“A cognitive prosthesis,” writes Harvey Lieberman of ChatGPT in his recent New York Times essay. As a therapist, I use AI too: to organize notes and surface themes. But Lieberman’s portrait, as thoughtful as it is, misses something essential about how therapy works.
He speaks of ChatGPT as a “thought partner and “steady.” But therapy is not just steady. It is relational. And relationships, especially therapeutic ones, are not frictionless. “Attunement” or “mirroring,” which Lieberman mentions, is only a starting point. In self psychology, Heinz Kohut identified deeper selfobject needs — idealization and twinship, the felt sense of not being alone in the world. These cannot emerge from reflection alone. They require another subjectivity. Two people with beating hearts.
This means inevitable “rupture and repair.” When the connection frays, yet both people stay in the room, transformation can occur.
“Lena,” an artist, was hurt. I said, “I didn’t expect so many guests at your show.” She heard it as judgment–as if I didn’t see her as socially capable or well-connected. I sensed a withdrawal but didn’t know why. I asked. She hesitated. Then answered. I had to reflect not just on what I said, but why I said it. Two things had colored my comment: my own dread of throwing parties and the tentative, sometimes avoidant quality of our dynamic. I revealed my “party paranoia.” She laughed. She then shared how slowly she processes emotion, how much she craves but avoids connection. Humor and regret helped reestablish trust in a way she doesn’t experience it “out there.” Possibilities opened up. The next week she went to a gay bar for the first time.
“Elias” told me he wanted to cancel a session after I described a message he sent to his college friend group as “thirsty.” He had been trying to organize reunion events. I had missed the frustration beneath his outreach. When he brought it up, we explored a deeper wound: a father who “talked at” him but never listened. His world was colored by a persistent sense of injustice, a current of rage that rarely found words. I apologized. We stayed with it. What emerged wasn’t just repair—it was recognition. He felt seen not for how he phrased things, but for why he tried so hard in the first place.
And there is also “play.” “Micah” described his fear of exposure in self-expression, especially around fashion and performance. I offered a metaphor — an “operating table” — to name the rawness of visibility. He didn’t flinch. He played back. We discovered another image together: himself as a gift — radiant, long hidden. He said he hadn’t expected the session to go where it did. But that is what play does. It creates what neither person could imagine alone.
AI can organize. It can steady. But therapy is also friction, misalignment, reparation, curiosity and shared invention.
No algorithm can do that.
