Talking to Machines (Part 1)

What happens when patients no longer need us to listen?

There’s a raging question that has started to enter my sessions as a clinician. It intrudes into my daily work of seeing patients during my ordinary practice days. And it is this:

What happens to psychotherapy—and all mental healthcare—when people no longer need another human being to be heard?

Because some already don’t.

Early research already suggests AI tools can reduce symptoms of depression, anxiety, and distress for some users.

AI is Everywhere

AI has entered everywhere, for the better and also with its awfulness. I use it all the time—for administrative tasks it’s amazing; A letter or email in 30 seconds; a survey questionnaire almost perfect; an outline for a talk as an able assistant. I get it. AI offers quick and useful solutions with endless energy.

One patient told me, he is talking to Claude when he is troubled and can’t sleep . Another patient uses it regularly to correct my minor mis-statements with the pleasure that only a patient with narcissistic personality disorder can truly enjoy.

Already, Artificial Intelligence (AI) is radically changing mental health care and the way I practice.

Contradictory Thoughts

AI is already improving access to care for many who have few options. However, it will blur the line between offering informational support and the treatment that comes with psychotherapy. For some, it creates the illusion of being known without the benefits of real relationships.

And yet with all that AI offers , I am so unsettled.

Clinicians Argue: Will AI Replace Us?

AI Can’t Replace Us? Many seek consolation believing that AI can’t replace what psychotherapy offers. They argue that psychotherapy is not just about knowledge and solutions; it’s about being heard, sharing pain, finding the inner strength to develop abilities, stay accountable to their values and find life’s meanings. People need to feel that they matter. These are thing psychotherapy does well.

Or can it? But in ten years with a tenfold increase in AI’s ability , will we really be able to differentiate the human from the machine? Will that distinction even matter?

What Unsettles Me Most

What is even most disquieting to me it that six people are controlling almost all of our AI future.

• Mark Zukerberg—Facebook
• Elon Musk xAI (Grock)
• Sam Altman— Open AI (Chat)
• Dario Amodei — Anthropic (Claude)
• CEO Satya Nadella — Microsoft CEO (Co-Pilot)
• Sundar Pichai — Google/Alphabet CEO (Gemini)

Can we really trust the judgement of these people with virtually no ethical oversight from mankind?

I am genuinely worried. Are you?

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Other Recent Articles of Mine

• A Practical Way to Treat Patients with Borderline Personality Disorder
• In the Wild with Patients Who Have a Personality Disorder

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Robert E. Feinstein, MD

Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell
Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@1052699pwpadmin
Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com

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