Framework For Rewiring The Nature Of Mental Health Support Via The Newly Emerging Therapist-AI-Client Triad

In today’s column, I examine the tectonic shift from traditional mental health support to a modern approach that leverages the adroit use of generative AI and large language models (LLMs). I’ve been referring to this new approach as the therapist-AI-client triad. It is a transformative departure from the customary dyad of therapist-client. You see, the old way of undertaking mental healthcare entailed two people doing talk therapy, namely a therapist and a client. The new way entails leveraging AI to serve as a co-partner throughout the therapeutic process. Some therapists flatly refuse to adopt AI into their practices. They insist that AI has no place at all in therapy. My prediction is that therapists of that ilk are going to gradually find themselves facing a depleting pool of existing and potential clients. People want to use AI for their mental health guidance. Period, end of story. Savvy therapists are getting on board with leveraging AI. The key is to sensibly manage how the AI fits into the new triad. Let’s talk about it. This analysis of AI breakthroughs is part of my ongoing Forbes column coverage on the latest in AI, including identifying and explaining various impactful AI complexities (see the link here). AI And Mental Health Therapy As a quick background, I’ve been extensively covering and analyzing a myriad of facets regarding the advent of modern-era AI that produces mental health advice and performs AI-driven therapy. This rising use of AI has principally been spurred by the evolving advances and widespread adoption of generative AI. For a quick summary of some of my posted columns on this evolving topic, see the link here, which briefly recaps about forty of the over one hundred column postings that I’ve made on the subject. There is little doubt that this is a rapidly developing field and that there are tremendous upsides to be had, but at the same time, regrettably, hidden risks and outright gotchas come into these endeavors too. I frequently speak up about these pressing matters, including in an appearance last year on an episode of CBS’s 60 Minutes, see the link here. People Are Using AI For Mental Health Advice The most popular use nowadays of the major LLMs is for getting mental health guidance, see my discussion at the link here. This occurs easily and can be undertaken quite simply, at a low cost or even for free, anywhere and 24/7. A person merely logs into the AI and engages in a dialogue led by the AI. The use of generic LLMs such as ChatGPT, Claude, Gemini, Llama, Grok, and others is a common example of using AI for mental health advice. There are sobering worries that AI can readily go off the rails or otherwise dispense unsuitable or even egregiously inappropriate mental health advice. Huge banner headlines in August of this year accompanied a lawsuit filed against OpenAI for their lack of AI safeguards when it came to providing cognitive advisement. Despite claims by AI makers that they are gradually instituting AI safeguards, there are still a lot of downside risks of the AI doing untoward acts, such as insidiously helping users in co-creating delusions that can lead to self-harm. For the details of the OpenAI lawsuit and how AI can foster delusional thinking in humans, see my analysis at the link here. I have been earnestly predicting that eventually all of the major AI makers will be taken to the woodshed for their paucity of robust AI safeguards. Lawsuits aplenty are arising. In addition, new laws about AI in mental healthcare are being enacted (see, for example, my explanation of the Illinois law, at the link here, the Nevada law at the link here, and the Utah law at the link here). Thinking In A Framework Mode The foregoing is ample evidence that people are eager to tap into AI for mental health guidance. And this is even despite AI’s weaknesses and failings. Overall, therapists need to realize that prospective clients are going to have increasing expectations that AI must be included in the therapist-client therapeutic process. An interesting twist is that therapists are becoming AI safeguards, such that OpenAI announced they are going to have a curated network of human therapists available online and on demand, so that when the AI isn’t sufficiently able to handle a situation, the AI will route the chat over to a human therapist (see my coverage at the link here). I have repeatedly noted that the classic dyad of therapist-client is gradually transforming into a triad of therapist-AI-client. One way or another, AI is getting intermingled into the sacred therapist-client combo. For my formative coverage of the new triad, see my discussion at the link here. Let’s take a big picture viewpoint and see the forest for the trees on this weighty topic. It is useful to establish a framework perspective. The Dyad And The Triad Consider that therapy can be considered as consisting of these two mainstay potential arrangements: (1) Dyad: The classical therapist-client arrangement, plus additional pairing combinations. (2) Triad: The emerging therapist-AI-client arrangement, plus additional pairing combinations. You might have observed that the dyad definition encompasses more than merely the traditional therapist-client arrangement. Here’s the fuller perspective: (1a) Therapist-Client dyad: This is the traditional dyad consisting of a human-to-human relationship between a therapist and a client (or patient). (1b) Client-AI dyad: This is the substitution or replacement of the human therapist with instead relying on AI as a mental health advisor, doing so as a human-AI relationship. This is happening on a global scale because of the widespread availability of LLMs. (1c) Therapist-AI dyad: This is a human-AI relationship of a human therapist in combination with leaning into AI, usually involving the AI being used as a therapeutic training aid, see my discussion at the link here. Meanwhile, the emerging triad can be handily portrayed as entailing three primary circumstances: (2a) Therapist-AI-Client triad: This is the joint use of AI as a therapeutic tool, wherein the therapist and the client are collaboratively using AI. AI is a helpful intermediary, hopefully, but only likely if the therapist suitably conducts this triad properly. (2b) Therapist-Client-AI triad: Sometimes (perhaps often) clients are dipping into AI for therapy and doing so behind the back of their therapist. I represent this circumstance by resequencing to put the AI aspect at the far edge rather than in the middle. Therapists would be astute to find out if their client is making use of AI on the side, see my discussion at the link here. (2c) AI-Therapist-Client triad: Some therapists are using AI behind the scenes and not directly in conjunction or collaboration with a client. A therapist might confer with AI prior to meeting with a client, or do so after a meeting with a client, or even surreptitiously use AI during a client session, see my analysis at the link here. It is worthwhile to dig deeper into these emerging triads; let’s do so. Explaining The Therapist-AI-Client Triad A balanced version of the triad consists of the therapist-AI-client configuration. If done well, the idea is that the therapist openly and overtly encourages their client to make use of AI as a therapeutic adjunct. The therapist can rely on the AI as an anytime, anyplace means of their client getting augmented therapy. Therapists are a constrained resource in the sense that few human therapists are readily available 24/7; thus, the AI helps to fill the availability gaps. Unfortunately, this approach can readily go awry. Suppose a therapist merely tells a client to use a popular AI such as ChatGPT, Claude, Grok, Gemini, etc., and takes no other interest in the matter. It is a vacuous hand-waving or nod to the use of AI. Not good. The therapist won’t particularly know what the client is doing with the AI, nor will the therapist be aware of what the AI is telling their client. This hands-off approach is almost surely going to be disastrous. The AI will be telling the client something about what to do therapeutically, and the therapist might be saying something else. All told, the therapist and the AI are bound to conflict with each other. Another example of actions going awry consists of the client bringing AI into the equation and asking their therapist to use the AI that the client is already using. Here’s how that goes. A client is using ChatGPT or some other major LLM and wants to find out what their therapist thinks about the mental health advice being touted by the AI. The client gives the therapist access to the AI. Therapists would be unwise to take this bait; see my warnings at the link here. A proper means of adopting the therapist-AI-client configuration is almost always done by the therapist. They pick the AI. They arrange for the client to have access to the AI. The therapist reviews what is going on regarding the AI usage by the client. That being said, the AI selection doesn’t necessarily need to be done in the absence of conferring with the client, namely, the therapist might opt to discuss which AI will be used and take as input the preferences of the client. Here then are the underlying possibilities of establishing the therapist-AI-client triad: (2a-1) Therapist-led AI: The therapist chooses and sets up the AI for joint use by the therapist and the client. This is the preferred approach at this time. (2a-2) Client-led AI: The client chooses the AI and allows the therapist to access the AI. This is generally not a recommended practice. (2a-3) Therapist-Client jointly led AI: As more people get accustomed to particular LLMs, the odds are they will want a say in which AI is going to be used for the triad. Therapists will increasingly need to confer with a client about the selection and setup. Explaining The Therapist-Client-AI Triad An unbalanced variation of the triad consists of the therapist-client-AI version. The client is using AI as a therapeutic tool, but the therapist is not involved in the activity. It is a recipe for problems and could wholly undermine the therapy being provided by the therapist. There are these two main avenues: (2b-1) Client behind-the-back: A client is using AI as a therapeutic advisor, but doesn’t let the therapist know that this is taking place. Therapists should be looking for telltale signs of behind-the-back usage of AI. For example, a client might pretend that a “friend” has been giving them mental health advice, implying this is an unnamed human companion, though the AI is really the so-called friend. (2b-2) Client informs therapist: A client is using AI as a therapeutic advisor and informs the therapist that this is taking place. Some therapists will ignore the proclaimed AI usage and shrug their shoulders as though it doesn’t matter. They don’t realize that it is akin to performing therapy when a client has a strong partner or colleague who is constantly whispering in their ear. Therapists usually, in that situation, will take a holistic approach and seek to encompass the third party into the process, rather than simply disregarding the influencer. Explaining The AI-Therapist-Client Triad A third variation of the triad consists of the AI-therapist-client version. A therapist is opting to use AI on their own. They are not incorporating the AI into the therapist-client relationship per se. The AI is somewhat like a therapeutic shadow guide. A therapist might confer with AI before conducting a client session, getting insights from the AI about what to discuss during the session. After a session, the therapist might go over their notes with the AI and see what commentary or assessment the AI can provide. One of the most controversial uses would be if the therapist surreptitiously uses the AI during a client session. I’ve discussed the details at the link here. Is this a proper use of the AI? A critic or skeptic would argue that the AI is distracting the therapist and undermining the cherished therapist-client interaction. Others would claim this is perfectly fine, including that the therapist benefits and the client ultimately benefits due to sharper and better sessions. Therapists can also make use of AI for administrative chores in their therapy office. The latest AI can produce transcripts of taped sessions. AI can be used to keep track of time consumption and prepare billings. These non-therapy uses of AI are a lot less controversial because they are outside the scope of therapy. A crucial aspect is that the therapist needs to ensure that the administrative use of AI doesn’t cause privacy intrusions or otherwise cause record-keeping problems. Here are the subordinated elements of this triad: (2c-1) Therapist administrative use of AI: A therapist might use AI for administrative chores of their therapy practice. This is likely okay, though keep in mind that the AI could be problematic in terms of violating privacy provisions, might make financial or administrative errors, and so on. Make sure to suitably embed AI into your administrative aspects and not do so willy-nilly. (2c-3) Therapist post-session AI use: A therapist might use AI after a therapy session, often to review how the meeting went and document the key points of the meeting. (2c-4) Therapist during session AI use: A therapist might use AI during a session. Whether this usage detracts or enhances the therapy is a big bone of contention. Furthermore, an ethics and code of conduct question arise about informing the client that AI usage is taking place. Some therapists believe there is no reason to explicitly tip their hand; others believe it is an absolute essential to let the client know what is happening. For more, see my analysis at the link here. The Big Picture All At Once Now that I’ve walked you through the big picture, here’s a helpful recap. The Dyads And Triads (1) Dyad: The classical therapist-client arrangement, plus additional pairing combinations. (2) Triad: The emerging therapist-AI-client arrangement, plus additional pairing combinations. The Dyads (1a) Therapist-Client dyad: This is the traditional dyad consisting of a human-to-human relationship between a therapist and a client (or patient). (1b) Client-AI dyad: This is the substitution or replacement of the human therapist with instead relying on AI as a mental health advisor, doing so as a human-AI relationship. This is happening on a global scale because of the widespread availability of LLMs. (1c) Therapist-AI dyad: This is a human-AI relationship of a human therapist in combination with leaning into AI, usually involving the AI being used as a therapeutic training aid. The Triads (2a) Therapist-AI-Client triad: This is the joint use of AI as a therapeutic tool, wherein the therapist and the client are collaboratively using AI. (2b) Therapist-Client-AI triad: Sometimes (perhaps often) clients are dipping into AI for therapy and doing so behind the back of their therapist. (2c) AI-Therapist-Client triad: Some therapists are using AI behind the scenes and not directly in conjunction or collaboration with a client. The Therapist-AI-Client Triad (2a-1) Therapist-led AI: The therapist chooses and sets up the AI for joint use by the therapist and the client. This is the preferred approach at this time. (2a-2) Client-led AI: The client chooses the AI and allows the therapist to access the AI. This is generally not a recommended practice. (2a-3) Therapist-Client jointly led AI: As more people get accustomed to particular LLMs, the odds are they will want a say in which AI is going to be used for the triad. The Therapist-Client-AI Triad (2b-1) Client behind-the-back: A client is using AI as a therapeutic advisor, but doesn’t let the therapist know that this is taking place. (2b-2) Client informs therapist: A client is using AI as a therapeutic advisor and informs the therapist that this is taking place. The AI-Therapist-Client Triad (2c-1) Therapist administrative use of AI: A therapist might use AI for administrative chores of their therapy practice. (2c-3) Therapist post-session AI use: A therapist might use AI after a therapy session, often to review how the meeting went and document the key points of the meeting. (2c-4) Therapist during session AI use: A therapist might use AI during a session. Whether this usage detracts or enhances the therapy is a big bone of contention. The Future Is Coming Up Fast Generative AI is currently being used as an ad hoc therapeutic advisor by millions upon millions of people, veering towards billions of people, and we are globally in the midst of a grandiose and wanton experiment. We don’t know what impact this AI-provided mental health guidance will have. Will society be better off, more mentally secure, and more cognitively healthy? Or will society be mentally bruised and harmed by this ready access to non-tested, non-systematic AI-generated guidance? Human therapists cannot sit idly by and merely watch what is occurring. As noted, therapists are starting to be tapped into as a kind of AI safeguard or backstop to AI mental health advisement. The role of therapists and the foundations of therapy are being dramatically transformed and disrupted due to the advent of LLMs. My strident recommendation is that therapists need to get on board and incorporate AI as a therapeutic tool in their practice. A final thought for now. Friedrich Nietzsche famously made this pointed remark: “There are instances when we are like horses, we psychologists, and grow restless: we see our own shadow wavering up and down before us. A psychologist must look away from themself in order to see anything at all.” I’d suggest that this is a timely reminder that therapists would be wise to see the world as it is and as it will be, consisting of ubiquitous AI and a whole lot of mental health challenges to be addressed.
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