Can AI replace therapy? AI, Therapy, and the Human Nervous System: Why I’m Not Worried

As a UK counsellor, I’m often asked about whether I am worried AI will replace therapy and, therefore, replace me too! So, can AI replace therapy?

The short answer, for me, is no, but it’s not because I think AI is useless and doesn’t have its place, but because therapy is not primarily an exchange of information in a one-way conversation. Therapy is a nervous system-to-nervous system experience, and that human element cannot be replicated by a computer. My longer answer explores this, whilst also thinking about the broader conversations about mental health and accessibility of support.

Therapy isn’t just about words; it’s about emotional attunement and co-regulation. For many of my clients, these were important relational needs that went unmet in childhood, and therapy offers the space for corrective emotional experiences. For those who have been relationally harmed, this can be a deeply healing encounter, helping to build trust in the self but also other human beings.

In the therapy room, we are constantly tracking the nervous system of our clients, so it isn’t about only what is said, but how it is shared. Breath, pace, posture and tone can all present subtle shifts that can hold deep significance and meaning, and a skilled therapist will adjust their own responses accordingly.

This is what we mean by co-regulation. It is two (or more in couples and family therapies) in a relationship where safety, attunement and responsiveness help someone to slowly build their capacity to stay with difficult emotions rather than escape them. Whilst escape may seem helpful in the moment, it can potentially reinforce the idea to your brain that emotions need to be constantly held at bay and might even therefore increase symptoms of anxiety.

I can see the appeal in AI. It can respond quickly with soothing words and reflect our experiences with accuracy, where we feel deeply understood. For many people, this may be their very first experience of that. However, it cannot track you in real time in the way a therapist might. It cannot attune to your responses, such as dissociation, overwhelm or notice when your defences are activated. Because it responds quickly, it can’t help you to slow down and pay attention to your thoughts and feelings, meaning a sense of urgency and rumination may follow.

It is this tracking and noticing that is the foundation to building real resilience, where we can hold space for our emotions, knowing they make sense in the context of our lives and that we can still make choices and have agency, even on those harder days.

AI can cushion and soothe, offering validation and maybe containment, but that is not the same as building capacity and resilience. This can feel regulating in the moment, but without any additional support options, you may find yourself turning back to the AI increasingly over time, which might in turn then have an impact on your personal relationships. You might even find yourself wondering why your friends and family can't just respond in the same, validating ways that AI can. But, AI doesn't have any needs as real people do. People are human with their own ideas, beliefs, nervous systems and experiences, and that's often the beauty and the tension of being in relationships with other human beings.

Therapy is a space that can offer gentle challenge alongside safety, and won’t simply agree and validate your worldview either, but it will explore it with you.

Having experimented with AI out of curiosity to see if it could help me with something, I noticed there is a risk that AI can go along with what you already believe to be true, reinforcing narratives without questioning them. This strengthens the earlier argument that, over time, this can make real-life relationships difficult as they are inevitably messy, challenging and frustrating and will feel much more difficult by comparison because you are across from another human with their own independent mind, perspectives and experiences.

Tension in relationships is normal, as is missattunement and repair (to an extent). They are not failures but are how we can grow to deeply understand one another and build trust that relationship difficulties will not always result in abandonment. This can again be deeply healing for those with such wounds.

Some of my own clients use AI between sessions, and I don’t judge this. Instead, I might get curious about what it is you feel the AI is able to help you with and explore what needs you may have been trying to get met. I have also heard many stories from people who felt AI had helped them figure something out more than any friend or therapist they had ever met. On the other hand, I have also heard many reports from those who felt it had made their current mental health difficulties worse.

AI can offer containment and a place to offload. But, it cannot offer further relational support and hold contradictions and human complexities.

So, I wouldn’t necessarily take the view that AI is all 'bad', but I do think it’s important we ask the question of why people are turning to it in the first place. What is happening in our relationships that we feel they will not be able to offer us connection and help us with our needs?

• Are we looking for a need to be heard without someone else making it about them?

• Do we want to feel contained without burdening another?

• Are we looking for a space where there is no demand in return?

• Are we afraid that other human beings will only shame or judge us?

These are very real factors, and their answers will hold something important. Not only about AI, but about relationships, loneliness, and the broader conversations around community, society, culture and mental health care.

Moreover, this opens up important conversations and accessibility of therapy and cost, especially in the context of the current cost-of-living crisis. Those on low incomes, unable to work or living with long-term instability, may instead seek support in short-term services offering free or reduced counselling rates. Though helpful, it can sometimes seem that those who would find longer-term support more beneficial may be only able to access this through self-funded private therapy options. Sustained long-term support should not be a luxury, but it can sometimes seem like it is.

With this consideration, it becomes understandable why some people in need of support may turn to free AI options. People may not be turning to AI because they think it is better than human connection, but because this is the only option available to them right now. This also could explain its use for those who feel trapped in unsafe homes or situations, where seeking outside support might not be possible right now.

I don’t see AI as an enemy, it can be a tool when handled with care and when its limitations are understood. I often use it for brain storming and ideas. But, therapy is not just about ideas or feeling better in the moment, but increasing our capacity, tolerating discomfort, navigating conflict and staying present in our relationships.

Being a counsellor who also works through an attachment lens, I believe this can happen through real, human connection over AI every time. But, I am sensitive to and can understand the multitude of reasons why people may turn to AI instead. All in all, it invites broader conversations on unmet needs, how we navigate distress, safety and decision making when there are few accessible alternatives, and how can our mental health services keep up with the ever increasing waitlists whilst offering sustainable and appropriate support. I am very keen to keep listening to others and their experiences and opinions on AI within the therapy space to see how this may evolve.

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