Why AI therapy might be inevitable (and that's not necessarily bad)

Indianapolis Star

2 days ago

Artificial intelligence therapy is here.
For now, it still probably strikes most people as a little weird to talk to a chatbot about your most private fears or let an algorithm offer comfort when you're in pain. But strangeness fades quickly in the face of convenience and affordability.
One reason that AI therapy might be attractive is a service-sector phenomenon called 'cost disease.'
Cost disease is shorthand for a dynamic first described by economist William Baumol. Some industries, like manufacturing, can achieve dramatic gains in productivity over time. The same number of workers can make more widgets faster and cheaper thanks to automation, technology and process improvement.
But in labor-intensive fields like health care, education or the performing arts, productivity growth is limited.
Mental health care is squarely in this category. Most treatments require a trained person to spend time with a patient. Over time, wages in the broader economy rise with productivity gains elsewhere, so therapists' salaries rise, too. But without corresponding efficiency gains, the cost of providing therapy goes up.
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That's the cost disease: the gap between what it costs to provide the service and what you get for those costs keeps widening. That's why simply 'expanding access' to traditional therapy in a cost-challenged fiscal environment cannot work by itself.
AI therapy, at least in theory, sidesteps this dynamic. A chatbot or AI-driven tool can be replicated infinitely at a near-zero marginal cost, making it dramatically cheaper to provide support at scale. That doesn't mean it's a replacement for human care, but it does explain why, in a cost-diseased world, the idea has such appeal.
Our beliefs about what therapy is will shape how we see and use AI. Here are four different lenses:
No single model is right, but each suggests different possibilities and limits for AI therapy.
If you see therapy as either a path to self-optimization or a way to manage symptoms, AI could fit neatly into that role. It is available 24/7, infinitely patient, low-cost and able to monitor progress, reinforce skills, and provide guidance between human-led sessions.
But if you see therapy as deep healing or social connection, AI is at best an adjunct. It can mimic empathy, but it cannot share the lived mutuality of a human relationship.
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The reality of cost disease means we will keep feeling pressure to find cheaper options for care. In Indiana, rapidly rising Medicaid costs have led state officials to explicitly float using technology, including AI, to help bridge the state's mental health gap. We should encourage such exploration while also remembering that cost isn't the only variable that matters.
The unsatisfying truth is that we will need to let AI therapy play out instead of making snap judgments, like Illinois' preemptive ban.
AI therapy may turn out to be a breakthrough, a disappointment, or something in between. As we are deciding if and where it fits into the broader mental health space, we should be honest about the trade-offs, and about which mental models we're using when we call something 'therapy.'