Some people will prefer a human therapist, but others will prefer AI.

The generalist will be more vulnerable, but certain specialities will likely be more protected.

Ethical and legal issues remain challenging as we venture into new territory.

There are real things we can do, but none are available if we aren't looking honestly at the problem.

In a recent post, I outlined four things the therapy profession is ignoring about its own future. The research on chatbot outcomes, the vulnerability of the 50-minute hour, what we actually ask of our clients, and what competition does to pricing in every market it touches. This is the follow-up I promised: what now?

First, Some Honesty About Where I Stand

I love my work, and it has given me real meaning and purpose for 30 years. I have always said I will never retire, and I mean that. I believe deeply in what skilled human therapists offer that AI genuinely cannot replicate.

But I also think we are ignoring something that rarely gets said out loud: therapy is not always a positive experience. I have done my share of my own work over the years, and I do not look back on every therapist I have seen with warmth or gratitude. Some of those experiences were unhelpful. One was worse than that. The idealized version of therapy that our profession projects, the transformative relationship, the healing alliance, is real for many people, but it is not universal, and I think that pretending otherwise does not serve our clients or our credibility.

Some people will always want the experience of being known by another person, of sitting across from someone with a human history and their own losses, who chose this work for reasons that have nothing to do with an algorithm. That is real, and I cannot fathom that it would........

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