This presentation, accredited for 3 Ethics CPD points, examines the ethical implications of AI use in mental health, with a particular focus on the use of AI chatbots for life-advice. It explores how patients are already turning to AI chatbots for emotional support, therapy-like conversations, and crisis help - often in ways that bypass a real mental health professional or psychotherapist entirely. Drawing on mostly psychoanalytically-informed, evidence-based, peer-reviewed research, the talk highlights the benefits of AI (accessibility, affordability, 24/7 availability). It also explores the limitations and risks of AI chatbot psychotherapy, including its inability to recognise unconscious processes or offer an independent, thinking mind.
An argument is made that distorted thinking linked to paranoid-schizoid states of mind can be fuelled and exacerbated when asking for guidance from an AI chatbot. This means that more vulnerable people can become further destabilised as the AI chatbot intensifies their persecutory view of the object who is causing them distress. The narcissistic mirror (where AI simply reflects back what the patient presents) validates rather than challenges persecutory thinking. The AI chatbot can fail to notice destructive processes in the mind of the patient - and this can lead to significant risk to mental health.
The presentation also addresses broader ethical and systemic concerns - including data privacy, professional liability under HPCSA guidelines, and the concentration of AI power in the hands of a few wealthy individuals. The presentation uses the example of George Orwell's concept of Newspeak to warn that AI risks narrowing the range of human thought by privileging certain constructs and ways of communicating over others. To some extent, whoever controls the AI controls the narrative.
Psychotherapists are encouraged to bring discussions about patients' use of AI into the consulting room as clinical material. The aim could be to help patients develop a conscious, critically informed relationship with AI, using it constructively and wisely, with appropriate safeguards in place. Rather than demonising or idealising AI, mental health professionals could position themselves as custodians of independent human thought.
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