Can I use AI for therapy? Why AI cannot replace therapy (or humans in general).

6 Oct

Over the past few years, we have seen a significant increase in Artificial Intelligence (AI) users utilising generative AI programs in place of talk therapy. This certainly makes sense, given the sustained increases in costs for every aspect of living, in addition to long waiting periods for subsidized psychology here in Australia [despite counsellors and psychotherapists begging for Medicare recognition to subsidize their services too – but that’s a conversation for another day]. Actual therapy has become that much more difficult to obtain. Of course, people are turning to the next, more affordable, and quicker option for mental health support: AI.

Many practitioners are in support of AI and use it for various administration tasks related to mental health support, like completing clinical notes. Personally, I’m not a fan of AI and prefer to do things myself (despite how painfully difficult that can be). Though most practitioners are in agreement that replacing therapists in general with AI is not a good idea and emphasize the importance of human-to-human contact in the therapy space.

Given this topic is one of quite a bit of discussion recently, I have been wondering:

If AI can be trained to respond in realistic and possibly even therapeutic ways, then why can’t people use AI as therapists?

Let me explain why AI is not a good idea for therapy and can never replace real human therapists. That is, aside from the obvious: that many of us who have undertaken 6+ years of study, with a huge student debt, will lose our careers.

Healing in Community

Community is a fundamental human need. Despite what some people might believe about not needing anyone else, we do need each other. Community helps us to feel like we are connected to something bigger than ourselves. It provides us with support and identity. We identify ourselves through the context of the communities we are a part of, such as the suburbs or towns we live in, our cultural similarities, our interests, etc. For example, I am a cat owner, so I identify with other cat owners more so than dog owners, but I also identify more with dog owners than with people without any pets.

Even more than identity, community is a necessary pillar of healing when it comes to things like trauma. Supportive relationships after experiencing a trauma can provide one with experiences of safety, which are extremely important when recovering from trauma (1). Experiencing something that is traumatising can also lead to feelings of isolation, especially if you were the only person who experienced it. Connecting with others, being in the community, having positive interactions, and engaging a support network of friends, family and practitioners helps to heal this isolating feeling.

Many people find that speaking their issues out loud, to another person, can be an emotional experience in itself. That is because speaking your problems out loud brings reality to them, they’re no longer just issues in your head that you think about - they are real. That reality can hit you when you’re talking about your worries - something that is missed if we are typing our problems to an AI chatbot.

Sure, you can tell an AI chatbot the things you’ve experienced, and the AI can provide some lovely words of validation. That may help a bit. But sharing your experience and feeling heard and understood and having another person bear witness to you and your experience, is extremely powerful. The intimacy and vulnerability of connection is extremely powerful.

There is significant healing power in community and connections with others.

Affordances

Environmental psychologist, James J. Gibson, conceptualised the term “affordances” to introduce a new way of thinking about our relationship with the environment around us, moving away from a stimulus-response ideology. Affordances is essentially the relationship between the potential uses of an object and the abilities of the user: what actions the object affords us. Say a shoe, for example: for us humans, a shoe affords us the ability to walk, run, hike, climb, to protect our feet to be able to use them for longer periods of time, or to display a personal style. For a dog, a shoe has a completely different set of uses, such as a potential meal or a toy for playing. An object can afford many things depending on the user of that object.

We also have affordances with other people and animals. According to Gibson (2), these are considered our richest and most elaborate affordances as when we interact with others, they interact back. “Behaviour affords behaviour.” This difference between object and living being is so significant, babies can distinguish it. Gibson states that all human behaviour ultimately depends on the perceptions, or misperceptions, of what the other or others afford. All of this is done unconsciously.

I think it is summed up well with this quote:

“There is only one environment, although it contains many observers with limitless opportunities for them to live in it.” - Gibson

Why is this important for therapy?

The reason as to why therapy is so effective at helping people recover from ill mental health or with changing behaviours is because of this mutual interaction of affordances. Both client and therapist afford each other worlds of knowledge about relationships, interactions, ideas, meanings and beliefs, which then affords many possibilities of interacting within the therapeutic relationship (3). The therapist is affording the client empathy, understanding, safety, while the client affords opportunities for inquiry about personal topics (3).

According to Tomm and Taylor (3), the coupling of these affordances may contribute to the effectiveness of the common factors theory – which indicates that a set of common traits or factors are the significant determinants of successful therapy outcomes (e.g. collaborating on a goal, empathy, positive regard for client, genuineness, alliance).

While AI presents with a world of knowledge (quite literally, all the knowledge in the world), it cannot participate in this reciprocal process of affordances, as it essentially is an object.

The Human Touch

There was a moment in the history of psychoanalysis, when theorists believed that it was essential for the therapist to act as a “blank slate”, providing a neutral environment in which patients can recover from mental illness. This meant essentially showing no emotion, giving no opinion, displaying no sign of humanness. This absence of influence meant the client was able to project their beliefs, opinions and ideas onto the therapist. There is a reason this technique is no longer employed – it doesn’t work!

While AI is designed to be more agreeable with supportive and helpful language, which is very different from a ‘blank slate’ therapist, there are similarities here with how this implicates therapy.

AI is designed for user satisfaction – it is designed to make us happy. That sounds like it should be exactly what we want in a therapist, however that’s not how therapy works if you want long lasting change. Therapists, the human kind, are trained to challenge us on some of our more dysfunctional thoughts and beliefs, while AI is designed to provide responses that align with the beliefs of the user. This means it may not be providing accurate information if that information doesn’t align with the user’s beliefs.

Further, an important part of therapy for many people is having or developing the ability to tolerate discomfort. Discomfort is a part of life that we encounter all the time, whether its waiting in traffic or having a difficult work interaction. We can’t avoid it, but we can manage it. If AI “therapists” are just trying to keep the user happy, then the expectation is that the AI program will tell the user whatever it needs to ensure the satisfaction of the user. This doesn’t help us increase our ability to tolerate discomfort, in fact perhaps the opposite.

Alfred Adler argued that all our problems are relational. That is, all our issues in life are due to our relationships and interactions with others. Therefore, we can’t heal relational issues in isolation. This is why we feel healed when we are single for a long period of time, only to find we experience the exact same patterns once we enter a new relationship. Some issues are better worked out in the context of a relationship. Therapy is the perfect place to do this. Therapy works like a microcosm of our outside world, where both client and therapist enter into an intimate relationship, bringing each of their histories and life experiences. Within that microcosm we can begin to model healthy relationships and better communication, and work to translate that to our life.

AI cannot replicate this, because AI cannot replicate humanness. If we introduced a relational issue to an AI, knowing that the goal of AI is to ensure user satisfaction, the AI would simply agree with us. While we may feel validated in that moment, our behaviour is reinforced and neither we nor our environment changes. This creates an echo chamber of the same patterns, same beliefs, same thoughts.

In conclusion…

Evidently, while AI “therapy” may appear to fill a gap in accessible therapeutic support, what users are really getting from the experience may not actually be all that therapeutic. All the important bits of therapy are being missed when people seek out therapeutic experiences with AI; vulnerability, mutual interaction of affordances, the power of speaking your worries out loud to another person, being witnessed and seen by another person, healing in the context of a relationship, being able to tolerate discomfort. These important bits are uniquely human experiences and cannot be replicated by a computer.

We cannot heal human issues with a non-human.

References:

1. Blue Knot Foundation: https://blueknot.org.au/wp-content/uploads/2023/12/3875-D-Healing-ER-FA_DEC23.pdf

2. James J Gibson: https://cs.brown.edu/courses/cs137/2017/readings/Gibson-AFF.pdf

3. Tomm & Taylor: https://onlinelibrary.wiley.com/doi/full/10.1111/jmft.70004#:~:text=Gibson%20(1977%2C%201979)%20was,systems%20to%20survive%20and%20thrive.

(Thank you to Sarah Schauer for introducing to me the idea of affordances).