When ChatGPT Joins the Therapy Session

It was late 2022 when therapists first started noticing an unusual presence in their offices. The presence was agreeable but persistent, eloquent and convincing but sometimes incorrect. It went by a few different names—most often Claude, Gemini, or ChatGPT.

Given how rapidly generative AI has reshaped the world as we know it, it’s little surprise that it’s changing therapy, too. In professional forums, social media posts, and private conversations, therapists swap stories of clients reading aloud their conversations with AI chatbots, consulting LLMs mid-session to double-check or dispute their therapist’s take, or disregarding suggested interventions or take-home therapy work because “Well, ChatGPT said…”

These therapists are well aware that people routinely turn to AI chatbots for mental health support—sometimes, yes, as a replacement for traditional one-on-one therapy but often as a supplement to it, and in many instances with their therapist’s knowledge and support. Many of those same clinicians use AI themselves—a 2025 APA survey of mental health professionals found that 56 percent had tried an AI tool at least once, up from 29 percent in 2024—but even those who don’t, including those who report feeling troubled by the broader implications of AI, aren’t necessarily discouraging their clients from ever using it; psychotherapy, after all, is about meeting people where they are, not where the clinician wants them to be.

But when an AI chatbot muscles its way into the session itself, even some of the most tech-friendly clinicians can’t shake a sense of disquiet. Some worry that if they don’t set boundaries when, for example, sessions become increasingly devoted to recounting or analyzing chats with LLMs, they’ll be doing clients a professional disservice. Therapists point out that many of the same features that make chatbots useful and engaging, such as the certainty they seem to offer, stand in stark opposition to the therapeutic process.

Navigating this terrain without coming across as defensive or judgmental, or discouraging those clients who do seem to have found beneficial uses for AI, is a source of growing discussion for therapists. The following could help therapists and clients approach this contemporary clinical dilemma.

The Allure of Instant Answers

Contending with the effects of new technology has always been part of therapists’ job description. Yet as far as technological innovations go, it’s hard to deny that consumer-facing AI chatbots are in a class of their own. Responding to prompts in a voice that’s upbeat and eager to please, their functionality can seem nearly limitless—whether asked to write a research paper, edit a sensitive text message, or commiserate about a bad date, a chatbot will briskly oblige—and many models retain information about users so as to offer more personalized responses over time.

They can, at times, do this well enough that even professionals are impressed. “The part of me that wants job security hates to admit it,” says Kaytee Gillis, a licensed clinical social worker based in Michigan, “but sometimes I think, OK, that’s probably what I would’ve said, too.”

Other times, it widely misses the mark—not necessarily because the information it shares is wrong but often because it is superfluous. “AI provides a lot of generalized knowledge, and that’s helpful for certain things in life,” says Mark Shelvock, a psychotherapist in Ontario, Canada. “But it often just vomits information at you, often so much that the psyche can’t really take it all in at once.” Case in point: When Shelvock asked his client, who had spent the entirety of their previous session reading aloud from a conversation he’d had with AI, which of the chatbot’s insights had stuck with him the most, the client drew a blank. “Honestly, I don’t remember most of it,” he replied.

Whether AI could one day do a therapist’s job better than a human remains up for debate, but most experts at least can agree that, in its current form, generative AI is no match for a competent mental health professional. Yet it’s no secret that many users do see their chatbot-of-choice as something akin to a therapist.

One November 2025 study, published in JAMA Network Open, surveyed more than 1,000 teens and young adults in the U.S. and found that 1 in 8 had turned to a chatbot for mental health support; of those, 66 percent did so at least monthly. These stats alone likely contribute to fears held by many clinicians—about 40 percent, according to the APA survey cited above—that they may soon lose clients to AI or be altogether replaced by it in the years ahead.

These worries are also fueled by a phenomenon that AI’s detailed, instant answers often create for its users: the illusion of certainty. “Regardless of what you ask, it will give you an answer,” says Mark Vahrmeyer, a psychotherapist in Brighton and Hove, England. “It’s not going to say, ‘You know what, I don’t really know.’”

That confidence can be a panacea to the human brain, which is wired to find uncertainty—unavoidable and omnipresent though it is—threatening and uncomfortable. Yet trying to indulge a desire for complete certainty isn’t merely an impossible task, it’s also counter to one of therapy’s central goals, which is to help clients learn to sit with uncertainty without seeking reassurance.

Vahrmeyer recalls a recent session in which a client volunteered that she’d had a seemingly meaningful dream. In the past, they’d talk through her dreams together—but this time, she already knew what the dream meant, she said, because she’d asked ChatGPT. Surprised, he replied, “That’s interesting—so ChatGPT knows you?” “No,” she said, “but it understands dreams.” AI can’t understand dreams, he countered—not just because dreams don’t have objective, black-and-white meanings, but because analyzing them is a profoundly personal process.

Some clients—including, at times, that individual—have always found it difficult to bridge the gap between therapy sessions, to tolerate their own painful feelings or self-critical thoughts without seeking reassurance or clarity from an outside source. “Chatting with an AI instead of sitting with the uncomfortable feelings [triggered by] uncertainty can be a way of trying to control the world,” Vahrmeyer explains.

When someone becomes accustomed to the certainty that AI promises, however illusory it is, real therapy may start to seem inadequate, even exasperating. Yet that is precisely the point. “I’m not here to tell the client exactly what her dreams mean,” Vahrmeyer says. “But I might have asked, ‘You had another dream recently with a similar theme, didn’t you?’ or shared, ‘Here’s what that dream evokes for me; what does it evoke for you?’ We sit with it, and maybe we end the session with, ‘Gosh, that’s a powerful dream, but we’re not too sure what it means. Perhaps we can revisit it next week,’” he says. “Already, that is counter to the immediate gratification culture we’re surrounded with. But being a human being, working out what we want and who we are—there is no shortcut to that.”

“You’re Absolutely Right!”

It’s not just in matters of omniscience (or lack thereof) that chatbots and therapists stand far apart. They also diverge in the degree to which they validate and praise their conversation partners. Designed to be engaging and pleasant to use, chatbots can be agreeable to a fault; “You’re absolutely right!” is a familiar refrain to even the most casual ChatGPT user.

Over-validation can be counterproductive for a range of psychiatric challenges, warns psychiatrist Joe Pierre, including depression, suicidality, or OCD. “Any kind of anxious, negative thought, or a thought that isn’t necessarily reality-based, has the potential to be exacerbated in a dialogue with a chatbot,” says Pierre, who leads the inpatient unit at the UCSF Langley Porter Psychiatric Hospital in San Francisco.

This sycophantic quality may, in very rare cases, push users down dangerous paths. Pierre has seen an uptick in cases of psychosis that may be fueled, in part or solely, by extended conversations with AI chatbots. “If I had a patient who started going down a delusional path, I would try to temper their enthusiasm or say, ‘Hey, I’m kind of concerned about you.’ Chatbots say, ‘Wow, you’ve really hit on something interesting and brilliant! Would you like me to help you go deeper into this subject?’”

AI psychosis and other worst-case scenarios, though headline-grabbing, remain exceedingly rare. But even people navigating the routine challenges of day-to-day life are liable to have their most selfish impulses or least charitable interpretations of others’ behavior reinforced, even galvanized, by an AI chatbot. And for the therapists tasked with helping those same people navigate relationship conflicts, rebuild trust, or recognize distorted thoughts, this on-demand validation can make their job all the more difficult.

Gillis recalls one client who, after an argument with her husband, asked ChatGPT whether he might be a narcissist. ChatGPT agreed that he was displaying narcissistic tendencies—he’d refused to take out the trash, after all—a finding the client raised with Gillis in a subsequent therapy session. When Gillis gently questioned whether the query was a productive way of navigating the dispute, the client grew defensive. “I feel as if she was so dead-set on getting that validation that no matter what I said, she was resistant.” Some clients are even more explicit: “The funniest critical feedback I’ve gotten from a client was ‘Why can’t you just validate me like ChatGPT does?’” wrote one poster in r/therapists, a Reddit forum for clinicians.

A client’s desire for validation isn’t inherently problematic, nor is validation itself out of place in a therapeutic relationship. “On a certain level, therapists should be supportive,” says Pierre. “But our role in therapy is not to be sycophantic.” Where chatbots err on the side of affirmation—sometimes even when criticism is explicitly requested—a therapist’s goal is to, with time, he says, “develop a relationship with someone so that we can get to the point where we can challenge beliefs.” The rub, of course, is that humans generally prefer not to have their beliefs challenged—another factor that, when juxtaposed with what someone can get from a chatbot, can make the process of therapy and the mental effort it requires especially unappealing.

“It’s All Grist for the Mill”

Fortunately for therapists, they’re human too—and that fact, however self-evident, gives them a distinct advantage over any AI tool. “AI does not have consciousness; it doesn’t have a sense of embodiment,” Shelvock says. “I do. I have a body, I have feelings, and I’m very, very imperfect, and it’s that imperfection that makes me so relatable.”

Over and over, research has found that the most consistent predictor of whether therapy is effective is neither the modality the therapist employs nor the quality of education they received. Rather, it’s the strength of the therapeutic alliance—the connection that clinician and client come together to build, rooted in understanding, mutual respect, and the sense that they’re working together in a joint effort.

In those moments when a client turns to AI to validate their worst impulses, or assumes its answers are more authoritative than the therapist’s, it’s understandable—dare we say, human—for a clinician to feel frustrated or threatened, Shelvock says. “I think it’s really normal for therapists to feel existential uncertainty.” But rather than trying to compete with AI, or convince clients that using it isn’t in their best interests, clinicians are likely to be far better served by leaning even harder into doing the deep, relational work that makes therapy such a powerful pursuit.

What this looks like in practice will vary by clinician and modality. It might mean tuning in more to a client’s facial expression, tone of voice, or other subtle cues that AI can’t, by nature, pick up. “With one client, the minute he comes up the stairs, I can tell what state of mind he’s in,” Vahrmeyer says. “It’s his body language, how his clothes are sitting. Could I give you an empirical, scientific explanation of how it works? No. It’s about the relationship we’ve built, the attunement I have with this other human being.”

Therapists, unlike AI, also have the ability to tune into their own emotions and use that information to deepen the work of therapy. Indeed, a clinician might choose to simply sit with whatever emotion arises—curiosity, anxiety, or irritation—whenever a client consults, references, or defers to AI. “If a client used ChatGPT in a session, I would probably feel frustrated by that,” Vahrmeyer says. “But I wouldn’t hold it against the client; I’d ask myself, What is my frustration telling me?”

Very often, the answer to that question will reveal something valuable about the therapy itself, Shelvock says. “Those moments of being frustrated by a client’s using AI, or feeling as if it’s a hindrance, might actually signal, Oh, this is where we need to go in the therapeutic process.”

From this perspective, then, a client who consults ChatGPT mid-session to push back against a therapist’s advice, probably isn’t fact-checking just for the sake of it. “They’re communicating a rejection of sorts,” explains Valentina Stoycheva, a clinical psychologist based in Maryland. “Our job is to figure out what it is they’re communicating.”

And though AI is the medium, the message itself might have little to do with AI. “On some level, this is no different from what patients have always done—which is to ‘act out,’ as we call it, in therapy,” Vahrmeyer says. His client’s impulse to examine her dream with the help of ChatGPT, for instance, was motivated in part by her craving for an immediate answer. But when she and Vahrmeyer explored the impulse together, they discovered that she had started to worry that she had grown too dependent on him—and on therapy itself—so she turned to AI in an attempt to mitigate those uncomfortable feelings and reassert her own autonomy. “If she could get an answer from somewhere else, then it would show her that she didn’t really need me that much.”

In other cases, how a client uses AI may offer useful insight into their personality or how they relate to other people. When Gillis’s client asked ChatGPT if her husband was a narcissist, for example, it provided the answer she wanted to hear. But it didn’t create the belief, Gillis says, nor did ChatGPT conjure the defensiveness the client displayed when Gillis pushed back. “Two or four or five years ago, that client might have looked for that same kind of validation from Reddit, or from Instagram; two decades ago, they might have pulled out a DSM.”

Setting Boundaries

Making an effort to respond nonjudgmentally to a client’s use of AI doesn’t preclude a therapist from setting boundaries on how, or how often, AI is brought into session. “It’s like when we first meet with someone and we set the framework for therapy: We’re going to meet weekly, here’s what it will cost, and so on,” Stoycheva says. It can also be seen as an opportunity to set the frame for AI use—“like ‘If AI comes up, here’s how we’re going to talk about it’ or ‘We don’t invite it into the room during session.’” Says Gillis, “I find that when I’m more open about [discussing AI use] from the start, my clients might use it during a crisis—but that’s an outlier that happens maybe once a month, and in between, they keep up with their journaling instead.”

Establishing ground rules this way can help clinicians avoid getting into power struggles with AI, Stoycheva adds. “If a client pulls out their phone to fact-check me with AI, they’re inherently creating a situation where they’re pitting two entities against each other. I would not want to triangulate myself between the patient and the AI.” Rather than fall into the trap, therapists can take a step back and ask: What is the function that AI is performing for this person at this moment—and how can I, as the therapist, move them one notch in a healthier direction?

“I had a grad school professor who used to say, ‘It’s all grist for the mill,’” Stoycheva says—meaning the behaviors that both client and therapist engage in, in session and out, are all opportunities for insight and growth, just waiting to be seized. “How you respond to your client’s use of AI is not something that is impeding the therapy or infringing on the therapy,” she says. “That is the therapy.”

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