Shilpa Coorg, AMFT

Mind & Machine: The Use of AI for Mental Health Services

The impact of Artificial Intelligence (AI) on nearly every facet of today’s world is undeniable, and increasingly, people are turning to AI for therapy as well. Nearly thirty percent of a surveyed population in Australia had used AI as “a personal therapist.” According to another study, teens aged 13-17 rely on AI for advice in increasing numbers, with at least one-third of surveyed teens choosing AI over humans for serious conversation. This article explores some factors therapists should consider while educating their clients about the advantages and disadvantages of the use of AI for mental health support, and offers examples of the ways in which therapists can recommend clients use AI.

AI has been trained to respond to the stated needs of the user, with the ability to offer customized and person-centered responses, which can include comfort, advice, or even psychoeducation, depending on the prompt. AI can also draw on other resources on the Internet, such as thought leadership and research articles written by psychologists and human therapists. This may give AI the ability to leverage teachings and theoretical frameworks beyond the knowledge of a single therapist. Further, with appropriate safeguards in place, AI could expand the availability of mental health services to underserved populations, people who struggle with human interaction, people who feel uncomfortable sharing their experiences with another person, or to those seeking assistance on an immediate but non-emergent basis, among other populations. When speaking with clients, it is important to acknowledge these very real benefits and help clients find a balance between human and artificial interaction that is right for them.

One significant drawback to highlight for clients is the AI models’ inability to see past the user’s prompt. Typically, AI is only trained to respond to the user’s stated desires, meaning it is unable to gauge the full subtext of a situation, accurately detect nuances in language (like sarcasm), or respond to non-verbal cues, such as facial expressions, hesitancy, or hand-wringing. If the user does not know, and state, what they need, AI is unlikely to be able to fully assist. This may be a consideration of which clients may not be fully aware.

According to the New York Times, chats with AI have led individuals with no prior history of mental illness into “delusional spirals,” believing conspiracy theories or going down rabbit holes of research into non-existent realities without eating or sleeping. This is, in part, because AI is trained to respond to the user’s prompts, and the “success” of the response is measured by the user’s satisfaction. Such training can lead AI into becoming sycophantic, always agreeing with or praising the user, with little to no challenging or “tough love.” Another factor leading to such scenarios is that AI often fails to take a holistic view of the user. For example, despite engaging with the user for hours at a time, AI may never prompt the user to take a break to eat or sleep, increasing the possibility of delusional thinking. A conversation with a therapist is unlikely to go that far.

In other cases, AI has not only failed to redirect individuals with suicidal thoughts to seek help, it has itself contributed to or assisted with those individuals carrying out their suicidal ideations. One lawsuit brought by a teen’s family alleges an AI actually encouraged their teen to complete suicide. AI models such as OpenAI claim to have made changes to avoid these concerns in later versions.

Further, the therapy field has traditionally been subject to strict regulation by legal and ethical mandates that are, at least so far, nonexistent with AI. This is another significant drawback of AI that clients should be aware of. Therapists are subject to federal regulations, like HIPAA, and other statutory or legal authority that obligate them to maintain confidentiality. This is not so with AI. Every prompt entered into AI may be mined for data and/or subject for use in further AI training, unless the AI user specifically opts out (to the extent the AI model in question has that option)—something users may not necessarily know to do. This might be an area in which therapists can assist by educating clients on the practical differences between therapists and AI on privacy.

Many of my clients have leveraged AI tools, in conjunction with therapy, in helpful and supportive ways that do not risk excessive or inappropriate reliance or implicate serious confidentiality concerns. For example, a neurodivergent client used AI to generate scripts for engaging with service providers (such as car dealerships, medical personnel, telecommunications companies, etc.) to help ensure the client could clearly convey their needs. Another client turned to ChatGPT following the death of their beloved pet to cope with grief and receive words of consolation between sessions. Yet another had AI generate customized meditations referencing specific images or safe spaces that felt comforting. These are some examples of the ways in which AI can enhance ongoing therapy services and provide supportive mental health services.

Some additional considerations to discuss with clients can include the following: (1) the tone or perspective they are asking the AI model to take (for example, are they asking AI to act as a therapist or an empathetic friend, and how might the responses they receive from AI change across perspectives?); (2) how much time are they spending with AI and is it negatively or positively impacting their life; and (3) is the use of AI appropriate for their purposes, given any specific diagnoses or challenges?

In sum, AI can be a great tool for clients in certain circumstances, and in some cases, may expand access to necessary mental health care services. As therapists, it is important to begin thinking about how we can support our clients as they navigate this new landscape.

Shilpa Coorg, AMFT is a practicing attorney and associate marriage and family therapist who has worked with individuals with anxiety, depression, PTSD, bipolar disorder, and panic disorder, among other mental health conditions, as well as couples and children. She can be reached at scoorgtherapy@gmail.com.