If the therapeutic alliance is a primary healing aspect of therapy, some feel it with chatbots.

The 50-minute hour isn’t a clinical necessity, and it’s about to be challenged.

Competition drives prices down in every market, and ours will not be the exception.

I have spent nearly 30 years as a clinician, and I believe that psychotherapy, at its best, is one of the most powerful forces for human change that exists. Yet the profession is sleepwalking into a transformation it is not prepared for. Therapists are very good at helping our clients face hard truths. It is time we extended that same courage to ourselves. Here are four points that I believe deserve our immediate discussion:

1. Clients are forming healing alliances with chatbots, and the outcomes data is starting to back them up.

For decades, the therapeutic alliance has been the cornerstone of our professional identity. Not a specific modality or technique, but the relationship itself. The bond between therapist and client is the single strongest predictor of positive therapeutic outcomes across every form of treatment we have studied. It is precisely what we point to when someone asks what human therapists offer that no app ever could.

Except that people are now reporting experiencing that alliance with artificial intelligence (AI). In a 2025 survey of adults with diagnosed mental health conditions who had used an AI chatbot for mental health support, 38 percent rated it as more beneficial than traditional therapy. A 2026 randomized controlled trial (RCT) found that a therapy chatbot produced a 51 percent reduction in depressive symptoms. That same year, a second RCT of nearly 1,000 university students found that an AI platform produced greater reductions in anxiety and greater improvement in life satisfaction than face-to-face group therapy. Furthermore, this is a snapshot of a single moment in time. Large language models (LLMs) mature faster than humans do, and those available today are already superior to the versions used in these studies. What feels like a distant threat today is likely to become an immediate one faster than many anticipate.

My........

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