Psychiatric Times: AI Chatbots and the Erosion of Therapeutic Discomfort
Author(s)Chantel Cohen, LCSW
Key Takeaways
- Utilization is widespread: roughly half of US adults use AI chatbots, and most psychologists report patients integrating them as adjuncts or substitutes for therapy.
- Accessibility drivers include clinician shortages, insurance and cost barriers, and reduced social threat compared with disclosing to a stranger, making on-demand interaction feel safer than waiting.
- Agreeableness and constant responsiveness impede therapeutic mirroring, challenge, and reflective silence, potentially weakening distress tolerance and reshaping expectations for human relationships through overvalidation and attachment.
- Safety limitations include poor crisis recognition, missed nonverbal and sociocultural context, and documented stigma toward schizophrenia and alcohol dependence; clinicians should position chatbots as structured aids, not diagnostic authorities.
AI chatbots flood mental health care—convenient and validating, yet risky. Learn where they help, where they harm, and why therapists still matter.
According to the Pew Research Center,1 about half of the adults in America use artificial intelligence (AI) chatbots, with 1 in 4 reportedly using them on a daily basis. They have become prolific tools that have introduced both new opportunities and new challenges in the mental health field, especially as we are starting to see patients use these chatbots as an addition to and, in some cases, as a replacement for traditional therapy.
I hear a lot of my own clients say something along the lines of, “I told ChatGPT about this, and it told me X, Y, and Z.” And I am not alone—the American Psychological Association surveyed more than 1200 licensed psychologists in the US, and 77% said they have spoken with patients who have used AI for added support.2
The Appeal of Chatbot Therapy
AI chatbots have become deeply appealing to so many people for a few reasons. First and foremost, the reality is that we are facing a mental health access crisis. As of December 2025, 137 million Americans live in what is referred to by the Health Resources and Services Administration as a Mental Health Professional Shortage Area.3 With the workforce shortage at an all-time high, the financial burden for patients has increased exponentially. Many are struggling to find a therapist who takes their insurance or is affordable enough to see consistently. For those who do not have access to professional care, using a chatbot can provide the sense that something is better than nothing at all.
For others, speaking with a human therapist might be intimidating. Opening up to a stranger about one’s most personal thoughts and emotions is an incredibly vulnerable experience, and people may fear that they will be judged. The discomfort can be terrifying, but with a chatbot, there is no one on the other side to fear, so it feels like the safer option. Plus, there is the aspect of availability—chatbots are available at the touch of a button anytime, virtually anywhere, without ever having to leave the comfort of one’s own home. But available does not necessarily mean effective.
