There’s a raging question that has started to enter my sessions as a clinician. It intrudes into my daily work of seeing patients during my ordinary practice days. And it is this:
What happens to psychotherapy—and all mental healthcare—when people no longer need another human being to be heard?
Because some already don’t.
Early research already suggests AI tools can reduce symptoms of depression, anxiety, and distress for some users.
AI is Everywhere
AI has entered everywhere, for the better and also with its awfulness. I use it all the time—for administrative tasks it’s amazing; A letter or email in 30 seconds; a survey questionnaire almost perfect; an outline for a talk as an able assistant. I get it. AI offers quick and useful solutions with endless energy.
One patient told me, he is talking to Claude when he is troubled and can’t sleep . Another patient uses it regularly to correct my minor mis-statements with the pleasure that only a patient with narcissistic personality disorder can truly enjoy.
Already, Artificial Intelligence (AI) is radically changing mental health care and the way I practice.
Contradictory Thoughts
AI is already improving access to care for many who have few options. However, it will blur the line between offering informational support and the treatment that comes with psychotherapy. For some, it creates the illusion of being known without the benefits of real relationships.
And yet with all that AI offers , I am so unsettled.
Clinicians Argue: Will AI Replace Us?
AI Can’t Replace Us? Many seek consolation believing that AI can’t replace what psychotherapy offers. They argue that psychotherapy is not just about knowledge and solutions; it’s about being heard, sharing pain, finding the inner strength to develop abilities, stay accountable to their values and find life’s meanings. People need to feel that they matter. These are thing psychotherapy does well.
Or can it? But in ten years with a tenfold increase in AI’s ability , will we really be able to differentiate the human from the machine? Will that distinction even matter?
What Unsettles Me Most
What is even most disquieting to me it that six people are controlling almost all of our AI future.
Mark Zukerberg—Facebook
Elon Musk xAI (Grock)
Sam Altman— Open AI (Chat)
Dario Amodei — Anthropic (Claude)
CEO Satya Nadella — Microsoft CEO (Co-Pilot)
Sundar Pichai — Google/Alphabet CEO (Gemini)
Can we really trust the judgement of these people with virtually no ethical oversight from mankind?
I am genuinely worried. Are you?
Other Recent Articles of Mine
Robert E. Feinstein, MD
Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell
Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com
Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com
Thanks for reading! Subscribe for free to receive new posts and support my work.
The American Psychoanalyst published an encouraging piece in Feb of this year titled “skin in the game.” It’s true that one can get quite a lot of validation, advice, education from the chatbot. More perfectly worded than ours. And even worse - “ The danger is that these systems will quietly reshape our expectations of what it means to be met by another mind.”
Where it will fail? And perhaps ultimately increase the burden of disrupted relationships, personality pathology, and human suffering? (Something I feel is almost akin to pornography) - AI will never, ever feel. It will never take real human risk.
“Empathy without skin in the game may feel comforting. It may even feel helpful. But it cannot replace the difficult, vital work of being in a relationship with another vulnerable human being. It is in the “hand-crafted” messiness of our attempts to be understood—the tremor in the voice or the awkward pause—that we signal to the other that they actually matter. That risky, imperfect, and costly labor is the very thing psychoanalysis exists to protect.”
Yes, I did 25 years ago, but NOT out of rage.
Bottom line:
My brain could no longer deal with the Cognitive Dissonance my brain sensed everywhere.
At age 50, I still had a lot to give SOMEPLACE.
I had frequently said, in frustration, "I would rather do this for NOTHING than go through what it takes to do this."
I liked my small town elderly patients. I had good specialists at a good hospital 10 miles away, on a very good highway. A hospitalist there sent my patients back to me.
I recalled that most pleasant people I had encountered could not imagine that "I LIKED to take care of sick people! " (their words.)
I had gone into medicine to become part of a community. By 1979, that possibility had long ago disappeared.
I grew up in abject poverty. People in my small West Texas town had supported me emotionally.
I wanted a house in a decent part of town. (No rich folks there.)
A car that did not break down wherever it went.
Be able to buy 4 new tires without a financial crisis.
I liked the luxuries, the travel, but they were not essential.
A recently retired businessman helped me untangle myself from rental properties, put everything into mutual funds