AI as therapist: help, risk or dangerous substitute?

Artificial intelligence entered everyday life very quickly. We use it to look for information, study, work, write or simply clarify a question. It was probably inevitable that people would also begin to use it to talk about personal problems.

For some people, ChatGPT and other chatbots have become a space where they can talk about anxiety, relationships, loneliness, difficulties at work or simply a day that went badly. Part of the appeal is easy to understand: they are always available, they answer immediately, and we may tell them things we would find difficult to say to another person.

The question has become common enough to draw the attention of researchers and health organisations. The American Psychological Association has warned about the growing use of artificial intelligence chatbots as psychological support, especially when these tools were not created or evaluated for that purpose.^[1] More recently, the World Health Organization has also highlighted the need to develop and use these tools responsibly in mental health.^[2]

Can talking to AI help?

In some situations, yes.

Writing about what we are feeling can, in itself, help organise thoughts. An AI system can ask questions, explain what anxiety is, suggest simple relaxation strategies or help someone prepare what they would like to discuss in a consultation.

This is not necessarily bad. The problem begins when the feeling of having had a good conversation is confused with receiving mental health care.

Current AI systems are particularly good at producing convincing language. They can respond in an empathic tone, remember what has been said earlier and adapt their response to the person speaking with them. All of this can create an experience surprisingly close to a human conversation.

But seeming to understand a person and clinically understanding a person are different things.

Does therapy with artificial intelligence work?

One thing is to open ChatGPT, Gemini or another general-purpose chatbot and ask it to be your therapist. It is quite another to use a system developed specifically for mental health intervention, built with the involvement of professionals and then studied in clinical research.

One of the most recent examples is Therabot, developed by researchers at Dartmouth College. In a clinical trial published in 2025, people with clinically significant symptoms of depression or anxiety, or at high risk of an eating disorder, used this chatbot for several weeks. Participants showed important reductions in some symptoms, and many reported developing a trusting relationship with the system.^[3]

But the study compared Therabot with a waitlist, not with psychotherapy or another active form of digital support. Nor did it show that talking to any AI is equivalent to psychotherapy. Therabot was created precisely for this purpose, with input from mental health professionals and specific safety mechanisms. Also, as often happens in this area, we still know relatively little about the effects of prolonged use of these tools.

A review of commercial chatbots found a modest improvement in depressive symptoms, but uncertain results for anxiety. Safety also remains poorly studied: only three of the 22 trials actively looked for possible adverse effects.^[4]

In another trial, an AI-enabled cognitive behavioural therapy app led people to use the programme more often and for longer than static digital materials. Even so, it did not produce a greater overall reduction in anxiety or depression.^[5] A tool can therefore be more engaging without necessarily being more effective.

The problem with an AI that always agrees with us

Imagine someone who is convinced that all their colleagues talk about them whenever they leave the room. A psychologist does not only have to recognise that this experience is causing distress. They also need to understand what is happening, explore other explanations and assess whether that belief may be part of a broader problem.

A chatbot may not make this distinction very well.

Language models were developed to maintain helpful and pleasant conversations, and they can become overly agreeable with the user. This is particularly problematic in the presence of persecutory ideas, manic states or highly distorted interpretations of reality.

A person worried about their health may repeatedly ask whether a symptom is dangerous. Someone insecure in a relationship may constantly seek confirmation that their partner will not leave them. The AI's response may reassure them for a few minutes. But if every doubt leads back to the chatbot, the tool may end up feeding the anxiety cycle itself.

What makes us feel better in the moment is not always what helps us in the long term.

What if there is a crisis?

Current chatbots do not always respond adequately to self-harm, suicidal ideation, psychosis, mania or other states of serious vulnerability.

A study published in 2026 examined precisely how different language models responded to psychological crisis situations. The results showed considerable differences between systems, with particular difficulties when risk signals were less explicit.^[6]

In real life, this is exactly how many situations appear. A person may not write directly, “I want to kill myself”. They may say they are tired of everything, that others would be better off without them, or that they no longer see any way out.

A professional can ask additional questions, assess risk and decide whether other people or services need to be involved. A chatbot may misread what it is receiving.

For this reason, in a crisis, AI should not be the only support available.

In Portugal, if you are having thoughts of suicide or experiencing a psychological crisis, you can contact the National Suicide Prevention and Psychological Support Line on 1411. In immediate danger, or if a suicide attempt has already occurred, call 112. In another country, contact the local emergency services.^[12]

Can we form a relationship with a chatbot?

In the Therabot study, for example, many participants reported an experience of trust and support, with scores that, on some measures, approached those observed in traditional care.^[3]

This does not mean, however, that the two relationships are equivalent. A recent review concluded that the instruments used to measure this “alliance” were largely developed for psychotherapy between people and have not yet been adequately validated for chatbots. The scores are better understood as a perceived relational experience than as a therapeutic relationship already shown to be equivalent to a human one.^[7]

An AI is available whenever we want. It does not get tired, has no needs of its own, does not become irritated and adapts much of the conversation to us. Human relationships do not work like that.

If someone gradually begins to prefer the relationship with the chatbot to relationships with other people, uses it to make decisions, or feels that it is the only entity that truly understands them, it is worth paying attention to what is happening.

If conversations with the chatbot begin to replace seeing people and asking them for help, it is worth asking whether they are easing loneliness or leaving the person more isolated.

In a study that followed more than two thousand people for a year, feeling less socially connected predicted more intensive later use of chatbots for social purposes. In the other direction, increased use also predicted some increase in emotional loneliness. Because these are longitudinal associations and some of the analyses were exploratory, the study does not show that chatbots cause isolation; rather, it suggests that the relationship may work in both directions.^[8]

What about young people?

A study published in 2026 in JAMA Pediatrics found that 19.2% of the adolescents and young adults surveyed in the United States had used chatbots for mental health advice. Among those who used them, 42.8% did so at least monthly, 91.7% considered the responses helpful and 63.3% had told no one that they were turning to AI in this way.^[9] Perceived helpfulness matters, but it does not in itself show that the advice is accurate or clinically effective.

Banning or ridiculing this use probably does not solve the problem. It may be more useful to ask what they are looking for in these systems, what the systems tell them, and whether there is anything they feel unable to tell a person.

If an adolescent feels that they can only talk about a particular suffering with a chatbot, perhaps the most important issue is not the chatbot. It is understanding why they have not yet found a person with whom they feel safe enough to speak.

A private conversation is not necessarily confidential

It is easy to feel that a conversation on a phone or computer is private. But the confidentiality of a psychological consultation has a professional, ethical and legal framework that is not equivalent to a conversation with a technology platform.

Policies vary between companies and services, and they may also change over time. Before writing very personal information about health, sexuality, relationships, family, work or other people, it is worth understanding what happens to that data.^[1]

In a small qualitative study, many people who used general-purpose chatbots for emotional support did not clearly understand how their conversations were handled, and some assumed that protections similar to those of a health service were in place.^[10]

A good rule is not to provide more identifiable information than necessary.

So what can it be useful for?

We do not need to choose between seeing AI as a threat and treating it as a psychologist available twenty-four hours a day.

It can be useful for understanding a psychological concept, organising what we are feeling, keeping a journal, preparing a difficult conversation or thinking about questions we want to bring to a consultation. During a therapeutic process, some people may also use it to remember or organise what they have worked on.

What deserves more caution is asking a chatbot to make a diagnosis, deciding to change medication based on what it says, using it as the only response to a crisis, or handing over important life decisions to it.

It can also be useful to ask ourselves a simple question: after speaking with AI, am I more able to return to my life, or do I feel the need to keep talking to it?

Will AI replace psychologists?

It is difficult to predict how far these technologies will go. It is entirely possible that artificial intelligence tools will come to play an important role in mental health, including prevention, symptom monitoring or support between consultations.

Psychotherapy involves technical knowledge, but it also involves a relationship between two people. The psychologist observes changes over time, notices contradictions, knows the person's context, asks questions that are not always comfortable and takes responsibility for the work being done.

Research on artificial intelligence and psychotherapy is still at an early stage. There are results interesting enough for us not to dismiss these tools, but there are also enough reasons not to attribute to them capacities they have not yet demonstrated.

For now, if a conversation with AI helps someone understand better what they feel, or even take the first step towards seeking help, it may have served an important function.

We should simply not confuse that first step with the whole path.

Frequently asked questions

Can I use ChatGPT as a psychologist?
You can use it to talk about what you feel, look for information or organise thoughts. But ChatGPT is a general-purpose chatbot and does not replace assessment or care from a professional.

Does AI therapy work?
Some tools developed specifically for mental health have shown promising results, especially for anxiety and depression. There is still little information about long-term use, and these findings cannot be generalised to any chatbot.

Can I use AI while I am in psychotherapy?
In principle, yes. It may help, for example, to organise ideas or questions between sessions. If AI use plays an important role in how you deal with your difficulties, it may also be useful to talk about it with your psychologist.^[11]

When should I seek help from a person?
When distress is intense or persistent, significantly interferes with daily life, there is loss of control, or thoughts of self-harm or suicide, major changes in the perception of reality or other signs of crisis appear. In those situations, a conversation with AI should not replace professional help or emergency services.

Revised on 27 September 2026.