Psychotherapy vs AI Chatbots: Dr. Helen Marlo on What Real Therapy Requires

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2026/03/19

Helen Marlo, Ph.D.,is Dean of the School of Psychology and Professor of Clinical Psychology at Notre Dame de Namur University. She is a practicing clinician with nearly 30 years of experience as a licensed clinical psychologist and certified psychoanalyst. Her work centers on long-term, depth-oriented care, emphasizing the therapeutic relationship, clinical nuance, and sustained healing beyond quick fixes. Marlo can speak to the growing use of AI chatbots for mental health guidance, the risks of substituting automated tools for live and clinically supervised treatment, and the limits of dehumanized care. She brings a grounded perspective on what meaningful psychotherapy requires in practice.

Scott Douglas Jacobsen interviews Dr. Helen Marlo about AI chatbots posing as therapy. Marlo argues real psychotherapy is not advice, venting, or quick tools, but an emergent, emotionally charged relationship where conflict, repair, and nuance drive change. Chatbots can deliver education and strategies, yet they cannot judge what fits a person’s history, motives, and unconscious patterns. She warns convenience, anonymity, and low vulnerability can reinforce the very issues treatment addresses, while AI guidance may distort major life decisions outside crises. Depth-oriented care, she says, builds durable inner capacities through sustained human attunement, and clinically supervised practice remains the safer standard.

Scott Douglas Jacobsen: When people use chatbots for something seen as digital-based therapy, what are common misunderstandings about real psychotherapy compared to what people are, in fact, engaging in interaction with these chat bots?

Dr. Helen Marlo: A common misconception about psychotherapy is that its main purpose or effectiveness is to offer support or serve as a space to vent, solve problems, receive advice, gain tools, or obtain answers. Although these aspects are often part of psychotherapy, they are typically not the elements that produce the deepest therapeutic change.

Another misconception about psychotherapy is the belief that a patient feels fully understood, affirmed, and supported by the psychotherapist, and therefore does not encounter relational conflict or experience difficult or negative emotions within the therapeutic process. Working through these challenges is a key part of psychotherapy.

Providing support, education, problem-solving, practical tools, and advice are areas in which chatbots and AI-based therapy tend to excel. These parts of psychotherapy are less complex and more concrete, so chatbots and AI are better-suited for these tasks. Knowing whether the education, solution, tool, or advice is best for that individual is where AI falters and is far less effective.

Real psychotherapy is a fluid, dynamic, and emergent process that unfolds between human beings, each bringing their own reactions, emotions, and thoughts into the encounter. There are incalculable ways that this interaction could unfold, which impact where the psychotherapy goes and what gets addressed through the work. AI does not capture the myriad, individualized, and flexible nature of these interactions, which make a profound difference in the quality and depth of the therapeutic experience.

Some of the most powerful and transformative moments in psychotherapy arise from the interpersonal engagement between therapist and patient. This involves, for example, when a psychotherapist attunes to emotional and less conscious, often unspoken aspects of experience; sees and addresses conflicts and patterns; gives language to painful or complex realities; listens actively, to what is said and not said both verbally and nonverbally; tracks and regulates affect; holds and remains present with suffering; notices subtle and less obvious patterns in behavior; and provides engagement and feedback that may be hard, yet ultimately, healing for a human being to hear.

The education and training required to become a licensed psychotherapist are extensive. Unlike many other professions, a therapist’s effectiveness depends not only on formal knowledge and clinical preparation but also on their ongoing personal development and psychological well-being.

Decades of psychotherapy research show that two of the strongest predictors of therapeutic change are the quality of the therapeutic relationship and the extent to which therapy is an active, affective process that engages emotion. In other words, meaningful change is less about techniques and more about the depth of relational connection and the capacity to access, tolerate, and work through emotional experience.

Therapists who are most effective at establishing and sustaining healthy therapeutic relationships tend to possess self-awareness, emotional maturity, and sensitivity to others’ inner worlds. Their clinical skill is inseparable from their personal development, as their ability to understand and regulate their own responses allows them to engage patients with attunement, authenticity, and psychological presence.

Jacobsen: What clinical functions does a real therapeutic relationship provide

Marlo: A genuine therapeutic relationship provides a living, relational experience grounded in moment-to-moment engagement. It allows for the recognition and repair of limiting patterns, misunderstandings, and challenging personal qualities, experiences, and ways of being. It creates a space in which difficulties can be explored and worked through over time. 

It is not a relationship defined by ready-made answers, instant reassurance, indiscriminate affirmation, and simply hearing what one wishes to hear—responses that may feel comforting in the moment but are often not the most therapeutic in the long term. Instead, real clinical work involves careful attention to nuance, complexity, contradictions, conflicts, patterns, and the subtle shifts that occur within the therapeutic process.

At the same time, the therapeutic relationship offers a secure and containing space in which the individual experiences the therapist as holding an integrated understanding of their unique past and present, while engaging collaboratively with them in shaping their future.

Jacobsen: Why do people turn to chatbots rather than psychotherapists, and what are the inherent risks in this emphasis on chatbots without guardrails  or professional specialization and input built into them to a sufficient degree so far?

Marlo: People are often drawn to these sources because they are instantly available, inexpensive, anonymous, highly convenient, require less emotional vulnerability, decrease a fear of judgment, demand minimal boundaries, are limitless, and frequently offer responses that align with what one hopes to hear.  Often, these are the very psychological issues one needs to address, so the way chatbots and AI offer care is, therefore, inherently problematic. 

Yet thinking, feeling, imagining, and reflecting are inherently complex and effortful human processes. While chatbots can simulate or simplify these activities, real psychotherapy seeks cultivate these capacities in others by being in the experience together, rather than providing “how to do it” for them. The therapeutic aim is not to make inner work easier by doing it for the person, but to strengthen their ability to engage in it independently, by cultivating it together.

At times, some of the most therapeutic moments arise when a clinician poses a difficult question—one that is carefully attuned to the individual, grounded in their lived experience, which is meaningful to the challenges of their life.

Jacobsen: Where do you see the biggest risks, e.g., misdiagnosis, false reassurance, or something else?

Marlo: One of the central concerns can be captured by the old proverb: give someone a fish, and they eat for a day; teach them to fish, and they eat for a lifetime. Effective psychotherapy aims to help individuals develop the internal psychological capacities to live more fully and navigate challenges independently. By contrast, AI-generated interactions can resemble providing the fish for the day—offering immediate input without necessarily fostering lasting growth.

These experiences may also fall short in preparing people to engage with mediating and repairing the imperfections, unpredictability, and complexity of real human relationships, which are essential for psychological development. 

I see serious risks in how chatbots and AI support may influence important decisions that impact daily life, in contrast to the dangers of their use in genuine crises. The average person can easily understand that AI is not best equipped to help a person through a suicidal crisis and its dangers and shortcomings with managing these serious issues is more understood. Safeguards are being developed in these areas. 

However, the use of AI for less serious issues concerns me more, given its profound impact on daily life. For example, consulting with AI on whether a spouse is being abusive, if they should have no contact with their parent, whether a friendship should be ended, or if they should quit their job are a few of many issues that people are blindly entrusting to AI rather than carefully examining the issue for themselves within a trusted therapeutic relationship.  Advice or feedback generated without a lived understanding of the individual, with limited understanding of how the consequences of this advice can impact one’s life, can be destructive, inaccurate, or overly aligned with what the person wishes to hear, potentially shaping decisions that are not beneficial in the long term. 

Jacobsen: What does depth-oriented care mean in plain terms?

Marlo: Depth-oriented care involves attending to both the conscious and unconscious dimensions of a person’s experience.  It occurs in the context of a consistent, engaged psychotherapeutic relationship with a trained professional who is dedicated to focusing on the patient and their life, which also differentiates it from speaking with a good friend. Depth psychotherapists are specifically trained to recognize, understand, and work with unconscious processes. Because many of the forces that shape psychological life operate outside of conscious awareness, this approach emphasizes exploring underlying meanings, patterns, and symbols that influence thoughts, emotions, and behavior in the here and now.

Jacobsen: If AI tools are an adjunct rather than a substitute, what are the potential benefits if sufficient guardrails are programmed into the algorithms’ processing weights?

Marlo: As an adjunct, AI is highly valuable for education, generating ideas, offering alternative perspectives, and providing concrete tools and strategies. The material it produces can serve as a catalyst for imagination, reflection, and change, that can be explored in psychotherapy.

Jacobsen: What should regulators and tech companies each do to reduce predictable harms?

Marlo: Users should be well informed of the limits and potential negative consequences. For example, this information is a general suggestion, may not be relevant for their situation, may be most valuable as a springboard for further reflection, and does not replace professional help.  

That said, the ultimate regulator would be to limit or reduce the financial incentive for its use in this way. 

Jacobsen: Thank you very much for the opportunity and your time, Helen.

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