The Part of Therapy AI Can't Replace

Every few weeks, another headline asks whether artificial intelligence will replace therapists. Friends send me articles. Clients ask what I think. Colleagues wonder how quickly technology will change our profession.

I understand why the question keeps coming up. From the outside, therapy looks deceptively simple. One person talks, another person listens. There are questions, reflections, perhaps a few moments of insight, and something begins to shift. If that is what therapy is, then it seems reasonable to wonder whether an increasingly sophisticated chatbot will eventually do the same thing.

The conversation feels especially timely as more health insurance companies begin encouraging members to use AI supported mental health services. I understand the motivation. Access to care remains difficult, demand continues to outpace the number of available therapists, cost can be and often is a barrier, and technology has the potential to increase support for many people. I hope access to quality mental health support continues to improve because people deserve more support, not less.

I already use AI in my own practice. It helps me organize information, reduce documentation, create helpful visuals to make up for my absolute lack of artistic ability, and I get to spend less time behind a computer. I recommend it to some clients between sessions, particularly for executive functioning, breaking overwhelming tasks into manageable steps, organizing thoughts before difficult conversations, and helping people move through task avoidance. It has earned a place in my therapeutic toolbox.

What gives me pause is the possibility that people will begin believing they have experienced psychotherapy when they have actually experienced a different kind of support.

Support, reflection, education, planning, problem solving, and learning new skills all have an important place in mental health care, and AI is becoming remarkably good at many of those things. Those are valuable forms of support. They simply are not the same experience as psychotherapy. After more than twenty years in the therapy room, I find myself asking a question:

Do people understand what therapists are actually doing?

When a client begins telling me about their week, I am rarely thinking about what I am going to say next. I am paying attention in ways that often remain invisible. I notice whether they look different than they did the week before. I wonder whether the person sitting in front of me feels older or younger than their chronological age today. I notice how they are holding themselves, whether their breathing is shallow, whether their body seems organized or restless, and whether their words match what I see unfolding in front of me.

At the same time, another conversation is happening quietly in my mind:

What am I seeing that I'm not hearing?

What isn't being said?

Did something just change in their nervous system?

Are they becoming overwhelmed, or are they beginning to shut down?

Are they speaking from the adult they know themselves to be, or has a younger protective part quietly taken over?

Am I following the story, or am I still connected to the person telling it?

When parents sit in my office believing they are failing their child, they rarely need another parenting strategy. By the time they reach therapy, most have already read the books, listened to the podcasts, and searched the internet for answers.

Many are trying to become the parent they needed instead of repeating the parent they had. That work is courageous and lonley and is in need of an outside human.

Many parents quietly worry they are being too soft. They wonder whether other people see them as permissive. They question whether empathy and boundaries are enough to prepare their child for the real world. Sometimes those fears come from grandparents or extended family. Sometimes they come from the old beliefs they are still trying to untangle within themselves.

That is the moment I become most interested in.

I'm not focused on offering another parenting technique. I'm paying attention to the fact that children take in their parent's nervous system long before they take in their words.

Parents often need someone who can sit with their fear without rushing to fix it, someone who notices the love hidden beneath the guilt, and someone who recognizes that they are grieving the childhood they never received while trying to create something different for their own child.

Before they can help their child regulate, they often need to experience regulation themselves. Before they can offer themselves compassion, they need to experience what it feels like to be met with curiosity instead of judgment. Children borrow regulation from the adults who love them. That is why the work is rarely only about the child. Helping a parent become aware of their own nervous system is often one of the most meaningful ways we help a child. AI cannot do that.

The same kind of curiosity follows me into every therapy room.

An adolescent may tell me they are fine while their shoulders are tight, their breathing is shallow, and they haven't looked up since they sat down. Before I decide what intervention to use, I want to understand whether their body agrees with their words.

I wonder whether they are anxious, overwhelmed, ashamed, exhausted, or simply protecting themselves until they know whether this relationship feels safe. I wonder whether I am meeting the version of themselves they show the world, or the version that finally appears when they no longer have to perform.

Some clients genuinely struggle to identify what they are feeling. Others have spent years masking, adapting, or protecting themselves so completely that they no longer recognize the signals coming from their own nervous system. When I notice their body language doesn't seem to match the story they're telling, I don't assume I know why. I become curious with them. We begin putting words to experiences that have often lived in the body long before they reached language.

That is why I pay as much attention to the body as I do to the words.

Sometimes there aren't words at all. With children, the conversation often happens through play.

One idea that has deeply influenced my work comes from Lisa Dion's writing about what she calls "The Offering." That idea gave language to something I had been noticing for years. Every child is communicating something, even when they cannot explain it. Their play often tells us what their words cannot.

One child buries every figure in the sand. Another knocks down every tower they build. Someone carefully lines up animals before scattering them across the room. One child asks me to rescue every character. Another makes sure no one is ever allowed to help.

Rather than asking, "What does this mean?" my first question is usually different.

"What might this child be inviting me to understand?"

I don't rush toward interpretation. I stay curious. I join them. I pay attention to what is said, what isn't said, what happens in their body, what happens in mine, and what begins to unfold between us. Children are already telling us something, they're simply not using words yet.

In couples therapy, words are only one part of the conversation. Tone, timing, body language, hesitation, repair attempts, and the meaning each partner assigns to those moments all become part of the work that AI cannot do. Couples therapy expands my attention even further because I am no longer tracking one nervous system. I am paying attention to a relationship, and relationships begin communicating long before anyone starts telling me what happened that week. 

Before a couple has spoken a word, they have often already told me something. They may choose opposite ends of the couch or unconsciously place several pillows between themselves. One partner may glance toward the other with unmistakable longing while their voice carries irritation or criticism. Sometimes someone answers every question while looking only at me, never once turning toward the person they came to reconnect with.

As they begin talking, I notice whether they breathe, whether they blink, and whether their bodies become more guarded or more open. I pay attention when someone's words sound angry but their face reveals hurt. I notice when criticism feels more like a desperate bid for connection than an attack. I wonder what story each person has quietly begun telling themselves about the other. Have they decided they will never be understood? Have they begun expecting rejection before the conversation has even started? Are they protecting themselves from being hurt, or are they trying to find a way back to one another?

These kinds of moments help me understand what each partner is experiencing, what the relationship has come to expect, and where hope for repair still exists. My role is never to decide who is right, but it is to help each person understand what is happening inside themselves, what is happening inside their partner, and what is happening between each other.

AI can support, educate, reflect, brainstorm, problem solve, and teach new skills and all have an important place in helping people. Psychotherapy itself something different.

Over time, therapy becomes a relationship where enough trust has been built that I can begin noticing the places where a client's story no longer serves them. I can gently challenge a belief they have carried for years. I can help them challenge their own perceptions. A therapist sometimes has to lovingly say, "I don't think that's true."

Or, "Can we consider another possibility?"

Those moments are often uncomfortable. But they are often the moments that make change possible.

That kind of work depends on trust. It depends on knowing when someone is ready to hear something difficult without becoming overwhelmed or ashamed. It depends on a relationship that has been built carefully enough that challenge is experienced as care rather than criticism. Without that relationship, the very same words can feel invalidating or even harmful. Within a trusted relationship, they create space for growth.

That is one of the places where I believe psychotherapy remains uniquely human.

Artificial intelligence can organize information, teach skills, offer reflection, and help people think through problems. Those are meaningful forms of support, and I believe they will continue to improve.

Every time someone walks into a therapy office, they are asking some version of the same questions.

Am I too much?

Am I not enough?

Will you still stay if you know all of me?

Those questions are rarely answered by advice alone. They are answered over time by a relationship built on attention, curiosity, honesty, and trust, and knowledge. They are answered by someone who is willing to stay present long enough for another person to begin seeing themselves differently.

I hope AI continues to become one of the helpful tools we use. I hope it expands access to care, reduces administrative burdens, and helps more people find meaningful support outside of session.

I also hope we never forget the difference between a tool and a therapeutic relationship.

Tools support people.

People heal people.

*Alexa Griffith, LMHC, LCAC, NCC, RPT is a Licensed Mental Health Therapist. Alexa enjoys providing individual counseling and family counseling. She also provides play therapy for children, as well as teen and adolescent counseling via telehealth or in office. Alexa's practice serves the Indianapolis area, including Carmel, Fishers, Noblesville, Zionsville, and Westfield. Learn more at AlexaGTherapy.com