In a recent postI have identified four things therapy profession is to ignore one’s future. Chatbot Outcomes Research, The Vulnerability of the 50-Minute Hour, What We Ask Our Customers, and What competition it sets prices in every market it touches. This is the sequel I promised: what next?
First, a little honesty about where I stand
I love my job and it has given me real meaning and purpose for 30 years. I’ve always said I’m not retiring, and I mean it. I deeply believe in the suggestions of skilled therapists that cannot be duplicated by artificial intelligence.
But I think we overlook something that is rarely said out loud: therapy is not always a positive experience. I’ve done my share over the years and I don’t look at every therapist I see with warmth or fondness. gratitude. Some of these experiments were useless. One was even worse. The idealized version of therapy that our profession projects, the transformative relationship, the healing alliance, is real for many, but it’s not universal, and I don’t think it serves our clients or our credibility to pretend otherwise.
A changed world
Some people always want to be recognized by another person, to sit across from someone who has chosen this job for reasons unrelated to an algorithm, with a history of humanity and their own loss. It’s true and I can’t imagine it ever going away.
And yet it is true that some people will always prefer LLM. This is not a failure of therapy, but a reflection of a changed world. Young people in particular have grown up with artificial intelligence. For many of them, a chatbot doesn’t feel like a lesser option. He feels familiar, personal and safe, because sitting across from a stranger is not normal. We need to make room for this reality rather than denying it. But “some customers will always prefer us” is not an effective strategy for reaching the future. It’s comfort, and comfort right now doesn’t require this moment.
Where AI really falls short
Understanding where AI is struggling is not only comforting, but strategically important. Clinicians who develop real expertise in areas where AI is most vulnerable will likely be the ones best positioned in the future.
The case of married couples is a good example. AI platforms are sycophantic. They are created to agree, to confirm, to avoid conflicts, to maintain the agreement. This is a big responsibility in couple therapy, where the work often requires holding two opposing realities at the same time, confronting both partners, and tolerating the discomfort of non-acceptance. An AI that tells each partner what they want to hear doesn’t do couples therapy and can easily make things worse. The same is true of psychedelic-assisted therapy, which requires a depth of human presence and clinical judgment that no algorithm can provide.
Crisis intervention is another area of concern. Big language models can produce answers that seem logical, but lack the common sense and real-time situational assessment that crisis work requires. They can’t read a room, hear a change in tone, calm a parent, or make a therapist’s split-second clinical judgment when someone is in real danger.
Cultural sensitivity is also an important issue. These algorithms are trained on data that reflects bias, regardless of who produced it. Customers from underrepresented communities may find that AI responses miss their cultural context. A culturally competent therapist brings critical knowledge to this relationship, no current model can replicate.
What can we do?
Knowing where AI will fall points directly to where I think therapists should invest. Skills Development in Couples Work, Crisis Intervention, traumacultural competence and complex family systems are not only good clinical practice. This is a good professional strategy.
AI literacy is also becoming a necessity. This means knowing how to ask customers about the use of AI, assess whether it will help or harm, and how to have informed conversations about what these tools can and cannot do. Customers are already using AI to support mental health, often without talking about it. A therapist who knows how to bring this into the therapy room offers something truly valuable.
There are also real opportunities to work thoughtfully with AI, essentially offering your clients the best of both AI and human therapy. Customized recreation and vigilance tools can be customized to the client and used between sessions, extending work without extending clinical hours. Therapy apps can help between sessions. Virtual reality offers the therapist new opportunities to guide and integrate experience into exposure and trauma processing. Therapists who learn to use these tools thoughtfully offer a richer model of care and a more competitive edge.
A note on ethics and accountability
This is really new territory and the law hasn’t kept up with the technology. Different states have different rules about informed consent, therapy bots, and liability when AI is part of treatment. If anything goes wrong, the responsibility remains with us.
As such, we must act thoughtfully, document carefully, and be aware of the legal landscape in our states. We’re breaking new ground, and while that’s really exciting, it also means watching our backs. Ethical and legal mistakes can be very costly, and our professional associations lack the guidance we need to move forward. Nevertheless, AI tools and hybrid therapy models are rapidly improving and costing a fraction of the cost of human therapies. This pressure will not go away. Therapists who manage this best are those who make decisions in the moment rather than hoping that the problem will resolve itself.
We are not alone in this
Of course, most, if not all, professions experience their own version of these pressures, and many people fear them. Nevertheless, I think we are very well equipped to meet this moment. We’ve spent our careers learning to sit with uncertainty, to tolerate not knowing, and to help others. fear to something that works more. This very moment asks us.
Let’s stop with the “AI can’t replace your job” and get into this. Only by doing so can we become midwives for the future instead of the remnants of another time.
