I have spent almost 30 years as a clinician and believe this psychotherapyat its best, it is one of the most powerful forces of human change in existence. Nevertheless, the profession is sleepwalking, it turns into changes for which it is not prepared. Therapists are very good at helping our clients face difficult realities. It is time to show the same courage to ourselves. Here are four points I believe we should discuss directly:
1. Customers are forming a healing alliance with chatbots, and results data is starting to back them up.
For decades, the therapeutic alliance has been the foundation of our profession person. Not a particular style or technique, but the relationship itself. The therapist-client bond is the single strongest predictor of positive therapeutic outcomes in every form of treatment we have studied. This is what we are referring to when human therapists suggest things that no application can do.
Also, people are now reporting that they are experiencing this union artificial intelligence (AI). In a 2025 survey of adults with a mental health diagnosis who used an AI chatbot for mental health support, 38 percent rated it as more helpful than traditional therapy. A 2026 randomized controlled trial (RCT) found that a therapy chatbot reduced depression symptoms by 51 percent. That same year, a second RCT of nearly 1,000 university students found that the AI platform caused more falls. worry and greater improvement in life satisfaction than face-to-face group therapy. Also, it’s a snapshot of a moment in time. Large language models (LLMs) mature faster than human ones, and those available today are already superior to the versions used in these studies. Today, a distant threat can appear immediately sooner than most people expect.
My personal experience may be relevant here. I have used AI to solve my personal problems. I’m here because I’m a therapist and know how to ask the right questions. Still, I didn’t expect it to help like this. I also feel something unexpected: gratitude. I am used to thanking people who helped me along the way. Feeling for something non-human is new, strange territory for me.
2. A 50-minute clock was never a clinical necessity.
There is nothing therapeutically sacred about 50 minutes. This structure appeared in the early days psychoanalysis as a practical way for therapists to see patients consecutively and in part because insurance companies paid reimbursements around it. At the same time, clients are now engaging with AI that can be accessed anytime, as needed, with no gaps between sessions where crises can deepen or insights can be lost. Of course, a 50-minute hour a week is important in creating space for deep work. However, this tradition may be changed by insurance companies and chatbots. Most hybrid therapy models coming to market are not built in 50 minutes. They offer artificial intelligence support between sessions, making a significant portion of what clients previously needed face-to-face time, followed by shorter, more targeted in-person interactions. Less human time, lower cost, AI fills the gaps. From the insurer’s point of view, this is a clear win. From the point of view of some customers, this can also be a win-win. But from a therapist’s point of view, it means a radical rethinking of the value of the clinical hour, and could have downstream effects on the profession as a whole.
3. A profession is not being honest about what we ask of our clients.
Think for a moment about what a typical customer would have to do to access support. Finding a therapist they like, who accepts new patients, gets their insurance, and has an opening that fits their schedule can be a frustrating and lengthy experience. Then comes the endless paperwork—HIPAA forms, therapy contracts, and the Good Faith Assessment mandated by the No More Surprises Act. Caring for children or arranging time off from work. And the list goes on. It’s hard to be honest with another person. Therapists know that clients always control, to some extent, how they are perceived. We know not to take customer reports alcoholic beverages for example, take it at face value, and we’re used to revealing important information to clients about their treatment for months. And then there’s the cost. Paying hundreds of dollars per session, possibly out of pocket, for a relationship that ends if they move or lose their insurance. Charging for missed appointments, even if they believe their excuses are legitimate and unavoidable. Effects of therapist yawning. In short, therapy can be more stressful than we care to admit.
A chatbot removes each of these barriers. It never has a waiting list. There is no charge for missed appointments. He adapts his voice, cultural background or therapeutic style to what the client wants. It is available anytime, anywhere. None of this makes a chatbot better. But this is a real competitive advantage that we tend to overlook.
4. Competition lowers prices in every market. Ours will not be an exception.
There is no industry where the introduction of a cheaper, scalable, always-on competitor has left the existing pricing structure intact. Not music. Not a trip. Not journalism. Not retail. Additionally, some of the wealthiest companies in human history are now pouring resources into AI mental health tools. Insurers will closely monitor the results of the study. They are already learning to pay for “measurable results” instead of covering the hour, and hybrid models that combine minimal human supervision with support provided by artificial intelligence are becoming more and more financially attractive to them. The logical consequence is that therapist wages, especially at the entry level, face downward pressure.
This worries me deeply. I don’t worry about clinicians with full practices and decades of credibility. I am concerned about the influx of therapists into this field now, and the non-specialists at the mid-level. Therapists have taken on graduate school debt, completed underpaid internships, built practices from scratch, all with the assumption that the landscape they studied for will be there for the rest of their lives. career. We fail to recognize that the economics of this profession will likely change in ways that we cannot fully predict.
Essential readings of the therapeutic alliance
This carelessness is not kindness. It’s the professional equivalent of parenting rejection. We sat down with clients whose lives were shaped by what their parents refused to see about them or their world. What the parent denies, the child inherits. New therapists entering the field are in this position with us now. They are children of a far-sighted profession. What we do not calculate, they alone absorb. We need to pass on to our younger colleagues the same honesty and courtesy that we show our customers every day.
Of course, no one can see the future, and I am no exception. But discussing these very real possibilities only empowers us as we move into the future. In the next post, I’ll explore what therapists can actually do. There are real options. But none of them exist for an industry that has not looked at the problem honestly.
