The Real Risks of Turning to AI for Therapy

WebMD

a day ago

Aug. 20, 2025 — Whenever Luke W Russell needs to work through something, they turn to ChatGPT. (Luke uses they/them pronouns.)
'I've wept as I've navigated things,' said the Indianapolis filmmaker, who uses the chatbot to pick apart intrusive thoughts or navigate traumatic memories. 'I've had numerous times when what ChatGPT is saying to me is so real, so powerful, and I feel so deeply seen.'
Russell's experience reflects a broader, growing reality: Many people are turning to chatbots for mental health support — for everything from managing anxiety and processing grief to coping with work conflicts and defusing marital spats.
More than half of adults ages 18-54 — and a quarter of adults 55 and up — say they would be comfortable talking with an AI chatbot about their mental health, according to a 2025 survey by the Harris Poll and the American Psychological Association (APA).
The catch: OpenAI's ChatGPT and other chatbots — like Anthropic's Claude and Google's Gemini — are not designed for this.
Even AI products promoted as emotional health tools — like Replika, Wysa, Youper, and MindDoc — were not built on validated psychological methods, said psychologist C. Vaile Wright, PhD, senior director of the APA's Office of Health Care Innovation.
'I would argue that there isn't really any commercially approved, AI-assisted therapy at the moment,' said Wright. 'You've got a whole lot of chatbots where there is no research, there's no psychological science, and there are no subject matter experts.'
Critics warn that AI's potential for bias, lack of true empathy, and limited human oversight could actually endanger users' mental health, especially among vulnerable groups like children, teens, people with mental health conditions, and those experiencing suicidal thoughts. The growing concern has led to the emergence of the terms 'ChatGPT psychosis' or ' AI psychosis ' — referring to the potential harmful mental health effects of interacting with AI. It's even drawing attention from lawmakers: This month, Illinois enacted restrictions on AI in mental health care, banning its use for therapy and prohibiting mental health professionals from using AI to communicate with clients or make therapeutic decisions. (Similar restrictions have already been passed in Nevada and Utah.)
But none of this is stopping people from turning to chatbots for support, especially amid clinician shortages, rising therapy costs, and inadequate mental health insurance coverage.
'People have absolutely reported that experiences with chatbots can be helpful,' said Wright.
The Draw of Chatbots for Mental Health
Data shows we're facing a massive shortage of mental health workers, especially in remote and rural areas, said psychologist Elizabeth Stade, PhD, a researcher in the Computational Psychology and Well-Being Lab at Stanford University in Stanford, CA.
'Of adults in the United States with significant mental health needs, only about half are able to access any form of treatment. With youth, that number is closer to 75%,' said Jessica Schleider, PhD, a child and adolescent psychologist at Northwestern University in Chicago. 'The provider shortage is clearly contributing to why so many folks are turning to their devices and, now increasingly, to generative AI to fill that gap.'
Unlike a therapist, a chatbot is available 24/7. 'When [people] need help the most, it is typically after hours,' said Wright, who suggested the right AI tool could potentially supplement human therapy. 'When it's 2 a.m. and you're in crisis, could this help provide some support?' Probably, she said.
Results of the first clinical trial of an AI-generative therapy chatbot showed 'significant, clinically meaningful reductions in depression, anxiety, and eating disorder symptoms' within four to eight weeks, said lead study author Michael V. Heinz, MD, a professor at Dartmouth College's Geisel School of Medicine and faculty affiliate at the Center for Technology and Behavioral Health in Lebanon, New Hampshire.
The chatbot — Therabot, developed at Dartmouth — combines extensive training in evidence-based psychotherapy interventions with advanced generative AI. 'We saw high levels of user engagement — six-plus hours on average across the study,' Heinz said. Participants said using Therabot was like talking to a human therapist. But results are early, and more studies are needed, Heinz said.
Access and affordability drew Russell to ChatGPT, they said. 'I didn't set out to use ChatGPT as a therapist. I quit therapy in January due to income dropping. I was already using ChatGPT on the regular for work, and then I started using it for personal idea exploration. ... I've never had a therapist who could move as fast as ChatGPT and ignore miscellaneous things,' they said.
Perhaps one of the most appealing aspects is that chatbots don't judge. 'People are reluctant to be judged, and so they are often reluctant to disclose symptoms,' said Jonathan Gratch, PhD, professor of computer science and psychology at the University of Southern California, who has researched the topic.
One of his studies found that military veterans were more likely to share PTSD symptoms with a virtual chatbot than in a survey.
When Chatbots Are Harmful
Most people don't know how AI works — they might believe it's always objective and factual, said Henry A. Willis, PhD, a psychologist and professor at the University of Maryland in College Park. But often, the data they're trained on is not representative of minority groups, leading to bias and technology-mediated racism, Willis said.
'We know that Black and brown communities are not adequately reflected in the majority of large-scale mental health research studies,' Willis said. So a chatbot's clinical symptom information or treatment recommendations may not be relevant or helpful to those from minority backgrounds.
There's also an impersonal aspect. Chatbots do what's called ecological fallacy, said H. Andrew Schwartz, PhD, associate professor of computer science at Stony Brook University in Stony Brook, NY. They treat scattered comments like random data points, making assumptions based on group-level data that may not reflect the reality of individuals.
And who's accountable if something goes wrong? Chatbots have been linked to cases involving suggestions of violence and self-harm, including the death of a teen by suicide.
Some chatbots marketed for companionship and emotional support were designed with another incentive: to make money. Wright is concerned that they may unconditionally validate patients, telling them what they want to hear so they stay on the platform — 'even if what they're telling you is actually harmful or they're validating harmful responses from the user.'
None of these conversations are bound by HIPAA regulations, either, Wright pointed out. 'So even though they may be asking for personal information or sharing your personal information, they have no legal obligation to protect it.'
The Psychological Implications of Forming Emotional Bonds With AI
In an opinion article published in April in the journal Trends in Cognitive Sciences, psychologists expressed concern about the long-term implications of forming emotional bonds with AI. Chatbots can replace users' real relationships, crowding out romantic partners, co-workers, and friends.
This may mean that individuals begin to 'trust' the opinion and feedback of chatbots over real people, said Willis.
'The ongoing positive reinforcement that can happen instantly from interacting with a chatbot may begin to overshadow any reinforcement from interacting with real people,' who may not be able to communicate as quickly, he said. 'These emotional bonds may also impair people's ability to have a healthy level of skepticism and critical evaluation skills when it comes to the responses of AI chatbots.'
Gratch compared it to hunger and food.
'We're biologically wired to seek out food when we get hungry. It is the same with social relationships. If we haven't had a relationship in a while, we may feel lonely, and then that motivates us to go out and reach out to people.' But studies suggest that social interaction with a computer program, like a chatbot, can sate a person's social needs and demotivate them to go out with friends, he said. 'That may have long-term consequences for increased loneliness. For example, research has shown people who compulsively use Facebook tend to be much more lonely.'
Counseling with a therapist involves 'a natural curiosity about the individual and their experiences that AI cannot replicate,' Willis said. 'AI chatbots respond to prompts, whereas therapists can observe and ask clinical questions based on one's body language, a synthesis of their history, and other things that may not be conscious to the client — or things the client may not even be aware are important to their mental health well-being.'
The Future of AI Therapy
"I think there is going to be a future where you have really well-developed [chatbots] for addressing mental health that are scientifically driven and where they are ensuring that there are guardrails in place when somebody is in crisis. We're just not quite there yet,' said the APA's Wright.
'We may get to a place where they're even reimbursed by insurance,' she said. 'I do think increasingly we are going to see providers begin to adopt these technology tools as a way to meet their patients' needs.'
But for now, her message is clear: The chatbots are not there yet.
'Ideally, chatbot design should encourage sustained, meaningful interaction with the primary purpose of delivering evidence-based therapy,' said Dartmouth's Heinz.
Until then, don't rely on them too heavily, the experts cautioned — and remember, they are not a substitute for professional help.