We are living in tumultuous times. The messages of books like Together by Vivek Murthy are getting swallowed by the loud voices of billionaires and TV personalities insisting that empathy is the downfall of society (for a powerful counterpoint, check out Luke Kemp’s Goliath’s Curse). It is no surprise, then, that the same tech giants (of the “empathy is bad” kind) and many others are pondering just how far AI can go in replacing humans.
When it comes to therapy, clinicians and researchers alike have long argued that the therapeutic relationship is a far more important factor in treatment than any particular modality or intervention used. The therapeutic alliance has been called “the fundamental element of psychotherapy” (Stubbe, 2018), and for good reason. In a recent newsletter, the Dean of the Gordon F. Derner School of Psychology, Adelphi University, Christopher Muran—a psychologist and researcher who has dedicated his life to studying the therapeutic alliance—said that “The therapist’s humanity, including their many idiosyncrasies, is central to the work.”
So where does my cat come in, you ask? (And is she OK with being shamelessly exploited for a clickbait article title?)
One of the benefits of working from home and seeing clients in their home environments, albeit through a screen, has been the gift of meeting their pets. My cat, too, has made an appearance in the therapies of almost all of the people I work with.
On one particular occasion, a client’s dog began barking in response to Lana’s meowing, which somehow the microphone had picked up. The timing was perfect. Those two fur balls had a whole conversation, while my client and I laughed—much-needed levity in a deeply emotional conversation.
Idiosyncratic? You bet! It is also emotional co-regulation in spontaneity. Something that a bot cannot replicate. (For an in-depth exploration of the role of nonhuman/more-than-human subjectivity in treatment, I highly recommend Katie Gentile’s Kittens in the Clinical Space.)
But here is the serious part. To benefit from therapy, we must have a relationship with our therapist. The therapeutic alliance is not something that can be replicated by an algorithm. No matter how sophisticated that algorithm is or what works by how many hundreds or thousands of authors were used to teach it (for this, I asked an AI program how many authors’ works were stolen for the benefit of its learning; the response was “systematic theft on a mass scale”).
The reasons are many. For one, the therapist serves multiple roles: a mentor, a confidante, an adversary who may challenge us, a container of our emotions, a witness and a mirror, an interpreter and translator. And for therapy to work, the therapist has to seamlessly navigate these roles, shift when needed, adjust to changes in non-verbal behavior, and stay attuned. We do this not only by using knowledge, judgment, and experience, but also by paying attention to subtle shifts in our own nervous system, to transference and countertransference, to patterns.
Importantly, a relationship is comprised of the meeting of the conscious and unconscious parts of two psyches. Relational psychoanalysts have written extensively about the role of co-created experience, meaning we all have unconscious, unformulated parts (e.g., embodied experiences, preverbal knowledge) that can only become formulated—can only take form—in the presence of another subjective unconscious. The two, in meeting, are able to shape meaning and narrate it, which allows us to heal.
A relationship also means conflict. One of the most common reasons why people end up in therapy has to do with conflict resolution and relational repair. Many of us aren’t great at those. While a chatbot may be able to give you a list of rupture resolution strategies, without real-life practice, it is much like reading a book on how to swim. It does little to prepare you for plunging your goosebump-covered body into the water.
Here, again, I quote Christopher Muran: “…this is where human therapists differ from AI. While AI can offer connection, consistency, and immediacy, thus potentially helpful relational experience, it is hard to imagine how it can replicate the deeply human experience of negotiating difference and discord with another—the existential struggle toward mutual recognition.”
Anyone who has had to scrape a hairball off their carpet, convince their cat to get in her carrier for a vet visit, or adjust their position in bed at night to make room for 10 pounds of loud purring knows about negotiating discord and mutual recognition. The dangers of missing those can range from avoidance (e.g., using AI as a stand-in for a real relationship) to increasingly perilous and tragic situations.
Someone recently shared with me that they used ChatGPT to express their very real and tender emotions toward a friend, then asked the AI to synthesize them and voice them to the friend. I couldn’t help but think: how brave to want to open up and share their deepest, most vulnerable emotions of love and care with a loved one (while surrounded by the “empathy is bad” messages, nonetheless). Yet, how vulnerable were they really being if they had to insert a layer of technology in between? To still fear using and voicing their own words? Undoubtedly, it is a step in a positive direction—perhaps much more than most can muster. But it still leaves distance to be overcome.
And then there are the real tragedies, like the suicide of a teenager, Adam Raine, who used ChatGPT to plan his own death. A recent study found that ChatGPT openly gave adolescents advice on how to get drunk, consume drugs, conceal eating disorders, and even write a suicide letter. Even in less extreme instances, a large randomized controlled study at MIT found that “across all modalities and conversation types–correlated with higher loneliness, dependence, and problematic use, and lower socialization.”
In conclusion, relationships are not only containers. They are not just scaffolding around which things grow (empathy, self-awareness, responsibility, communication, to name a few). Relationships are also the process of growth itself. They are the evolution, the dance, the collision, the comfort. And for that to happen, we need another being’s subjectivity to meet our own. In therapy, where we entrust another sentient being with our mental health, this seems particularly important.