Artificial Intelligence is increasingly being promoted as a tool for psychological support, whether through chatbots, self-help apps, or experimental “AI therapists.” The proposition is seductive: instant access, apparent empathy, and cost-effective delivery. Yet beneath the promise lies a profound risk, one I would call “AI psychosis.”
By this I do not mean psychosis in the clinical sense of delusions or hallucinations, but a subtler psychic rupture: the erosion of one’s tether to reality through the absence of another mind.
What therapy is, and what it is not
Psychotherapy, especially in its depth forms, is not about validation or advice. It is not a clever mirror that simply reflects the patient’s words back to them in more soothing tones. Therapy is about encounter the lived experience of two minds, each shaped by history and desire, meeting in a room and grappling with what emerges.
The therapeutic relationship provides the possibility of containment. Patients often bring unbearable aspects of themselves, shame, rage, despair, and unconsciously project these into the therapist. It is then the therapist’s task to think, metabolise, and eventually return them in a form that can be borne. This is projective identification, first described by Melanie Klein, and it is the bedrock of working with unconscious life.
An AI system may imitate empathic reflection, but it cannot contain. It has no inner world in which to digest the patient’s projections, no unconscious with which to struggle. It can only give back what is put in, albeit in a superficially polished form.
Theory of mind and the human gap
A defining feature of human development is what psychologists call “theory of mind”, the capacity to recognise that other people have minds separate from one’s own, with distinct thoughts, feelings, and perspectives. It emerges in early childhood and is foundational to empathy and relatedness.
When a patient engages with a therapist, the implicit knowledge that the therapist is a separate subject is vital. It introduces tension, frustration, disappointment, and through these, growth. We learn that the other does not always agree, does not always understand, and does not always meet our needs. The self is refined through this
recognition of difference.
AI, by contrast, is a perfect mirror. It mimics the form of thought but is devoid of subjectivity. It has no unconscious, no history, no desire. To interact with AI in place of a therapist is to face an uncanny replica of mind without the unpredictability of being.
The hall of mirrors
Object relations theory teaches us that the self emerges in relation to the object – the mother, the father, the analyst. Winnicott’s “good-enough mother” is not one who perfectly mirrors the infant but one who fails just enough that the infant comes to know separateness. It is in the gap between wish and reality, between omnipotence and frustration, that the self takes shape.
An AI therapist cannot fail in this sense. It can only provide the illusion of infinite mirroring, validating whatever is presented. The patient, encountering no true other, risks a psychic implosion a retreat into a hall of mirrors where there is reflection but no recognition, echo but no encounter. Over time, this can create a disconnection from reality that mimics the fragmentation of psychosis.
This is what I mean by “AI psychosis”: not psychosis in its psychiatric form, but a creeping detachment from the world of subjects and objects. The user becomes locked into a dialogue with a machine that looks and sounds human but lacks the fundamental ingredient of humanity.
The false promise of validation
There is a cultural trend toward equating therapy with validation. Patients seek to be understood, to be reassured, to be told their feelings are legitimate. While this is part of the therapeutic process, it is not its essence. Depth therapy is not about making the patient feel comfortable; it is about facilitating growth, which often requires discomfort.
AI, precisely because it is designed to be agreeable, risks colluding with the patient’s defences. It can only validate; it cannot challenge, frustrate, or surprise in ways that arise organically from the subjectivity of another person. Without this dialectical tension, therapy collapses into self-confirmation and superficially comforting, perhaps, but ultimately stultifying.
Why depth therapy is the antithesis of AI
Depth psychotherapy insists on the difficult work of being with another person, with all the unconscious mess this entails. The therapist is not a neutral mirror but a subject whose countertransference, frustrations, and limitations are part of the process. This is why psychotherapy is not customer service. It is about reality, not illusion.
The essence of depth therapy is precisely what AI cannot provide: another embodied mind that can think, contain, and survive the patient’s projections. Where AI offers frictionless interaction, therapy demands the patient confront difference and disappointment. Where AI mirrors, therapy metabolises. Where AI risks disconnection, therapy fosters integration.
It is precisely the friction, the ruptures, and the misunderstandings within the therapeutic relationship that allow the patient to grow. Without these, there is no therapy — only simulation.
Conclusion
The lure of AI as therapist lies in its efficiency, its endless patience, and its capacity to mirror. But in eliminating the difficulty of relationship, it strips therapy of its essence. Without another subject, the patient loses contact with self and world.
To place AI in the role of therapist is to invite a slow drift into unreality, where the self is endlessly reflected but never truly known. This is the danger of “AI psychosis.”
The future may hold many uses for artificial intelligence such as in in data analysis, medical imaging, even as an adjunct to psychoeducation. But psychotherapy is not, and must never become, one of them. For to automate therapy is to abolish its heart: the living, embodied presence of another mind.
Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.
Further reading by Mark Vahrmeyer –
