Ep. 144 | Therapy in the Age of Artificial Intelligence: What Works, What Doesn’t, and What’s Next?

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Welcome to Everyday Therapy, where simple and practical concepts of therapy meet your everyday life. Hosted by a licensed marriage and family therapist Brett Cushing and Krista Overton, we're here to help you unlock tools and strategies you need to become the best version of yourself. Whether you're looking for guidance, inspiration, anecdotes, or actionable advice, you're in the right place.

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Hello! Welcome to another episode of Everyday Therapy. I'm here with doctor Karen Ryan. Hello. We are delighted to have Doctor Ryan here. We're talking about a very relevant topic today. I everybody seems to be talking about AI in every context now, and we're talking about AI and therapy. Are we going to be replaced? Yeah. Is it the end for us?

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Right. This is our final podcast. It's going to be AI versions of us next week. But you know, it's funny because everybody I think is wondering, there's a bit of anxiety. Am I going to be replaced? Right. And I thought of this. I got my haircut a couple days ago and person doing my hair. She said, oh, your therapist?

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And I said, yeah. And she said, oh, I love my therapist. And I said, well, great. What did you like? What what really is meaningful and helpful to you? So down to earth totally can relate to me. And you could you could see this really wonderful connection. Yeah. Therapeutic relationship. Yeah. And so I was relieved. And yet at the same time as we're going to dive in today, there are people who are having real relationships with AI therapists getting real benefits.

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Yes. Right. So yeah, it's pretty provocative. And we really think it's incredibly relevant not just for us and our career, but for our clients. Can they can they benefit from this? Are there harmful things they need to be aware of? Well let's try and answer some of that. Yeah. And even what is I like. How do you even use it for those who are listening and have no idea.

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Right. We know that there's general AI where you can get information. And then there are specific formats and structures for therapy in particular. Right. So you can ask questions and get therapeutic content back. And so you're asking a question to the computer. And then AI is giving you a response. Right. And they seem a lot smarter than me at least.

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So I find that a little bit threatening. It can scan through the data faster right? Yeah, a lot faster than I can. So there was an AI chat bot that was developed by Dartmouth, and they programed it and it was pretty successful. You know, we've got to give credit where credit's due. Absolutely. And it was pretty limited in terms of working on, I think, eating disorders and some mood disorders like depression and anxiety.

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And yet the the effects were pretty compelling, right? Yeah, really. And what they really focus on was CBT or cognitive behavioral therapy. And the AI giving interventions or skills or techniques kind of based on that CBT. Right. Structure. Yeah. Which is is rather basic. Yeah. And really well researched right. We know this has positive impact and is beneficial for a variety of different mental health needs.

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Right. Yes. So and when we think about them developing a chat bot sounds weird. A AI chat bot. Yeah. What what are we talking about then? I think because people are asking, what does this mean? What is a AI? Artificial intelligence? As a therapist, do you have any thoughts on that? What that means for people? I think it can be helpful to have an actual example of what that can look like.

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So you are on the robot and you ask, hey there bot, I'm having trouble stopping or not thinking about an interaction I just had with my friend. Yeah, and might say, tell me more about that. Well, I feel like I really offended her and now she's not calling me back, and I'm afraid I've ruined the friendship. And then the zero bot will ask you questions.

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Kind of focused of what evidence you have for that. What are the facts? When did you last talk to her? Like and so makes you kind of check the facts and do those skills. And so that's what it can look like. I think it's helpful to have that example. Yes, it can look that way and it can feel very much like a real person.

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You're interacting with me. So I'm looking at Facebook and I show my son who's 22, hey, dude, look at this. And it's pretty wild in two seconds. He says, oh yeah, that's AI. Yeah. It's just, you know, computer generated. He can tell. And yet that's going to develop more and more where it's going to be very difficult to distinguish between artificial intelligence and human intelligence.

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But for now, it already feels very much like you're talking to a real person. Yeah. And that's why they found in their study not only did they have effective outcomes, but the people who went through this actually developed a relationship, if you can call it that. I mean, that's a question. Can you really have a relationship? But they described it as such and they felt like they could they could be more themself because they felt like I was less judgmental and and like what I was saying earlier, smarter, you know, had more credibility.

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Yeah. And what I recognize is I've been researching and watching some videos and examples of it is the the therapist does a really good job of validating. Oh, that makes a lot of sense. That sounds really hard or you're not alone in this. A lot of people struggle with that. And so it can be this helpful kind of validation and normalization of what you're going through.

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Because if you you're thinking it is AI, but you know, oh, they know that research shows I'm not alone in this. There are millions of people. That's a logical thing. And so sometimes, you know, therapists are we're pretty good at validating. But sometimes we miss those nuggets. We do. Sometimes we're thinking about a different context or another question or another thing we want to explore with them.

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And we might miss that. So that, I think, was where a lot of people feel really heard. And validated. That's a really good point. I think in a very fundamental sense, therapy is good. Therapy is comprised of validation and understanding and change. And sometimes as therapists, we want so much for our clients to improve and heal that we can go to change pretty quickly.

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Yeah. So it's part of being human, right? And flawed. And I feel like that's sometimes the flip side. Right. So the flip side of when we think about what might be missing in AI therapy, and you're kind of highlighting that where we do a Da so a Da or an intake with a person, and we ask them about your social history and your work history and how that's going and your medical things.

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And so we kind of really try to get a full sense of that individual. Right. And we're working with that person and we have them that context in that understanding. And so we might that really helps guide us sometimes on interventions we might give. Right. If we know that person, is struggling with, emotion regulation and they are trying to figure out how do I decrease conflict with my partner, right.

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We know that we can't suggest for one client to leave and take a break because they have three young kids. So we are able to apply that. So that's where you can see that benefit of really knowing that person have these other contextual factors that I might not. Absolutely. Not to mention, I don't know if AI is going to be able to do this in the future.

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I don't think it can yet, but we talk about incongruent messages sometimes with, yeah, with our clients. Do you love your spouse? Well, of course I love my spouse. That's an incongruent message because people are saying one thing, but they're tone and or maybe not even their tone. Their body language is inconsistent. And we can pick up on that and we can challenge it.

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I don't know if I can be able to do that. Yeah, but it speaks to that contextual framework that we can have that they don't. Right. And I think there is some research showing that when those contextual are those, nonverbal and those cues, they can be mis and then that can lead to some negative. Yes, interventions or suggestions that feel invalidating to that individual.

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And so that's, I think, where they're still trying to refine AI therapy to be more sensitive to those nuances. Yeah. And there are lots of other advantages to maybe we can talk a little bit more about some of the advantages because. Yeah, there is concern. There's questions, will it replace therapists and there's good reasons to go down that road because there are some initial compelling outcomes and it's less expensive.

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They're available 24 seven. And that really speaks to they don't necessarily have to replicate or replace, but they can reinforce what we're trying to do. What are your thoughts about how I can reinforce what we're doing? Yeah, I think it could be a wonderful supplemental thing that reinforces what you're working on in therapy, because sometimes we know the stuff comes up in between therapy sessions.

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Right? And that's the work we do work in session. And then clients are doing work outside of session. And it can be really beneficial to have a source to go to to help kind of implement those skills where when we're in the moment, those reminders of what resources are available to us. I just had a client who literally just did this this week, was in.

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We've been working a lot on family dynamics and anxiety and healthy boundaries and found themselves like having trouble and those boundaries were getting crossed and trying to be reassured of what was healthy for them. And they were able to use ChatGPT and get validation and help and guidance and just, yeah, those are the steps they were already thinking would be helpful.

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And then that was reinforced and that was really helpful. And then we process it, process that in our next therapy session. And really like being able to dive deeper on that so well. And that's I think that speaks to a very compelling part because some of the frustration I have is I see my client 53 minutes or 60 minutes a week, and then they have the whole rest of their week with their interacting and doing things, and maybe I'll get an email from them or something, whereas I can be there, I can give homework for them to do.

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They could do it with AI. Help me. What's a mindfulness thing I can do right now? What's, what's a skill that can help me break down my emotional intensity so that you have all that reinforcement right at their fingertips throughout the week? Even, I know there's been work done with, AI and mood tracking. A lot of times, we don't know.

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What am I feeling? I have no idea. I know everybody else feels. I don't know how I'm feeling. And there's these mood, I know apps, but AI uses, these, trackers for people to kind of log in and say how they were feeling or be prompted on things to help identify what their thoughts and what their feelings are.

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Yeah. And I always say like three days of good therapy is awareness, acceptance. And then that helps us make adjustments. And so yeah, I just think that can help. Yeah. And the combination of being able to track your mood and track your behaviors. Right. So how much are you sleeping. How much caffeine are you taking in. Like how social have you been.

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So you can see the power of being able to like, accurately track it and that I can step back and really look at it accurately and be like, I'm wondering if their sleep patterns have had played a role in your irritability and feeling more frustrated this week, or you haven't gotten out of the house in the past four days?

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Yeah, and so it really helps increase that awareness. Yeah. And I think, the way, the way I'm trying to look at this whole topic of AI in general and as it relates to our field is, in a very dire ethical manner. I love that word just means to in a balanced way so that it's not all or nothing.

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Yep. Because that's when we think all or nothing. That's when our anxiety goes up and and we can't regulate it. But I do see how AI can bring greater enhancement of therapy and balance it more so that there's, there's greater, import and greater opportunity for people to be interacting about mental health topics out the week. Because a lot of times my clients, hey, did you do your homework?

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Yeah. Yeah. Or they have anxiety about coming in. And it's not that they they're trying to be avoided. A lot of times they just busyness of life gets to where I can really help with that. Yeah. And I like the APA, which is the American psychological Association. Right. And as a psychologist by association, I'm most connected to.

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And they called it a mix of caution and cautious optimism. Right. And so how do you just use this. Well, but we're excited about it like as a field. And those who are working on it I think are really trying to be ethical and really being thoughtful about how can this be a resource. So I'm thankful for the people, those professionals behind it who are trying to make it be.

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Yep. And sometimes people are early adopters in life. Yes. And then there are late adopters and bunch of people in the middle. I think for those of us that might be early adopters, there is some caution and there are some limitations with AI that we can talk about. One, I don't know if you heard about this. I just read recently that MIT did a study on people who use I just I in general, not for therapy in particular, but they've noticed some cognitive decline as they've been using AI on a regular basis.

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Yeah. And I just think that's noteworthy as we are talking about AI specifically with with therapy. But there's other concerns. Yeah. One of the concerns is, decrease in the social engagement or that social interaction that yeah, that is what therapy really affords you the opportunity to do as a here and now experience of a social interaction. And so the more we utilize AI and computers and phones and tablets, the less we're interacting with people, right?

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That's those nonverbals that's that eye contact that is being able to read body language. And it's also having some care and concern for that other person. Therapy is a unique therapeutic relationship where the focus is on the client. But there also is that just natural benefit of how am I socially engaging with this person? And here's a really safe person who can give me feedback and we need that.

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Yes, we need that absolutely we need that. It's not sort of a bonus. It's an essential part of being a human being is this social connection. And I think that book I don't know if you read The Anxious Generation, have you read that or. I have not read that one. Oh, it's great, especially with teenagers. My kids have grown up in the younger 20s or mid 20s.

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They said spot on. And one of the things they highlighted in there was that social isolation that happened not just in Covid, but increasingly in a digital world. Teens were growing up in not having live interactions with other people and I was just speaking to some people about adolescence and loneliness and how it has gone up so much since Covid and since all of this isolation from human contact, like depression, anxiety gone up like 150% amongst teens.

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And I think it really speaks to the concern you bring up, but also the ease of continually avoiding right human contact. Right, and how that increases our anxiety. And so it really is some exposure work of doing that. Right. A good example, I'm just thinking of, as you're describing that brat, is when you walk down the hall and somebody kind of says, oh, hi, how are you?

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And you can of past that, that in itself feels good. But when that person locks eyes with you, right, like I am right now with you, and I say, how are you? Yes. It just like physiologically has a different impact on us. And like you highlighted our we are designed to be social creatures and our bodies are designed to interact and to respond to one another.

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And that's the beauty of being in person or with the person. Yeah. And, and I think why we're so vulnerable with this is because if I'm interacting with and I. And I start to feel better. Well, why do I need social interaction just really reinforces my desire to avoid and isolate. So I think I'm glad you brought that up.

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I don't think we can stress that enough. I also have some concern concerns too. And just terms neurologically what this means for people. Yeah. And we are it's not just our mental health. It's all connected systemically with our physiologic body. And so wondering and concerned how I is able to affect negatively our neurological makeup and our arousal system.

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Sympathetic, our parasympathetic kind of, network. And what that what that means for our overall functioning. And can I really pick up on all of those complexities? Right. Because you and I are both eMDR therapists, right? Yeah. And so we really know about the benefit of that bilateral using both hemispheres of our brain. Right? So that really allows us to think like, through logics and facts and be creative.

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And so what we know on research and the work we've done is the more, the more parts of our brain, the more neurological networks that are utilized in therapeutic work or in our lives, the healthier we are, the better we can problem solve, the better we can process. And so if AI is processing and problem solving for us, we are not utilizing our brains.

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And there's pruning that goes right. Like our brains become less good at it, use it or lose it. And so that's I think that piece I'm interested to see the cognitive deficits or the concerns that come with. We were just talking, before we started the episode about what kind of things we grew up with or our kids grew up with.

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Did you ever see the movie Wall-E? Yes. Yeah, I remember everybody was in there, their, like, lounge chairs with their screen in front of them. They'd be right next to each other. And all they did, they never got out of their lounge chair and just looked at the screen. And it was funny and sad and, and yet maybe a prophetic vision of where we could go if we're not careful.

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Right? Oh, yeah. I mean, my teenager. Right. Volleyball team, we're out to dinner and they're all sitting next to one another on, on their phones. And I'm like, stack up the phones and they will. They are they stack them up in the middle of the table and they start interacting. But we're we're inching closer and closer to that hour.

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We have to be vigilant. And lastly, maybe before we wrap it up is just some ethical concerns too. Yeah. I think people are very worried now. You know, like we were talking about Alexa in our home. Oh, Alexa is listening. Everything we say. And where does all this information go that we're sharing in an AI therapy session?

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Where does that go? Is that protected? Can I really have assurance that that's not going to come back to haunt me? So that's one ethical consideration. We've talked a little bit about the overreliance on AI too. And I think sometimes it ai artificial. This is what I've heard from people that are really well steeped in this.

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Artificial intelligence is only as good as the human intelligence that's developing. Yeah. And so that's an important reminder for us, that there are there going to be limitations in general. We don't even know it all right now. But we have to be vigilant and, considerate. Yeah. And I think, you know, like we highlighted, it's available 24 over seven.

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But I think one of the other things of concern is just in a crisis. Right. And that importance of utilizing, you know, an individual utilizing nine, eight, eight or other resources where you can get that trained person to really give you that advice. Because if some of those nuances are missed, I think that can be a concern. And they just know we can't diagnose as well.

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We resource. We just want to cautious caution and cautious optimism. Yeah, I like that. Yeah. We don't want to be doom and gloom in Sagent. We want to be ahead of the curve with us. And I think our stance is pretty much let's just be aware and let's not panic and let's have a balanced perspective on this.

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Know that, yes, this can be really helpful. And we need to be a little bit cautious to help ourselves as providers. And our clients use it as, intuitively and effectively and insightfully as possible. Yeah. Well, Sagent does not have artificial intelligence. Sports therapist so far. And we're good. We're good to go. Yeah, we got a lot of great people, so, we'd love to have, people, seek us out.

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We are here. And, we'd love to connect with you in a very real way. Absolutely.

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Thanks for joining us. Take care all.

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