The Empty Promise of Therapy Without a Therapist

Therapy can involve a lot of words, but it’s often the pauses that matter most.

If you transcribed a session, the pauses would look like nothing: beats of silence, extra breaths, slowing down.

But these can represent the crux of the practice: entry points into feeling.

My job as a psychoanalyst is to listen as much to silence as to words, to be present with the patient while they’re quiet—to stay with them as they allow their feelings to emerge.

I was trained across diverse theories and techniques, but in my clinical work I have found that the cornerstone of the process is feeling.

The patient’s emotional experience is the destination and the terrain.

But I also feel; I am moved.

And the work I do with my patients relies on our relationship and our capacity for mutual feeling.

In many ways, the history of my field from Freud on has been a growing acknowledgement of the reality of this relationship—moving from the therapist as sealed off and standing apart, toward approaches that view the real human relationship between patient and therapist as the territory where healing happens.

Now the rise of the AI therapist is upon us.

The growing cadre of AI mental-health services tend to avoid using words like therapist and therapy .

They say that they do not replace professional help and that they can refer users to human therapists if needed.

But their positioning as a therapy-like service is clear.

In June, the therapy giant Talkspace launched its AI mental-health agent, Tee, “developed to help individuals navigate life’s daily mental health challenges.” Then there’s Ash, which offers to support your “emotional wellbeing,” helping you to “connect the dots between thoughts, feelings, and behaviors.” Abby promises to be “warm, thoughtful, and direct” and to help you “work through the kinds of everyday emotional challenges that often go unspoken.” And Headspace’s Ebb advertises: “Stressed at work? Family drama? Trouble sleeping? Ebb can help you unpack what’s on your mind and move forward with more clarity.” When I reached Talkspace for comment, a company spokesperson told me in an email that Tee is “absolutely not a replacement for human therapy.