Can AI replace not only therapists and romantic partners but the selves we once knew?

A bot on the side: is it adultery if you cheat with an AI companion?

The Guardian (Fleming, 2023)

Users can personalize their AI chatbot’s avatar and give it certain personality traits depending on if they want a friend, mentor, romantic or sexual partner. They then message the chatbot, as if they were sexting. How they deal with the erotic feelings that arise in their physical bodies is up to them.

Business Insider (Kenny, 2023)

After Covid, could the above quotes represent the issues clients/patients will be increasingly bringing to their psychotherapists and will their psychotherapists increasingly be AI bots? For some, technological change to our ways of being may have started with central heating no longer requiring families to be together in one room around a fire … but now has the advent of Covid accelerated:

… the emergence of new technologies restructured, violently and forever, the nature of the .[psychotherapist, the patient/client and the therapy] . and the relationship between them?

This last quotation is from Kirby’s (2006) seminal work, The Death of Postmodernism and Beyond, where his ‘author, the reader and the text’ has been replaced by ‘psychotherapist, the patient/client and the therapy’. Here, Kirby argues, with potentially significant consequences for the psychological therapies, that as a result of the pressure of new technologies and contemporary social forces,

The terms by which authority, knowledge, selfhood, reality and time are conceived have been altered, suddenly and forever. (Kirby, 2006, p. 35)

Thus, the purpose of this Special Issue of the European Journal of Psychotherapy and Counselling (EJPC) is to explore what we can learn with regards to what is happening and what is going to happen in our increasingly digital economy regarding our future psychotherapeutic theories, research methods and practices.

I will shortly be presenting here the results from the call for papers, with its three research questions, sent out in association with the United Kingdom Council for Psychotherapy (to clinicians, theoreticians and researchers) for this Special Issue. From these eight papers and three respondents it appears clear that internet therapy, whilst there are concerns, is here to stay. However, first I would like to offer some preliminary thoughts, echoed in part in similar and other ways in some of our papers, including whether online therapy and other developments could also be the thin end of a technological wedge. This could, and may already, be affecting what we regard as humanity with resulting dangers for us as psychotherapists, clients/patients and peoples.

‘Technology’, philosophy and poetry

There is a concern prevalent in our newspapers and media as to how technology through the Internet, AI bots, et cetera not just enhances but could also be detrimental. A key question is the extent that we will no longer be able to control such technology and instead it will take over and control us. But how? Perhaps not through the more popular notions of robots becoming more intelligent than humans, but; through the, perhaps more difficult to understand, changes that technology, which itself can be an elusive concept (Hansen & Froelich, 1994; Ropohl, 1997), can make through technical thinking to our very psyches.

Questioning the pros and cons of the use of technology in terms of technical thinking in psychotherapy has been raised long before our digital age. Plato can be seen as warning us when he first defined Therapea that whilst scientific and technical thinking are important we need constant reminding, they must be secondary to the resources of the human soul (Cushman, 2002). Plato feared that one day we would lose that battle to give a primacy to the ‘human soul’ but we must keep trying.

Heidegger (1977) more than reinforced such warnings against technology (in fact he didn’t think Plato went far enough in understanding our being and the potential detrimental effects of technology on our very being). For Heidegger considers that with technology: ‘Everything functions and the functioning drives us further and further to more functioning, and technology tears people away and uproots them from the earth more and more’ (Heidegger, 1977). For Heidegger with modern technology we, including as psychotherapists, can be ‘forcing into being’ rather than ‘helping come into being’ with different consequences for what we uncover and cover-up as the truth.

If such technical thinking, which can also be seen to link with a move from craft industries to factory production and now the technological era, takes over then don’t we become subject to it? Here we wrongly lose control. We are no longer as thoughtful, through our mind, body and soul, both as people and psychotherapeutic practitioners.

Technical thinking then can rule us. But can technical thinking not only occur with the more obvious forms of manualised therapies that might be found, for example within the U.K’.s Improving Access to Psychological Therapies (IAPT); but, also take the form of all psychotherapeutic theories and research we are trained in (whether they be humanistic, existential, psychoanalytic or behavioural etc). Isn’t there then also a danger that we have to prove everything we say in the consulting room comes from our particular theoretical Guru or narrow notions of evidence-based practice? There is also the important question of how our clients have been taken over by technical encroachment so their (and our) abilities to think and allow thoughts to come to us also diminishes their, and our, potency and potentiality.

Hence one initial question we invited our clinicians, theoreticians and researchers to consider is:

• ‘The effects of our “information economy” on our brains, consciousness, inner world and the way as psychotherapists we conceptualise’

So might it be better if we can consider, and keep, technological aspects and theories as implications and not applications? Perhaps, we should turn to the poets more when considering how, if we have choice, we might engage with what may appeal as theories and technologies. For example, William Blake’s Eternity, (1757–1827):

He who binds to himself a joy

Doth the winged life destroy;

But he who kisses the joy as it flies

Lives in Eternity’s sunrise.

(William Blake)

AI bots: Psychotherapist, client/patient, and communication technology

So, what is going to happen to psychotherapy with the evolution of AI Bots? This is the second term in the title of this Special Issue. It was also the second question in the ‘Call for Papers’:

• The promise of autonomous psychotherapy programmes that integrate ‘therapy with the actual relationship experiences of the individual user’

It appears that at least young people increasingly communicate with each other, not by speaking, let alone person-to-person, but by text. A BBC report (Tidy, 2024) quotes the inventor of the, popular with young people, ‘Psychologist’ AI bot as reporting: ‘Talking by text is potentially less daunting than picking up the phone or having a face-to-face conversation’. So, could an AI bot be better as a psychotherapist texting back than a person who is a psychotherapist? Plus the bot is, unlike (hopefully!) a therapist, available in your pocket 24/7.

Well apparently the idea of bots is not new. ELIZA was a very basic Rogerian psychotherapist chatbot:

This early natural language processing programme was written in the mid-1960s … ELIZA was one of the first chatterbots (later clipped to chatbot). It was also an early case for the Turing Test, a test of a machine’s ability to exhibit intelligent behaviour equivalent to, or indistinguishable from, that of a human. By today’s standards ELIZA fails very quickly if you ask it complex questions (Ronkowitz, 2017).

But, there have been different means of doing therapy even before ELIZA. Hannah Zeavin in ‘The Distance Cure: A History of Teletherapy’ (Zeavin, 2021, p. 2) argues, ‘Therapy has long understood itself as taking place in a room, with two (or more) people engaged in person-to-person conversation’. And yet, she points out that including Freud’s treatments by letter, psychotherapy has operated through multiple communication technologies and media. For Zeavin, these have included advice columns, radio broadcasts, crisis hotlines, video, personal computers, and mobile phones.

Furthermore, Zeavin considers therapists can be broadly defined as professional or untrained, strangers or chatbots; and, proposes a reconfiguration of the traditional therapeutic dyad: ‘therapist and patient’ to a triad: ‘therapist, patient, and communication technology’. Zeavin argues, it was never just a ‘talking cure’; it has always been a ‘communication cure’ (Zeavin, 2021, p. 58).

So what AI bots are available? Here are some currently in the USA and/or the U.K. in this rapidly developing field: 7 Cups of Tea, Bing, Ginger, Mindspa, Replika, Talkspace, Woebot Health, Wysa, and Youper. With regards to Replika, there is the well-known story:

When you sign up for the Eva AI app, it prompts you to create the “perfect partner”, giving you options like “hot, funny, bold”, “shy, modest, considerate” or “smart, strict, rational”. It will also ask if you want to opt in to sending explicit messages and photos … However, Replika’s faced a backlash from users earlier this year when the company hastily removed erotic role play functions, a move which many of the company’s users found akin to gutting the Rep’s personality (Taylor, 2023).

The same Guardian article concludes with:

“According to an analysis by venture capital firm a16z, the next era of AI relationship apps will be even more realistic. The a16z analysts said the proliferation of AI bot apps replicating human relationships is ‘just the beginning of a seismic shift in human-computer interactions that will require us to re-examine what it means to have a relationship with someone.

We’re entering a new world that will be a lot weirder, wilder, and more wonderful than we can even imagine’.” (Taylor, 2023).

The importance of sociotechnical systems

This first came literally home to me when I moved from a bedsitter/studio room to student accommodation with each cluster of four individual rooms having a shared kitchen. Whether one experiences this as a move from isolation and loneliness to conviviality, or from independence to the horrors of shared living, the change can be incredible!

This term sociotechnical can be seen to be derived from the work of Trist and Bamforth (1951) at the Tavistock London. An exploration of social technical forces that is very much in line with Kirby’s (2006) seminal work, quoted at the start of this editorial, is Rogers Brubaker’s Hypperconnectivity and its Discontents (Brubaker, 2023).

Brubaker considers Digital hyperconnectivity as a defining fact of our time. This is, ‘The Silicon Valley dream of universal connection – the dream of connecting everyone and everything to everyone and everything else, everywhere and all the time – which is rapidly becoming a reality … . He traces transformations of: the self, social relations, culture, economics, politics … ’. These are considered ‘ … socio-technical forces that are profoundly remaking our world’ (cover copy). Throughout, Brubaker underscores again the ambivalence of digital hyperconnectivity, which opens up many new and exciting possibilities for our clients and ourselves, yet at the same time threatens ‘human freedom and flourishing’. This book, and that of aforementioned Zeavin, are also reviewed in this Special Issue.

However, I also concur with the final book I wish to quote from, and which is also reviewed in this Special Issue:

In our opinion, even when (or if) the vaccine for COVID-19 eliminates the pandemic and life returns to what is considered normal online therapy is here to stay. Its legitimacy increased dramatically following the world crisis, and although it has some limitations, some. In the coming future more therapy sessions would be conducted online, and more specific research would be carried out about them. (Weinberg et al., 2023)

Is there still a vital place for traditional therapy given the advantages of online therapy?

So, we arrive at the third question originally posed for this special issue:

• Whether traditional psychotherapy can provide the best antidote to the ills of our digital age.

Interestingly for most of our papers this question was considered more indirectly through evaluating online therapy. Elsewhere there is some research. For example, ‘What have we lost?’, where Rizq (2020) quotes how when comparing a painter with a photographer, Walter Benjamin writes ‘The images they both come up with are enormously different’ (Benjamin, 1936, p. 248) and this effects our capacities for a particular mode of experiencing (Rizq, 2020, p. 340). Personally, one effect for me when working online is that I can see more clients and supervisees as I find this takes less out of me compared with working face to face; but what else is lost?

However, rather than my anecdote, research recently published in Nature (Stieger et al., 2023) and carried out during the recent Covid pandemic lockdowns conclude:

… that digital communication was far less relevant for lockdown mental health than face-to-face communication. . . . . Our results underscore the importance of face-to-face communication for mental health. Our results also suggest that videoconferencing was only negligibly associated with mental health … (Stieger et al., 2023)

So, as psychotherapists what are we to conclude from these researchers for whilst they claim that face-to-face communication was much more important for lockdown mental health than digital communication, they also interestingly state:

Digital text-based communication (e.g., e-mail, WhatsApp, SMS) nevertheless was meaningfully associated with mental health, and both face-to-face and digital text communication were more predictive of mental health than either physical or outdoor activity (Stieger et al., 2023).

We therefore need more practice, theoretical and empirical based research, and welcome papers for our journal, on what is lost and gained. Such research is urgently needed not only regarding the effect of the digital age on the the processes of the psychological therapies but the effects on us as people who are clients/patients and psychological therapists – perhaps before, if isn’t already, too late?

Prior to introducing the papers, I first very much want to thank the following for their invaluable assistance in developing this special issue of the European Journal of Psychotherapy and Counselling:

Amelia Ahmer, Gauri Beecroft, Ellen Dunn, Anastasios Gaitanidis, Aurelia Sauerbrei, Helen Gilbert, William Horsnell, Tejinder Kondel, Dan Li, Emmanouil Manakas, Anthony McSherry, Elizabeth Nicholl, Sally Parsloe, Francesca Robinson, Margherita Spagnuolo, Patricia Talens, Jean Wells, and David Winter.

My thanks also to the book reviewers for this issue, namely, Schoretsanitis Nikolaos for reviewing Hypperconnectivity and its Discontents by Roger Brubakers, Christina Chrysoula for reviewing The Distance Cure: A History of Teletherapy by Hannah Zeavin, and Dimitris Karamanavis for reviewing Advances in Online Therapy: Emergence of a New Paradigm edited by Haim Weinberg, Arnon Rolnick, and Adam Leighton. My further thanks to our book review editors Ioannis Papadopoulos and Emmanouil Manakas for sourcing these helpful books.

I would also like to again thank our abstract translators: Nicole Fisher (German), Patricia Talens (Spanish), Lea Misen (French) and Anna Mylona & Christina Lagogianni (Greek).

Finally, my further thanks to the authors of the following papers for this issue. Our first paper is: Looking and Listening in Online Therapy. Here, the author Gail Simon argues that looking and listening activities are so well integrated into the practice of psychotherapy that we don’t often study what is involved. The author questions whether psychotherapy is trying to reproduce old, colonised ways of doing in-person therapy in an online environment. Instead, the author interestingly posits that embracing online living might affect how we learn more about the possibilities for doing therapy in virtual worlds.

Reviewers comments include:

‘This paper was a joy to read as it took a deep dive into a topic that has rarely been noticed in such detail since the transition took place. Exploring the nuanced brings a helpful questioning in this paper. Particularly like the “Listening and relational reaching” section. A great paper with a very personal touch and wonderful writing style’.

Our next paper is The Shaping Force of Technology in Psychotherapy. Here the author, Patricia Talens, considers the dangers if we adopt any therapeutic technique as something learnt, deployed and applied. For then we condition inquiry, and this inquiry may in turn condition us. This paper is particularly helpful in providing ground for this special issue to not only consider the effects of technology on our practices in terms of manualised learning in our digitalised era but the efficacy of therapeutic technique in all our modalities from Freud onwards.

Reviewers comments include:

‘This is a well written article that addresses how the therapeutic relationship is impacted by technological thinking. The theoretical arguments are very strong’.

Our third paper is AI, automation and psychotherapy – a proposed model for losses and gains in the automated therapeutic encounter. This interesting research is particularly relevant with the author Helen Molden conceptualising how artificial intelligence (AI) and automation, given they are increasingly embedded in most aspects of life, will benefit or inhibit the therapeutic encounter. Five levels of a model are outlined and are referenced against key elements of the therapeutic encounter considered known to contribute to an effective therapeutic outcome, from the working alliance, to collaborative elements, to a confidential setting. The author states that the objective is not to pit human therapist against non-human system, but to propose a human-centred framework for the integration of AI into clinical reality.

Reviewers comments include:

‘This is a very well thought out article with an intriguing proposed model – it certainly raises key questions about the somewhat daunting future of our profession’.

Our next paper is:

Virtual Reality and Screen Relations in Clinical Practice – exploring co-creation, inclusivity and exclusivity. Here the author, Ronen Stilman, invites practitioners to reflect on their relationship with technology and consider interpersonal and political dynamics at play. This is with particular emphasis for accounting for new emerging issues of inclusion, exclusion and power presented as a result of these changes, and exploring what might be gained by paying attention to these dynamics.

Reviewers comments include:

‘I think in summation this paper raises some very important and pertinent questions in terms of the ethical aspects of working online. It uncovers some of the inherent biases that we may have as practitioners and explores what we might have missed about working online that could be particularly valuable’.

The next paper Moving-sensing-feeling bodies clamouring for contact in on-line therapy groups is by Billy Desmond. Here the author examines working with groups on-line from a Gestalt therapy perspective. The author explores the relational grail of on-line therapy as an inter-embodied experience. It is argued that this can be supported by the therapist cultivating an embodied presence, accompanied by an intentional disposition to ‘wander with wonder’ as a way of surrendering to the unknown of the virtual-between. This includes adopting an embodied, hermeneutic phenomenological approach in group work that supports the co-creation of meaning between members in this trans-subjective space.

Reviewers comments include:

‘A very interesting piece the I felt really captured in writing the sense of the kinetics in the group dynamics and how this could be attended to in the online group. It outlines ideas for what might need to be held in mind for the online group, what is presented I thought was very helpful and thoughtful. Love the end vignette of the therapists experience as they prepare for the group’.

Our next paper, Connecting in a Remote World: Psychotherapy & Counselling Students’ experiences of Remote Teaching and Learning is by Geraldine Sheedy. This study explores students’ experiences of remote learning on a Psychotherapy & Counselling training. A Thematic Analysis was carried out on the data and the central organising theme of ‘Connection’ emerged with three sub-‘Connection to Self’, ‘Connection to Others’ and ‘Connection to Lecturers’. Findings indicated that connection can be nurtured online through intentional instruction; but, also suggest students miss the personal connections that face to face teaching affords with a preference for a blended approach to learning.

Reviewers comments include:

‘I loved this research. It is a very timely and relevant issue. The findings are thought provoking and should have implications for educators in many settings’.

Our penultimate paper before presenting our three published respondents is: Virtual Parent Infant Psychotherapy is Impactful and Accessible for Mothers and Babies Attending a Community Perinatal Service, by Adele Greaves, Rachel O’Brien, Hannah McKenzie, Anna Roberts, and Kate Alexander. They describe how the pandemic necessitated the rapid transfer of Parent-Infant Psychotherapy (PIP) to a virtual platform to continue delivery at the time of increased vulnerability for mothers and babies. They claim that the findings from their resulting service evaluation demonstrated that virtual PIP is impactful and accessible for mothers and their babies, with statistically significant improvements found in maternal mental health and postpartum bonding. Furthermore, Interpretative Phenomenological Analysis of interviews exploring the experience and meaning for mothers and babies engaging in virtual PIP, illuminated the complex therapeutic processes underlying the positive clinical outcomes.

Reviewers comments included: ‘This was a great manuscript with promising quantitative and qualitative results for virtual PIP. I hope the authors continue to collect data so that they can publish their findings with a larger sample size. I found it very interesting to hear about the women’s experience of doing therapy in their own home and how they perceived this as challenging to be left in their home after the session without a transitional space, etc’.

Our final paper before introducing our published respondents is: Schrödinger’s Cat Goes Online: Exploring the psychopathology of digital life by Daniel Rubinstein. Drawing upon Heidegger’s philosophy of technology and Whitehead’s process philosophy, this author argues that our environment and technologies shape our consciousness and subjectivity, and that both the therapist and client are partly a product of the media ecologies of the digital age. By integrating theoretical perspectives of transitionality as proposed by Winnicott with Deleuze and Guattari’s notion of faciality and the social construction of subjectivity through the screen/face as a territorializing force, the author helpfully considers the intricate relationship between individual subjectivity and online environments in shaping our experiences and identities on the screen.

Reviewers comments include:

‘This paper makes a valuable contribution by spotlighting the under examined impacts of our digitised ecology on inner life. It raises thought-provoking questions about selfhood and relationality in the internet age while opening up novel directions for understanding the contemporary psyche. Sensitive and discerning, this papers prompts much-needed reflection on how to further cultivate meaningful therapeutic connections in virtual environments’.

Our first response paper is: The Agentic Role of Psychotherapy in Retaining Human Connection in the Age of Technology. Here, psychotherapist and author, Aaron Balick draws on the variety of themes that have arisen within the contributed papers to reflect on the wider issue of computer mediated human relations. In it, he makes a distinction between the papers that focus on the therapeutic process mediated by technology and those that look more broadly at the paradigm of therapy practice in this context. Framing technology as a tool, the author pulls together both strands to explore what psychotherapy research may say about the broader issues of societies mediated by technology and how therapeutic research may contribute to these larger social issues.

Reviewers comments include:

‘This is a well-written and thoughtful response paper that provides a nuanced perspective on technology and psychotherapy. It draws together key themes from the other papers to highlight important issues and makes an insightful distinction between papers focusing on therapeutic process mediated by technology and those looking at broader paradigm shifts. There is a good balance of acknowledging both challenges/concerns with technology as well as opportunities/benefits and it avoids either techno-utopian or techno-dystopian extremes. There is also a reasonable argument in the “Looking Outward” section that psychotherapists should apply insights from practice to help shape technology development in society more broadly’.

Our second respondent is Ian Tucker. In his paper, Digitally mediated psychotherapy: Intimacy, distance, and connection in virtual therapeutic spaces, he discusses key themes resonating across this Special Issue, along with attending to the some of the nuance and diversity of the potential and real implications of a greater integration of digital technologies in current and future therapeutic practice.

Reviewers comments include:

‘The author’s commentary effectively situates the papers within broader conceptual and empirical contexts related to digital mental health and the role of technology in psychotherapy. Providing these references to relevant literature helps situate the ideas. Finally, the author draws out insightful conceptual lenses from theorists like Simondon and Lewin that provide productive framings for making sense of online psychotherapy. The notions of individuation, topologies of connection, and vitality of technology add an important perspective’.

Our third and final response is Leora Trub’s To the Screen, and Beyond. Here, the author argues that digital technology has a ubiquitous presence in psychotherapy. For whilst, we recognise its immediate impact on our work, we are less attuned to its symbolic – yet highly consequential – implications for our field, much less its penetrating grip on the human psyche. The author concludes that rather than shrinking ourselves to adjust to the screen’s limits, we need to expand our understanding of its impact both inside and outside of the therapeutic context.

Reviewers comments include:

‘The respondent finds much to value in all the papers, particularly the authors’ engagement with how therapists can remain fully human when our work is conducted through a screen’.

So, I hope you will agree, these papers provide important ideas for our practices and future research not only on how our digital age affects psychotherapy provision; but, us as people – including those who are also clients/patients and psychological therapists.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Del Loewenthal

Del Loewenthal is Emeritus Professor of Psychotherapy and Counselling at the University of Roehampton and is Chair of the Southern Association for Psychotherapy and Counselling (SAFPAC), London, UK. He is an existential-analytic psychotherapist, and chartered psychologist, with a particular interest in phenomenology. His books include Existential Psychotherapy and Counselling after Postmodernism (Routledge 2017). www.delloewenthal.com; www.safpac.co.uk.