My Clients Are Using ChatGPT Between Sessions. Here’s What I’ve Noticed — and What Still Can’t Be Replaced.
- Jillian Southworth
- Apr 22
- 7 min read
Next week marks a year since I gave birth to my first child. Becoming a parent has shifted just about everything in my life — emotions, finances, physical health, and of course my calendar. My husband and I tag team childcare, a freedom that I am both grateful for and continuously overwhelmed by. I now see clients primarily on weekends and evenings, with the typical workweek hours instead being filled with a mix of watching my son discover the world and constant overstimulation while he does so. By the time I sit down to join my first session of the day, I feel like I’ve lived three days. But I show up — tired, human, and fully present.
I’ve thought about that a lot lately, as more and more of my clients mention ChatGPT in session.
Not as a replacement for therapy. Usually as a bridge — something to turn to at 11 p.m. when anxiety spikes, or on a Saturday when they don’t want to “bother” anyone. I understand the appeal completely. Mental health support has historically been hard to access, expensive, and stigmatized. If an AI tool helps someone reflect, calm down, or feel a little less alone at midnight, that matters.
But I’ve also noticed something else. And it’s worth talking about honestly.
What I've Actually Seen
I have never pretended to be technologically savvy, so it’s no surprise to me that my clients were much better informed about what AI is capable of. A few months ago, a client — who was working to redefine who she is after a history of childhood trauma and a series of professional setbacks — told me she asked ChatGPT who she was. I thought she was joking. I had seen the AI summaries integrated into search engines, the chatbots that now accompany many websites, and had even used ChatGPT myself a time or two to narrow down a complex list of information for a project I was working on. It was helpful, saved me time, and sometimes prevented me from having to wait on hold for a representative to answer a question I had — all features deeply appreciated by a new mom. But how could a robot, or more specifically a Generative Pre-trained Transformer (GPT), know more information about ourselves than we did? Still dumbfounded, I asked about ChatGPT’s response. The client shared how the AI tool had analyzed all of her previous entries and determined a list of positive attributes with examples to back them up:
You’re caring because on [enter date] you asked me how to help your former roommate process a recent breakup.
You’re inquisitive because on [enter date] you wrote…
You’re compassionate because on [enter date] you stated…
I didn’t know how to respond. This is not an indictment of AI. Clearly ChatGPT had helped her in the moment and who was I to say she shouldn’t utilize every support tool she has? But at the same time, shouldn’t we strive to answer that question ourselves? And if we’re unsure about who we are, what we want in life, and how we fit into the larger landscape of society, isn’t therapy supposed to be a space to explore these existential questions? And what happens when a question so personal, so fundamental to our being, is answered by a machine?
Another client told me he uses AI to rehearse difficult conversations before having them with real people. For him, it works beautifully — he arrives at those conversations less flooded, more grounded. That’s exactly the kind of complementary use that makes sense.
The difference, I’ve come to believe, isn’t really about AI being good or bad. It’s about what you’re trying to do — and whether the tool matches the task.
What AI Can Do Well
I want to be fair here, because dismissing AI tools entirely would be both inaccurate and a little intellectually dishonest.
AI can help you:
Reflect on your own patterns when you’re too activated to think clearly
Prepare for hard conversations — with a partner, a parent, a boss
Access psychoeducation on anxiety, attachment, communication styles, at any hour
Find crisis resources quickly when you’re not sure where to turn
Bridge the gap between sessions when something comes up and you need to externalize your thoughts
These are real contributions. Used thoughtfully, AI tools can actually make therapy more productive — clients arrive having already done some processing, which lets us go deeper faster.
But “go deeper” is the key phrase. Because depth is where AI reaches its limit.
What Still Can’t Be Replaced
1. The relationship itself is the medicine
This isn’t a metaphor. Decades of psychotherapy research consistently point to the therapeutic alliance — the quality of the relationship between therapist and client — as one of the strongest predictors of positive outcomes. Not the specific technique. Not the modality. The relationship.
When I sit with my clients week after week, something builds. I not only learn their history, but I notice the particular way they carry it. I notice energy shifts. I point out patterns such as, “I notice some similarities between the dynamic you have at work and at home. Do you think the frustrations you’re describing about your supervisor may be amplified by already feeling discounted and unsupported by your siblings?” I do my best to connect what they are sharing today with the themes I see throughout the time we’ve met, albeit similar to how ChatGPT did in the example above. I don’t systematically store their data in servers, but I remember because their words are important. Because they are important.
2. Everything you don’t say
In therapy, the most important communication is often nonverbal. The way you pause before answering a question about your mother. The way your body shifts when we talk about a particular memory. The way you laugh when something isn’t funny.
A skilled therapist tracks all of this in real time — not to analyze you, but to be curious with you. “I noticed you got quiet there. What was happening for you?”
Text-based AI cannot see you. It cannot hear you. It cannot notice the thing you didn’t say. This is not a criticism of the technology — it’s simply a structural limitation. And for many of the people who come to therapy, what they most need is to be seen, fully, by another human being who is actually paying attention.
3. Crisis is not a content problem
If you are in a genuine mental health crisis — overwhelmed, unsafe, at the edge of what you can hold — what you need is not information. AI can locate a crisis hotline in seconds. It can walk you through a grounding exercise. These things have value.
But they cannot ensure your safety. They cannot make a judgment call about risk. They cannot reach through the screen and be with you in the way that another person can. In a crisis, human presence — a voice, a face, someone who can actually respond to what’s happening in real time — is not optional. It is the intervention.
Why My Humanness Is the Point
I show up tired most days — this past year, nearly all of them. I have hard weeks. I’ve sat with clients while carrying grief of my own, while navigating uncertainty, while feeling the weight of things I couldn’t fully put down at the door.
I used to think this was something to manage or minimize. Now I think it’s part of what I offer. This became especially clear after becoming a parent. Before my son, clients would describe the realities of caring for little ones and I thought I grasped their words. But earlier this week I met with a first-time mom who was 7-months postpartum, only 5 months behind where I am. She hesitantly confessed, “I feel out of my mind.” I asked her about sleep deprivation, strained social connections, and if she had been experiencing any intrusive thoughts about her baby getting hurt. She paused, then explained the unsettling visions she’d been having of her daughter to which I replied, “for me, it was always my son falling down the stairs or some horrific injury cracking his skull. It’s scary, it gets better, and you’re not alone.”
I understand fear because I’ve been afraid. I understand the particular exhaustion of trying to hold everything together because I’ve felt it. I understand embarrassment, excitement, shame, hope, guilt, and the beautifully terrifying process of falling in love. I understand what it means to reach for connection and not be sure it’s safe — because I’m human, and that’s a human experience.
When a client takes a risk in session — shares something they’ve never said out loud, allows themselves to be seen in a moment of real vulnerability — what meets them on the other side is not a sophisticated language model. It’s another person, who has also known what it is to be uncertain and tender and trying.
That shared humanity is not a feature. It is the foundation of healing.
A Note on How to Use These Tools Wisely
If you’re currently using AI for mental health support, you don’t need to stop. But here are a few questions worth sitting with:
Am I using this to process and prepare — or to avoid and rehearse?
Is this helping me show up more openly in my relationships and in therapy, or am I using it as a substitute for the real thing?
When I’m in crisis, do I know who my human support is?
AI works best as a complement — a place to think out loud, to learn, to bridge gaps. It works poorly as a replacement for the messy, nonlinear, deeply relational work of actually healing.
If You’re Looking for Support
Therapy isn’t for everyone, and it isn’t the only path. But if you’re navigating something hard — something that has roots, something that keeps showing up, something you’re tired of carrying alone — it might be worth talking to someone who can actually be there with you.
Whether that’s me or another clinician, I hope you find someone you trust. Someone who will show up, imperfectly and honestly, and stay.
Comments