On the latest Got Therapy?, Dr. Dan Rose and I asked whether a chatbot could take a therapist's job. We didn't reach a comforting answer. Dan was blunt: as the field moved toward manualized, symptom-focused treatment, it "opened itself up to become much more of a technician field," and the worksheets and homework at the center of that model are "things that ChatGPT probably could do fairly easily."
We can argue about what a machine can't do: felt knowing, silence, the music behind the words. We'll keep arguing about it. But one conclusion doesn't need to wait.
Here is the position: asking about AI use should become a standard part of intake and ongoing assessment, and AI belongs in our informed-consent conversations, whether or not the clinician uses it.
The reason is simple. Our clients are already using it. Dan sees it in his own caseload. For some of them it helps; reaching out at all, he argued, "is a form of empowerment." But clients may never mention it unless we ask. That's why I said on the show that "you have a responsibility now, I think, to really ask those questions."
Asking isn't surveillance. It's clinical information. Dan's psychoanalytic instinct is the right model: don't get lost in the surface of it. Ask why the client is bringing it up now, what it means to them, and whether there is "a subtle criticism of the work that we're doing." For one client it's better than nothing. For another it may be keeping them from the very connection they came to therapy to build.
We also have to name the incentive problem out loud. As therapists, we want the client to get better "and eventually move away from therapy." A chatbot, as I put it, "only gets rewarded when you stay connected." And we are, frankly, "behind the curve" on "just how dangerous this might be for folks who are in a crisis."
On Systems in Session, Dr. Richard Long and I worked through the code of ethics standard by standard. Everything started with informed consent. Clinicians who use AI in their own work owe clients that disclosure, and all of us need to know what our clients are doing on their side. It's "almost disclosure as if there's a third entity in the room."
That third entity is already there. "It's embedded in the work, whether we want to admit that or not." The least we can do is ask about it.
Got Therapy? is hosted by Michael Baltimore Ph.D. and Dan Rose Psy.D.