12. Can AI Offer Real Therapy

Rapid developments and jaw dropping capacities of ChatGPT (from writing uni assignments to lyrics) have created a lot of excitement. At the same time, many have started to wonder if AI will eventually take over our jobs, like make therapists redundant? Perhaps not, for quite obvious reasons.

Substituting Human Connections?

In short, humans have not evolved to emotionally connect and interact with inanimate objects and computer programs. While it is normative to talk to and feel supported by tedding bears and such at an early age, it is not a good sign when this receptiveness manifests later in life. One example exists in my hometown Hong Kong and places like Japan, where many teenagers and even older men seek comfort and support from animated female characters (“waifu”) programmed to respond to their emotional needs and turmoils by pretending to understand, affirm, and care. Perhaps in desperate states, people can use anything as substitute for human connections (think Tom Hanks and Wilson the volleyball in Cast Away). But this is not in our nature, and rewiring people to connect with AI is not as simple as how we made geese imprint on
planes instead of their mother.

Being able to share the depths of our pain with another person who can receive it attentively and unflinchingly is an intrinsically therapeutic experience. Likewise, being able to reveal our selfish motives, socially unacceptable beliefs, embarrassing fears, and other aspects of our concealed self to another person who can empathise (and perhaps relate) is a humanising experience. These interpersonal experiences not only relieve distress, but are pivotal to helping the person introspect candidly and consider changes non-defensively (i.e., for therapy to progress effectively).

Therapy as an Interpersonal Experience

As implied, therapy is more than a collection of theories and techniques that can be codified into AI – it is fundamentally an interpersonal process. This is why so many Psychologists and Psychiatrists (trained to be self-reflective and know the theories and tools already) still seek personal therapy. Speaking more empirically, research consistently showed the biggest contributor to client improvements after therapy is the human-to-human connection and measured interactions between therapist and client.

In fact, it is not just the recipient, even the provider depends on something uniquely human to make therapy work. A basic example relates to working with emotionally avoidant or detached clients (e.g., jokingly or robotically talk about what is disturbing or heart-breaking). To bypass these defences, therapists partly rely on the “contagious” effect of emotions. This means the client may be led to feel what the therapist is feeling (expressed subtly and thoughtfully), which is in turn an empathic response to what the client is deep down feeling or should have been feeling.

Reciprocal Attunement

The above “reciprocal attunement” to each other’s internal experiences is crucial to therapies for personality disorders and some forms of psychosis. It is in these therapist-client (in place of caregiver-child) exchanges that the client learns to comprehend (aka mentalise) other people’s feelings and intentions; take on morals, values, and other human qualities (like child take on from parent to build a foundation and later shed or reshape internalised subjectivities to individuate); form healthier styles of attachment (e.g., a loner learning to tolerate and later appreciate the warmth and care extended by therapist), and so on. But if therapy is provided by AI, there would be no genuine feelings for the client to be attuned to, no human qualities for the client to organically internalize, and no authentic relationships for the client to experience (perhaps like interacting with a psychopath who signed a contract to fake a connection and manipulate the client to make some changes).

Current Boundaries and Future of AI

To be sure, the possibilities of AI may exceed my imagination. But if there comes a day when most of us have been rewired to find connecting with computer programs no different to connecting with another person, and if AI has attained the sentience to truly feel what humans feel, then we have much bigger things to worry about than how to retrain therapists for other occupations. For now, AI can certainly be useful, mostly for offering intelligently adapted self-help strategies and psycho-education.