Can AI Be Your Therapist? A Trauma Therapist and an AI Builder Talk It Out

We got all the way to the end of a really good conversation about artificial intelligence and I realized I had never pressed the button.

Carla’s response was not annoyance. It was relief. She said she has been so immersed in AI, where everything is perfect and programmed, that a human forgetting something felt like a gift.

So we did it again. And this one was the same conversation and a completely different one.

Here is where we each started.

Carla spent the last year and a half working in East Africa on mental health. In Kenya there is something like one certified therapist for every 100,000 people. She built a program putting counselors into schools, and it worked so well she wanted to spread it across the region and could not, because there were not enough therapists to spread. So her team built a chatbot instead. Swahili, English and Sheng. Running on WhatsApp, because that is what people already had. Crisis keywords built in. School counselors reporting back every month with new slang, because the language kids use for wanting to die changes faster than any guardrail can keep up with.

She came in as someone who has seen AI be the difference between something and nothing.

I came in ranting. I had done a whole episode about AI in the therapy office. Note taking software listening in on sessions. Recruitment emails landing in my inbox weekly, offering me more money than I make as a therapist to go help these companies do my job. It struck me as funny in a bleak way, being paid well to train the thing that would put me out of work.

But my real objection was never about my job. It is that these models are built to give you what you want. That is the design. Take you in, learn you, feed it back. That is the exact opposite of what a therapist does. We are trained not to hand you answers. The work is getting you to a place where you find them yourself.

And then we both moved.

Carla realized partway through that she has not been using AI as a therapist at all. She has been using it as a coach. Situational. Eleven o’clock at night, at a crossroads, no one awake to call. She writes a careful prompt, she asks for brutal feedback, she gets something she had not considered. That is a skill. She has it because she is 56 and has been wordsmithing professionally for twenty years.

I moved on access. I have never had a problem with video therapy, because getting into someone’s home who cannot leave it is a good thing. Rural mental health deserts are not just a Kenya problem. There are plenty of them in the United States. If a tool fills a gap where there is otherwise nothing, I am not going to argue against nothing.

Then Carla told me the piece that gave me actual chills.