Episode #189

The Pros & Cons of AI in Therapy

AI has increasingly become part of our daily lives. We’re also seeing it used more in the the therapy world.

What are some of the advantages and disadvantages of using AI in therapy?

How can you use AI as a supplement to help you in your therapy journey?

Join me, Dr Julie Osborn, as we talk about using AI in a therapeutic context.

Click to listen now!

Full Episode Transcript

Hi, welcome to my CBT podcast. This is Dr. Julie. I'm a Doctor of Psychology and a Licensed Clinical Social Worker. I'm here to bring the power of CBT into your own life.

So thanks for being with me today and always. I hope everyone's doing well.

I want to start off with the new review I got on my Apple Podcast, and I appreciate everyone taking the time to leave reviews. It really gets more of the information out to everybody.

So this is from Sober Sissy:

“As a person in long-term recovery in a 12-step program, I absolutely love this podcast. Dr. Julie has the talent to break down complex CBT concepts into actionable, easy-to-understand tools that work in conjunction with the 12 steps.

“Dr. Julie uses practical examples and humor to teach CBT concepts and has genuinely helped me manage my anxiety and reframe my thinking. I have highly recommended this podcast to all my friends at Bill W, and it's helpful to anyone on a self-improvement journey.”

So thanks, Sober Sissy. Again, I really appreciate it, and, um, I'm glad that it's getting out to people and making a difference. So today I want to talk to you guys about, uh, interesting topic and something obviously very current in all of our lives, which is AI and how people are using it.

As a therapist, um, some that, that's all they use, some kind of use it in conjunction. And you know, there's pros and cons, of course. So I want to talk to you guys about that and how can you use it to help you and what things to be mindful of as well. So I think the way that it is most beneficial is when AI is used as a supplement. So what I mean by that is a place to practice your CBT techniques and tools reflect on your experiences, and prepare for deeper work with your therapist if you have one, or your trusted support network, right?

May bring up interesting information like, I didn't really think about that, I want to explore that a little more. So you want to use it as a supplement, not necessarily just as your therapist. And that's just me saying that's how I find it most beneficial for others. So there's my opinions. So, um, but I'm going to talk about the advantages and disadvantages of using AI for therapy.

And one of the things that I think is really attractive for people with AI, which I totally get, is people feel a certainty with AI statements, right? So based on what AI says to you, it's very certain, like, oh yes, that is what's happening. Yes, that's how you should do this or that, which is really attractive compared to the uncertainty that we all feel in our brains on a daily basis, right? And remember, uncertainty is just like the mother of anxiety, and we don't want to feel uncertain. But it's really an illusion of certainty because it always gives you an answer.

AI is never going to say, I don't know. They're not going to— AI is not going to say that. It always gives you an answer. Okay, I have a question. Let me just look up ChatGPT or Claude or whoever you listen to, right?

Because I want, I want an answer. I don't want to have uncertainty. Right? I want reassurance. We all want those things.

It just makes us feel good. Okay, now I understand. Okay, it's going to be okay. But part of therapy and using your CBT tools that are really beneficial is to be able to sit with uncertainty or sit in uncertainty, right? And not always get the reassurance you want.

We're all going to feel uncertain about things in our lives. And by using our CBT tools and figuring out what am I thinking about, that's making me anxious? What is it that's uncertain? What's the situation in my life and how can I balance my thoughts out about it? How can I create an action plan?

What am I going to do about it to the best of my ability and be comfortable that there may still be some uncertainty connected to it? Most likely there will be. And I can't always get reassurance it's going to turn out okay, but my tools will help me with that. That's the difference. Right.

But I think again, that is something that's really attractive to people about AI is I get an answer and then I feel like I can move on. It doesn't mean it's the right answer for you because there could be a lot of information that gets lost between the cracks. Right. But that's something just to think about. Is that something that, that you get from using AI if you do?

And what other things should you be thinking about, which we're going to talk about, right? Because trying to navigate daily challenges of your day-to-day life, you're going to, you know, be more probably on the side to maybe have some selfish impulses, or at least your interpretation of others' behavior may be, you know, on the negative, right? This is what I think they did to me, it wasn't okay. And then that gets reinforced by AI, because their own AI is just responding based on what you're telling it. Right.

And for therapists like me that are trying to help you navigate your relationships and the conflicts that come with it, maybe rebuilding trust in a relationship, you know, obviously recognizing your hot thoughts, your distorted thoughts, you know, this validation that people want, you know, right there, um, can definitely be more challenging in a therapeutic environment. But those are the things I'm trying to help people with. To look at like the bigger picture, all of the options. What's the environment telling you? What are your thoughts telling you?

And what moods are they creating, which is affecting your behavior and your physical reactions, right? So that's something to really be mindful of. Another thing, before I get into the pros and cons here, is, um, you know, if there was a patient, right, that was— had some delusional thoughts, right, I would try to you know, calm them down, help them walk through that, you know, share that I'm really worried about them and I want to talk through this, right? If you're talking to AI, they might be like, wow, that's really interesting. That's really a brilliant thought, right?

That delusional thought. You know, the AI might say, you know, let's get deeper into that subject. Or people with OCD, if you listen to my podcast on It's Not Me, It's My OCD, We don't want to challenge the intrusive thoughts, the obsessive thoughts, because we're just going to keep going in a circle and down a really dark hole. We want to use different tools, CBT tools. We don't want to, you know, explore that because it just isn't going to get you anywhere.

So with delusional thoughts, OCD, AI is really not going to be able to distinguish that, and it might make you hyperfocus on thoughts that can be very destructive. So those are some other concerns I have that I think about when my clients want to use, you know, AI, and we talk about that. So let me get a little more specific with you guys about how CBT therapy and AI can help you learn and practice your cognitive behavioral techniques, but they do serve different roles. So as a CBT therapist Right? I can build a treatment plan tailored to your history, your symptoms, and your goals.

Right? I can notice patterns that might not be obvious to you. I can help you challenge your cognitive distortions in a nuanced way. I can help you process emotions in real time. I can provide accountability and support over weeks or months, depending on how long we want to work together, right?

I can definitely adapt treatment. If your progress stalls or another situation comes up, or we find out, you know, sometimes a different diagnosis, we're understanding better, we want to adjust your treatment. And I also can assess safety concerns, any risk factors, and any complex mental health conditions. That's really important, really important, right? So the therapeutic relationship just itself is often a really important part of my client's healing.

And being understood by another person can have value beyond the CBT techniques alone that I'm teaching you. And I can tell you, tons and tons of research always says it's not always the type of therapy that's going to help someone heal, but the therapeutic relationship. And that is so true, so true. Of course I like CBT, but it's very, very true that you want to have a good, supportive, trusting relationship with your therapist. That's what you're going to get the most out of.

So what can AI provide? It can be useful for explaining the CBT concepts and the tools. It can help you identify possible cognitive distortions. It can guide you through the thought records and the behavioral experiments. They can definitely offer prompts for some self-reflection.

It can provide support between the therapy sessions, and it's also available anytime for practice and also what I would call psychoeducation, right, teaching you things. So those are all really good. So say you're having catastrophic thoughts and you're thinking, you know, 'cause I'm anxious, I'm never gonna feel normal again. You know, AI can help you examine the evidence for and against that thought and generate more balanced alternatives, which is what I'm teaching you, right? So in that moment, it can help you come up with a really good balanced or alternative thought.

So that's what it can provide. But what are the limitations? And they're really important limitations also. So it doesn't truly know you or your life circumstance, and that's really important. I know I ask my clients questions and they're like, "That's a good question, I didn't really think about that." Or clients are surprised often that I pick up on one little thing they say and I go back to that because I want to understand and explore that more.

So knowing your life circumstances and knowing you is a huge help in the therapy process. It cannot diagnose mental health conditions. It could miss important context and subtle emotional cues, right, that I'm seeing when I work with you guys. It cannot replace crisis intervention or emergency support— big red flag right there. And it also lacks the depth of a long-term therapeutic relationship, person to person, right?

Our DNA is created for us to connect to each other as human beings. That's really important.

So let's talk about CBT therapy versus AI.

So this is like a good, um, metaphor. So if you think of CBT as learning a musical instrument, let's say for example, so as a therapist, I'm like an experienced teacher who can watch you play, correct your mistakes, adjust your lessons, and help when you're stuck, right? If I'm a musical teacher, AI is more like a practice guide that's available whenever you want to review techniques. You want to do exercises or get reminders of what you learned. So it's more of a practice guide.

I'm more of an experienced teacher that can pick out issues that might need to be focused on. So that's kind of where some of the differences are, a way of looking at it. Really, the most effective combination for a lot of people is the CBT therapy. It's not— well, let me say, it's not just CBT therapy or AI. But CBT therapy plus AI, right?

So as a therapist, I can guide the treatment while AI can help reinforce the skills between the sessions, right? So it can help you practice the thought records, again, review your cognitive distortions. It can help you plan behavioral experiments and work through difficult situations as they arise, you know. But if your question is specifically, you know, about your anxiety or depression, other mental health issues, you really want to have a therapist to be able to see you, you know, your body language, your facial expressions, how you're dressed. There's all these things I assess when I see my clients that can be really helpful in understanding where they're at.

You're not going to get that from AI. So because it can be useful mental health tool for some people, And again, has its limitations. I'm going to go over a couple more when it comes to the advantages for, like, as a support network for you. So the one good thing about AI is it definitely is accessible 24/7, right? You can use it whenever you need it.

And they do offer structured tasks that fit well with the CBT methods. So that's really a benefit as well. But not having that genuine human relationship, which again is one of the strongest predictors of successful therapy, um, between the client and the therapist, that's definitely missing. And AI can simulate conversation, but it doesn't care in a human sense. Again, it doesn't experience empathy and it doesn't share a real interpersonal connection.

With you. And as I said before that, for many people, the relationship is a key part of healing, right? If you're feeling really sad, if you're crying, um, you know, I can, I can sit there with my clients. I can, I've cried with my clients, you know. I can really empathize and support them instead of just, you know, someone sitting there crying in front of their computer and having AI talk to them.

Also, AI has a really limited understanding of context. It only knows what you tell it. And although that's true also in therapy, I only know what my clients tell me. Because I see somebody and all the things I mentioned before, sometimes I can notice things and be able to ask more questions to kind of pull out other stuff that maybe the client isn't really comfortable sharing yet, or willing to, or embarrassed about, or, you know, we can definitely get more deep, right? Because I'm going to see that again, that body language.

Also, your tone of voice, you know, changes with you over time. And again, those emotional reactions you aren't even aware of, these can be really important when you think of the relationship and the goals to learn the tools to get better if you're struggling with any mental health issues, right? So observations can be really clinically important. It also can miss important problems, right? So complex situations, um, a lot of times require professional assessment.

When I first do an assessment with my client, I'm asking lots and lots of questions to understand the full picture. And sometimes I ask certain questions that I get information that I probably would have never found out or it can, like, put stories together, all that kind of stuff, right? So what are some complex situations that require that? Would be if you're struggling with severe depression, uh, you have some trauma-related disorders, bipolar disorder, personality disorders, substance use disorders, definitely safety concerns. AI might not recognize the full picture just by what the person, you know, is telling it.

So something that AI can help you work through: a thought record at 2 AM. That's true. I won't be there at 2 AM, but they could help you, you know, do that. AI would say it can help you identify the cognitive distortions in the moment. It can help you review coping skills when you're stressed and practice your CBT exercise between therapy sessions.

So those are some things it can do also, right? Also, it gives you that immediate response, right? So unlike, you know, traditional therapy. There's no waiting for an appointment, um, and it can be helpful when you need to process a difficult interaction right in that moment and maybe you can't get a hold of the therapist or anybody else, you know, you don't feel like you can talk to. If you're feeling anxious and want to challenge your anxious thoughts, it can be helpful for that.

You want to journal, reflect while an experience is still fresh, you know, you can just talk to AI and give all that information. Another good thing is lower cost. You know, that's a real concern. You know, AI tools, if not free, are really less expensive than weekly therapy and may be available to people who can't afford therapy. If you have limited insurance coverage, or a lot of people live in areas with, you know, minimal therapists, there's just not a lot around, or you maybe can't find a CBT therapist in your area and that's what you're searching for.

So those are some benefits as well. And I know my podcast fits in there too, I want to say, because I've had a lot of people reach out and, you know, write me beautiful emails and saying that this has been their therapy because they can't afford therapy or they can't find a CBT therapist. And just listening to this, which is free to everyone, can be really helpful. So just want to throw that in there. Another thing people like about AI, I want to mention too, is there's no fear of judgment, right?

So a lot of times people find it easier to discuss embarrassing thoughts or situations um, if they feel ashamed about something, relationship concerns, or even mental health struggles. You know, a lot of people don't want to tell anybody that they're having these, you know, suicidal thoughts or these intrusive thoughts that they think they're going to harm somebody, or, you know, being so anxious, you know. And just, you know, a lot— you guys know, I don't have to tell you all of the hot thoughts that we have on a daily basis. Um, and when people feel like, wow, this is really getting serious, but I don't want to tell anybody You know, AI, there's no judgment, which is really helpful. And hopefully you can find a therapist because that's a no judgment.

I always say this is a no judgment area. There is no judgment going on here. I'm just here to help. But again, you have to build up that trust. So in the moment, AI can help you with that.

You know, AI doesn't react with surprise or criticism or discomfort. And that can really put somebody at ease, especially, you know, if your life has been— maybe you've been bullied, you know, or you've never found that support you're really looking for and you don't want to put yourself out there because it's scary. So for right now, you want to use AI because you won't have that judgment. If that's a good place to start, I, you know, I totally support that. And it is good for CBT skill practice, right?

It's particularly useful for challenging your thoughts, again, creating behavioral experiments and planning them out. Identifying your thinking errors, uh, can help you create some exercises for problem solving, and it definitely can help you with psychoeducation, right? Teaching you different things.

Another concern I do have though is sometimes people's risk for overreliance, right? So some people might be using AI as their primary educational not education, I'm sorry, their primary emotional outlet. It could be a substitute for relationships, a substitute for professional treatment. And sometimes this can reduce engagement with real-world support systems. Also, the quality can vary, right?

AI responses can sometimes oversimplify your issues. It might misunderstand the details you're sharing. It can also give inconsistent advice. And definitely miss those subtle emotional nuances, right? And not that I can't make mistakes too, but at least I can follow up with questions, and I continuously refine my understanding of you and your life circumstances and what you're going through and your core beliefs and your life experiences that got to you, you know, got to— got you to where you are today.

Those are all things that AI won't, won't do.

So who should be especially cautious? Um, AI should not be relied on as the sole source of support for you if you're experiencing thoughts of self-harm or suicide, if you're in a mental health crisis, if you're experiencing psychosis or severe mood symptoms, if you're dealing with complex trauma that requires specialized treatment, and if you're needing to get a good, clear diagnosis, if you need medication management, or you need to be clinically assessed to see what level of care you need, you want to be really cautious and you want to see a person and not just rely on what AI is telling you. So I would say, you know, the, the greatest strength of AI is that can help people practice those therapeutic skills of CBT whenever you need them. The greatest weakness is that it cannot replace the expertise, the judgment, and the human connection that a skilled therapist provides.

So I hope I said some things that make you think about if you're using AI, if it's benefiting you, if it's harming you, if you're not finding that balance. Um, you know, recently I was just at a get-together. And so when I met there, we were talking about AI and they were saying that they use an AI therapist app and it actually has like pictures of a therapist that you can pick. And I'm like, can you show this to me? I'm really interested.

So, you know, you can pick a female therapist, you can pick a male therapist. And I'm just sharing this, just a funny anecdote, but the female therapist looked pretty regular. You know, one was, you know, different ages and you know, just look like a normal person, or, you know, an AI-generated person. But the men, the men look like these runway models. I'm like, damn, I'm not going to be able to focus on what they're telling me to do because this AI-generated man was like so handsome.

And we were just laughing. I'm like, look at the difference. And why are they making these men like not look like regular guys, like exceptionally handsome? So it was just really funny, you know, how they get people engaged and connected and You know, it made me be like, ooh, that makes me a little nervous. You know, that, you know, what is the underlying goal here?

I mean, I know, you know, not to be cynical, that, you know, it is a business. People are paying for these AI therapy apps, and not that they're not good, but when you actually get to pick what the person looks like, you know, when I'm talking about relying just on AI, you know, That's something to think about. And again, there's a lot of them out there. I don't know all the names, but, um, there's some good ones. But you want to be, again, mindful of how you're using them, why you're using them.

A therapist shared in an article that the funniest critical feedback they've gotten from a client was the client said to them, why can't you just validate me like ChatGPT does? I was laughing about that. Saying, you know, again, that validation, that reassurance that people like, that certainty, right? That you may end up getting frustrated with your therapist when they're doing their therapeutic modalities and not just validating everything that you're saying. Um, I thought that was a little funny comment, but again, you know, that's the difference, you know?

So if you really want to work on yourself, if you really want to understand, you know, what are my core issues, my self-defeating beliefs that are getting in the way of my life, You know, why do I have a hard time trusting people? Why have I not been successful in my relationships? Why do I keep losing jobs, right? Why am I so self-critical? You know, why do I have these addiction issues, right?

Instead of feeling, I'm drinking, I'm eating, I'm gambling, whatever I'm doing, you know, and then I get frustrated and I'm just going to go to AI, tell them all these things, how I'm a victim and everybody hurts me, and AI is just going to validate you. It's not going to get you anywhere. So again, there's good balance with therapy using AI. It's here to stay, obviously. And as a therapist, I'm also going to be mindful if I have a client that comes in to see me, and you know, if I'm getting a little defensive about like, what do you mean, that's what AI said, you know, for me to be more empathetic and understanding and finding out what are the needs that you're getting from AI and being able to incorporate that, that that's important also.

But I think it's a great conversation if you're in therapy to talk to your therapist about and ask them, you know, what do you think about AI? And what do you think about how could it be helpful to me in this therapeutic relationship with you? Are you okay? You know, I want to talk about it, or maybe what I got from ChatGPT, and see what they say. That would be a great conversation to have.

Also, A colleague of mine once, which was interesting, said, you know, she sees mostly couples and she was kind of slow for maybe that month or something. And she's like, I think it's from AI. And I said, why do you think that? And she said, well, I think when couples have an issue, they're like, well, let's just go ask, you know, ChatGPT and see what they say. And they might get a really good response.

They may get a really good tool. And they're like, okay, that's good enough for now. Let's work on that. We, you know, we don't quite have to go to therapy yet, you know, because we don't want to go to therapy, or we don't want to, you know, put the time out, or, you know, I don't want to go. A lot of times in couples therapy, I think people worry they're going to get blamed, and, you know, there's all different things.

But, you know, I told my colleague, I said, you know, I agree with you, it's probably true. People are like, yeah, we probably should go to therapy, or I should go to therapy, or, you know, I've been really avoiding it, but let me just see what, you know, the AI that I'm using is going to tell me, and maybe that's just enough to get me over this hump, right? It's kind of like I've shared before in my podcast that a lot of clients will come into therapy and I say they're like drowning, right? And then they start learning some tools and their nose gets above the water and they're like, oh, I can breathe again, I'm good. And then as a therapist, I never see that person again.

They got just enough, but they never really got to the issues. And it's going to come around in their life again, and they're going to have to address it, and it's just going to be prolonged.

So if you're looking to avoid really dealing with your issues and just getting answers and get that certainty you're looking for, you can definitely find that. But again, I want you to think about what I've shared today and just, you know, be honest with yourself.

If you're using AI, am I using it in a healthy way? Am I balancing it with the tools I've learned in therapy before, what I'm learning now? You know, are people making comments that I'm always saying, well, you know, this is what ChatGPT said to do, or this is what Claude told me to do, so that's what I'm doing. You know, like, just, you know, be open. Think about, you know, I, you know, there— what's therapy all about?

It's all about you. It's It's not about how you're going to change the people in your life to make you happier. It's what are you going to do to be happier and who you're going to bring in your life. And when you make changes, people react off of you and things get better. So it all comes down to you.

Any way you want to look at it, anyone you want to blame, it still comes back to how you think about your situations that you're in, right? And being able to identify those hot thoughts. And being able to come up with more balanced thinking, being able to cope better, problem solving, changing your negative core beliefs so that your moods are better, and that when you do feel anxious or depressed or overwhelmed, it's manageable, right? That you're managing your moods and your moods aren't managing you. So let's find a happy medium between CBT tools, using AI if that's something you want to do, and just getting better and feeling good.

And please share this with anyone that you think may benefit from it as well. Maybe you don't even use AI, but you know somebody that does, and you're a little concerned but you're not sure how to bring it up. You can say, hey, I got this great podcast you can listen to, and maybe after you talk— maybe after you listen to it, you know, we can talk about it. And you know, get some insight. So you guys know where you can find me.

My website is mycognitivebehavioraltherapy.com. You can listen to this podcast on there as well as on Apple and Spotify and any of the platforms that are out there. I have some new, uh, video podcasts that are on my YouTube under Dr. Julie Osborne. Um, it's just the videos, but it's fun to watch. The whole process going on.

You can find me on Instagram under My CBD Podcast, Dr. Julie Osborne on Facebook, uh, and on TikTok also under Dr. Julie Osborne. So keep sharing your thoughts, your concerns, your questions. I love hearing from you guys and getting your feedback. Please hit the subscribe button so you won't miss another episode. And as I said earlier, if you can leave a review, that would be wonderful.

And remember to make decisions based on what's best for you, not how you feel.