AI Therapy: Always there
This, I’m sure, is going to prove to be a part 1.
We’ve all been seeing more and more of them everywhere. I see it in my subway commute, on billboards, advertisements everywhere. AI “friends.” AI “therapists.” There are lots of different things to say about this. For now, I want to address just one piece: the basic premise of a therapist who is “always there” for you.
One of the ads I’ve seen advertises that anxiety doesn’t wait for your next scheduled appointment. This is undeniably true. We are complex systems, dealing with thousands of inputs and dozens of factors every moment. If you meet with a therapist weekly, there will be thousands of emotional reactions in between. Some of these will be anxiety, others anger, others joy, others shame, others anticipation, … the list goes on.
What is this ad’s implied message? It’s pretty clear, right? Emotions can’t wait. They need immediate response. Why? The premise is that emotions are unhealthy, or dysfunctional, or dangerous. That you are alone with this monster. The message is that if you have intense anxiety, that is dangerous and you need help. Hundreds of moments of danger, day after day, left unaided by therapists. Remember, this is an app selling therapy.
You know what? They’re right. These are important moments. Just not how they’re implying.
Emotions and choice
These moments are important, because they can present us with choices. I add the word can, because most of the time they don’t: most of the time we respond automatically, keeping to learned habits. The very same habits the advertisements are playing off of, that assume that these moments are to be eliminated.
The truth is, the magic of (good) psychotherapy doesn’t happen during the meeting. The magic happens in scattered moments across the week. I hear about these moments all the time. Someone is going about their week, a difficult situation comes up, and there’s a click. What we discussed in the meeting merges into their consciousness in the moment of interaction, and like a lightening bolt, they recognize choice. Perhaps they don’t even do anything different that time, just are struck by the new paths before them. They recognize that what they feel isn’t a padlock, but the keys to multiple doorways they could try going through. And for the first time in a long while, they are considering which door to try, instead of staring at the locks.
These moments are magic for multiple reasons. Of course, importantly, they offer the potential to open doors to greater connection and more meaningful life. But they also lead to more such moments. People feel the power and freedom of such choice, and after multiple times trying, the confidence of making meaningful change. This momentum never ceases to amaze me. I’ll be going over one thing with someone, persistently for weeks, and then suddenly they will come back and tell me the joy of applying it in a totally different way in a completely different part of their life. Opportunities I was unaware even existed.
Emotional acceptance creates opportunities for self-efficacy
This is related to what psychologist Albert Bandura identified as “self-efficacy”. It’s not the same as independence – not I do it on my own – but rather, the recognition of one’s ability to act autonomously, to be responsible for handling one’s challenges.
An ever-present therapist, AI or otherwise, could destroy that.
Even if it could show the person the doorways. Even if it could illuminate all of what the person is experiencing, and help the person connect to what they are aiming for, and take appropriate action. That magic would likely never appear.
Why not? Think about who (or, hint hint, what) is doing the learning there, who is building self-efficacy. The therapist. Well, not quite – both are learning. But the therapist learns efficacy in perceived control over others. While the person learns that the way to solve novel problems (and really, isn’t every problem new in some way?) is to rely on others for answers. Instead of self-efficacy, dependence.
Emotional avoidance creates more anxiety and avoidance
The anxiety itself plays a part in this new learning. The anxiety becomes a cue for “I can’t do this on my own,” and then guess what happens the next time the person faces a similar situation? That anxiety has been given an important role. Instead of being a cue that gets extinguished and replaced by efficacy and mastery, the anxiety gains in force.
At best, perhaps the therapist/AI is adept enough to let the person lead their own attempt. There could be some specific learning of managing that situation. But no magic, no new unforeseen paths. Unfortunately, even this is unlikely. Especially with an AI “therapist” that seems to buy into the idea that anxiety is a problem to fix (here’s a previous post challenging misconceptions about what emotions are). And ultimately, AI apps that are first and foremost interested in selling more therapy.
Avoidance is always tempting
If you view emotions, such as anxiety, as the problem, think about the quickest way to solve this problem. I could simply avoid the situation: I could drink. I could ask my family or my partner or my friend for reassurance. Or, I could ask my therapist for reassurance or for the ‘answer.’ With an AI that buys into that misconception, I solve the ‘problem’ almost effortlessly. And the AI has now made for itself an intrinsic role in my life. Great for the AI business owner. What about for me?
So far, we’re just talking about one situation. Remember the premise: emotions don’t wait. This is not just one situation, but a person can train this same dependence many times a day, in many types of situations.
Of course, every person’s situation is different. Some people are in such persistent distress, across so many situations, that support once a week truly is not enough. There are intensive outpatient programs, where people attend for hours each day. There are intensive exposure and response prevention programs where people have individual meetings for a few hours multiple times per week. In Dialectical Behavior Therapy, the person has access to a 24/7 crisis phone. But for each of these, there are strict rules about how this broader access is applied. Each of these are designed to promote self-efficacy and to reduce support over time.
Why not dependence? Let AI handle it!
After all, anxiety can feel miserable. AI will take care of it, and then I can live my life. Right?
Sorry. Our systems don’t work that way. We are not designed for ease, or tranquility, or even “health” (this could be a future post). We’re designed to survive. And surviving means adapting. Emotions are a core human system. The more we cede control over how we handle them, the more power we give away over our lives.
The people I work with have seen this in action. After years of fighting their anxiety instead of using it, more and more of their lives go away. Some find it hard to even step out of the door.
This isn’t dysfunction: it’s adaptation. Their bodies have learned to see all the world as dangerous. Staying inside is survival.
This is the potential outcome of ever-present AI therapists.
Always there: AI therapy apps
I’ve laid out my concerns about one specific feature of the AI “therapists” (and, in a similar way, “friends”): their capacity to be always there. This buys into cultural misinformation that emotions are unhealthy, and in practice, may remove our potential to grow and build self-efficacy and replace this with avoidance and dependence.
This is a lesson people have been struggling with throughout our history. Easy answers are always there, and always tempting. Our lives are hard. They are grueling and demanding, and filled with uncertainties and suffering. They are also beautiful. Filled with grace and connection, with exploration and wonder. When we accept this internal balance*, and treat ourselves and others with compassion, we grow. When we try to eliminate the suffering, we instead become consumed by it.
Hope through empowering each other
A concluding note. I want to remind you all that we control the future of AI; it does not control us. If we continue to feed it information and follow where it blindly leads, we too will continue to be blind. But if we, not just individually but most importantly collectively, join together and say “Here’s how it’s going to be,” we can protect ourselves.
This is our world, and we can be there for each other.
*Note: This applies to internal suffering, not the external causes. Many times the demands we face or causes of suffering can be tackled and overcome, and this involves change.