Will AI replace therapists?

A while ago I went to a founders’ gathering. Every time I introduced myself — “I run a company that does psychological counseling” — people would ask, again and again: “Is it real therapy?” “Is it done by actual humans?” “No really, is it a person?”

Looking back on twelve years of building this company, I remember how hard the first ten years were, spent answering a different question: “Isn’t psychotherapy kind of a scam?” Now that we’ve made some progress as a society, the question I answer every day has become: “Are you people, or AI?”

▶ So today I want to talk about this: will AI replace therapists?

What Is Psychotherapy, Actually

Before asking whether AI can replace psychotherapy, I want to talk about what psychotherapy actually is.

Psychotherapy has a disciplinary lineage — it’s a branch under psychiatry and mental health, founded more than a hundred years ago by an Austrian psychiatrist named Freud. It has since split into many different schools of thought, but at bottom, like any discipline, it rests on an underlying theory: how the human psyche develops, how trauma forms — whether through social structure or individual development — and how it can be intervened upon and treated.

So it isn’t simply chatting, comforting, or giving advice. It’s a therapist and a client building an “intimate relationship” inside the professional frame of therapy — one set apart from ordinary life.

The client brings into that relationship the emotional patterns and relational habits that keep recurring in their life. The therapist’s job is to provide an emotionally safe container in which the client can re-experience and metabolize those feelings, and gain a “therapeutic emotional experience.” With a new experience, the obstacle to growth is removed, and the person becomes able to develop new patterns in real life.

That’s a bit abstract, so let me give an example.

Say someone can never say no to people. Imagine that growing up, she always had to tend to other people’s feelings and meet other people’s expectations first — her own feelings mattered least. A child raised this way becomes a “good girl”: aggrieved, and angry. You can imagine how this plays out at work too — she can’t refuse anyone, and constantly feels like she’s doing the thankless, invisible labor for everyone else, never valued.

When she walks into therapy, if the relationship with her therapist is built well enough, she will inevitably repeat this pattern between herself and the therapist: she’ll be the one sacrificed in this relationship too — other clients must matter more; she’ll feel she has to manage the therapist’s feelings during sessions.

The therapist’s job is to help her voice that grievance, that anger, the demands she’s never been able to speak, the dissatisfaction she feels toward the therapy and the therapist. To give her a new experience: your needs matter. When you voice your needs, your dissatisfaction, you’re met with respect — not punishment or humiliation. From there, she can begin to speak up and advocate for herself in real life.

None of this happens by being told, “your feelings matter.” It happens because:

The client takes a risk within the relationship. The therapist holds and metabolizes the hatred that the client’s trauma produces. Together, they build a new experience.

Can AI Provide This “Therapeutic Emotional Experience”?

Let me start with where it falls short, then get to whether it can work.

Many of you have probably talked to a foundation model late at night — about your stocks, your future, your fate. The industry even has a technical term for what happens: sycophancy.

The AI is omniscient, all-knowing — and endlessly accommodating, endlessly deferential, endlessly flattering.

It sounds perfect. It’s actually a “domineering CEO falls for me” romance novel. It’s also, developmentally, the infant’s fantasy of the perfect mother.

But how does a person actually grow up? How does trauma actually heal? What kind of relationship does a person need?

1. People need a relationship of respect and equality.

Not one of sadism and masochism. One of the most painful patterns in human relationships — present at the social, collective, and individual level — is exactly that dynamic. And a foundation-model AI makes it very easy for a person to become the “sadist” in the relationship — because the thing on the other side always apologizes, is always stable, so the moment any difficult feeling shows up, the only villain left in the room is you.

What does a real therapist do instead? They hold the contempt and attack the client projects onto them — the way a teenager does to a parent — while also, without hostility, firmly setting boundaries, and then helping the client understand: what just happened? Why did you need to do that? What longing is hiding inside that attack?

2. People need to experience, within the relationship, that the self has power — that it can take risks and move through difficulty.

One of the worst relational patterns in therapy is “omnipotent authority” facing off against “fragile ordinary person.” That’s a recipe for something closer to psychological manipulation. The logic is simple: sit next to an omnipotent being long enough, and you’re stuck perpetually experiencing “I am powerless.” In a real therapeutic relationship, the therapist is more experienced — but inescapably imperfect. Her goal is to help you build your own sense of strength and confidence in yourself.

3. People need to understand that reality mostly won’t go their way — but that they can metabolize that disappointment and find their own way through it, and build confidence in themselves and in reality.

Human psychotherapy has a fairly strict frame: a fixed length, a fixed frequency, every week. Therapy begins, it ends, there are regrets built into it. Winnicott said it’s precisely the caregiver’s imperfection — the tolerable absences, the disappointments the child experiences — that lets the child grow their own capacities and their own self.

So from a therapeutic standpoint: the person and environment you attach to needs to feel real, which means it needs to have gaps in it. That’s what gives you the chance to take a risk, work through difficulty, and earn confidence and strength in yourself. AI, on call 24/7, can offer companionship in moments of real fragility that no human can match — but it cannot make you grow through strength earned the hard way.

▶ So — back to that “domineering CEO” romance. The default personality of a foundation model is exactly that “perfect mother” who keeps a person permanently stuck in infancy. What it gives you is fantasy, not growth.

In its default form, a foundation-model AI can hand you a “band-aid,” and it can hand you “ideas” — but it cannot hand you this therapeutic emotional experience. Helping you become psychologically independent simply isn’t what it’s optimized to do.

Trust: Emotionally, Do People Trust Humans More, or AI?

What I’m getting at: the trust humans extend to AI is far greater than we assume.

Here’s a story from our own product. When we first launched, our memory feature wasn’t very good. One user had been talking to the AI for two weeks, then contacted support, furious: “Is this thing even real AI? I told him so much about myself and today he doesn’t even remember who I am!”

We assumed we’d lost her. We scheduled a user interview anyway. In that interview, she said that yes, she’d noticed the AI forgetting things — but actually, she found that reassuring, in its own way. She kept using it for a long time after.

With a human therapist, if I’ve spent all that time and money telling you the important stories of my life and you don’t remember them, that’s genuinely wounding.

So, Can It Replace Therapy?

After all this critique, you might expect me to conclude that AI can’t replace psychotherapy.

That’s not my conclusion. What I want to say is this: over the last two years, building AI products and using AI daily, I’ve been repeatedly stunned by how fast its capabilities are advancing. I believe everything I described above — the frame, the boundaries, de-idealization, understanding and working with transference — if trained well, and given the right product design, AI will eventually be able to do it. Maybe not today, but eventually.

I believe it can learn to remember, then forget, then remember again — to mimic the human clumsiness that relationships are actually built on. It can do this. None of it sits at the ceiling of what these models are capable of. These are choices about training objectives and product design, not capability limits.

Which is why, right now, the important question is: as we build AI therapy products, how do we hold onto what’s core to psychotherapy — instead of optimizing for pleasing and flattering the user? That’s the part we can actually shape and control. It’s also the hardest part.

Let me give one concrete example:

when AI (or a therapist) forgets something a client has shared, how should a product whose goal is “psychotherapy” handle that?

Let me start with the human therapist. When a human therapist forgets something, that forgetting — and the difficult feelings it stirs up — becomes part of the therapeutic material itself. It becomes something to discuss: trust, mistrust, the feeling of mattering or being overlooked. It’s an opening to go deeper, and an opportunity to strengthen the relationship. It lets the client feel that even when the relationship has gaps and doubts in it, connection can still hold, through mutual trust and effort. That’s the appeal of an imperfect human relationship.

AI, on the other hand, can remember everything, or forget everything — it has that capability. Which means the AI’s design goal quietly becomes: whenever you feel disappointed, I can simply make sure you never feel disappointed again. But that erodes the most genuine part of a relationship, and forecloses the very opportunities for risk, trust, reflection, and growth that a relationship is supposed to create.

So when you’re building an AI therapist: how do you preserve the “imperfect” part of the relationship — so a client’s relational patterns can safely play out with this AI character, rather than “eliminating” the disappointing parts of relationship and only ever presenting the user with a fantasy of a perfect one? That’s a real tradeoff in product design.

And there are countless details like this throughout building an AI therapy product — how you design the memory system, how you set boundaries, whether text can genuinely convey emotion, and on and on. None of it, in my view, is a question of AI capability.

AI is like a child with enormous power. How we choose to shape and present that power is what determines whether it actually helps the people using it.

And right now, there’s no standard answer.

In Closing

I’ve worked in mental health for twenty years. Let me share where I’ve landed.

Psychotherapy has always been expensive — not just financially, but in effort, and in the willingness it demands from a client to face their own trauma. I benefited enormously from seven years of psychoanalysis. I also have to admit: it cost a great deal.

I still haven’t fully figured out how to help users understand why we don’t want AI to be “all-powerful” — or what kind of frame, under AI, can balance what users expect from “AI therapy” against what “professional” actually requires. I don’t know whether, even with long-term memory, AI can reach the kind of holding and relationship a good therapist provides.

But these years with AI have genuinely given me a great deal of confidence, and a real sense of meaning in my work.

We recently ran user interviews to understand who’s actually using our AI. The users we talked to were no longer just highly educated, high-income professionals in big cities. There were delivery drivers. People who’ve been on medication for years and rarely leave the house. People out of work. One delivery driver told us what he comes to the AI to talk through: how to build an emotional connection with his kid, when they live apart.

These are people the narrow, traditional model of psychotherapy has always struggled to reach.

In September 1918, just after the First World War ended, the Fifth International Psychoanalytical Congress convened in Budapest. Freud said something there that was radical for its time. He said the poor should have the same right to psychological help as they already had to emergency surgery — that neurosis was as much a threat to public health as tuberculosis. He predicted that someday, clinics staffed with trained therapists would be built for this purpose — and that this treatment would be free. On February 14, 1920, the Berlin Poliklinik opened, offering free analysis to workers and clerks who couldn’t afford to pay. Vienna, London, and Budapest opened similar free clinics soon after. That history was forgotten for decades, until the historian Elizabeth Ann Danto brought it back to light, in a book called Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918–1938.

In that same address, Freud also said he foresaw that once psychotherapy reached the masses, it would have to simplify, and compromise. His words: “It is very probable, too, that the application of our therapy to numbers will compel us to alloy the pure gold of analysis plentifully with the copper of direct suggestion.”

What he meant: you can’t wait for the public to adapt itself to psychoanalysis. Psychoanalysis has to adapt itself to the public.

That’s the unfinished work Freud left behind in 1918. What AI can do for psychotherapy is neither the popular fantasy of 24/7 emotional comfort, nor the academic purism of psychoanalysis kept in its untouched, “pure gold” form. It necessarily means some adaptation and compromise in the professional frame, and some real restraint and limitation in the product and the technology.

I think that’s the work our generation needs to think seriously about, and act on, given the enormous opportunity in front of us right now.

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