefits of having AI listen to sessions, to summarize and generate the clinical notes that we livingbreathing therapists write by hand after every session. I haven't been interested in this, though many therapists use AI this way with confidence.

Families have brought ChatGPT's clinical opinions into our sessions and they are always welcome because, thus so far, ChatGPT has deferred the difficult clinical subtleties to me. Toward the end of these ChatGPT therapy sessions, ChatGPT usually advises the family to "seek out the guidance of a trusted expert" or some such thing. I'm grateful to be the "trusted expert" they seek in these cases.

Some adults have prompted ChatGPT to respond to them, and offer clinical observations for their disclosures, in the same manner as a mental health professional. This yields wild results, as I have found (as a livingbreathing therapist) that many times, human beings don't know the prompts that are relevant to resolving their distress. Sometimes people are focused on the Little Thing, and lose sight of the Big Thing. Sometimes the Big Thing obscures the Little Things.

Part of my job, as a livingbreathing therapist, is to pinpoint the exact places for change and illuminate those pinpoints in our safe space. Sometimes a child not doing chores is a small problem, compared to his overwhelming feeling of worthlessness. Sometimes a child's overwhelming worry overshadows the small daily opportunities to feel powerful. Sometimes, the child's problem is unexpectedly rooted in a parent's distress, and I have the expertise to shift our focus away from the bloom of unwanted behavior and toward the root of where change can happen.

But, recently, a child shared that he was playing "Therapy" on Roblox. This is a Roblox microgame where one player "plays" The Therapist and one player "plays" The Patient. Of course, neither of these players are actual therapists, but I worry that maybe one of them could be a person, a child, with a very real mental health concern. It was explained that the "therapist" in this scenario could take the liberty of doing very un-therapeutic, even hurtful, things to the "patient". The "therapist" can make fun of the "patient", berate the "patient" and even hit or assault the "patient." I wonder if the "patient" has the liberty of reciprocating this harm. I wonder if the "patient" is a child who wants the experience of therapy, but does not have the agency to seek out her own help.

Therapy can be a lot of things, to many different people, but it is never a game. Though the exchanges between a therapist and patient may be funny (I often laugh in session), there is nothing funny about therapy itself. I hold sacred the livingbreathing relationships I build with the humans who are brave enough to walk into my office. And, a family's choice, to enter into my safe space, is not a once-and-done, quickie-answer, 5-step-plan-for-healing experience. My expertise and experience is far richer than what ChatGPT offers and my personal commitment is far beyond the bounds of a chat session.

I encourage every person who is struggling to consider all of their options- though I deeply hope they disregard playing Therapy on Roblox as an option- and then compare that to the experience with a livingbreathing therapist. Feel free to ChatGPT it. Or, notice that your kid is playing Therapy on Roblox. But then, call a therapist. Call our office. Because I know, with absolute certainty, that the experience we offer in this office far surpasses anything AI can supplement or provide.